RESUMO
Dental caries remains a worldwide public health problem because of its magnitude and impact on affected people's quality of life. Among preventive strategies, water fluoridation is one of the most important, but its value still remains uncertain after more than a half of Century of its use. The aim of this study is to analyse some of the ethical arguments for and against water fluoridation and to determine if empirical data allow to decide if there are correct policies from a bioethical perspective. Autonomy, compulsory medication (mass medication), precautionary principle, justice in health care and ethics of protection are discussed. It is concluded that fluoridation is beneficial and that there is no ethical reason to oppose it, based on a specific kind of ethics developed to analyse and clarify complex public health's issues.
Assuntos
Humanos , Cárie Dentária/prevenção & controle , Fluoretação , Fluoretos/administração & dosagem , Temas Bioéticos , Política PúblicaRESUMO
The aim of this work was to assess the evolution of the food situation in Chile between 1964 and 2003. Food balance sheets (FAO), household survey of budget expenses (National Institute of Statistics) and quality of life and health survey (Health Ministry) were analysed. The dietary energy supply rose from 2,630 kcal/day/person in 1965 to 2,872 kcal/day/person in 2003. The amount of meat available for human consumption increased 20,6% between 1995 and 2003, but there was a decrease in fish/seafood (-33,3%) and fruits (-20,6%)availability. The intake of fat rose 50,5% between 1988 and 1997; household food expenses increased 31,1%, while its weight on total household expenses decreased 18,5%. This nutritional profile could explain the high prevalence of overweight/obesity and non-communicable chronic diseases observed in Chile. The modification of household food expenses also suggests an improvement in household income. Some opportunities and challenges for intervention in the Chilean population are proposed.
El objetivo fue evaluar la evolución de la situación alimentaria en Chile entre 1964 y 2003. Se analizó la información disponible en hojas de balance (FAO), encuestas de presupuestos familiares (INE) y encuesta de calidad de vida y salud (MINSAL). Los resultados mostraron aumento del suministro de energía alimentario desde 2630 kcal/día/persona en 1965 a 2872 en 2003. La disponibilidad de carnes aumentó 20,6% entre 1995 y 2003, pero disminuyó la de pescados/mariscos (-33%) y frutas (-22,1%). Entre 1988 y 1997, el consumo aparente de grasas aumentó 50,5%; el gasto en alimentación aumentó 31,1%, mientras que su ponderación del gasto total disminuyó 18,5%. Este cambio en el perfil alimentario contribuye a explicar las altas prevalencias de trastornos nutricionales por exceso y de enfermedades crónicas no transmisibles, mientras que las modificaciones en el gasto en alimentación sugieren un aumento en el nivel de ingresos. A partir de lo anterior se identifican oportunidades y desafíos de intervención para la población chilena.