Aspectos éticos e o uso de produtos fluorados na visão de lideranças de saúde / Ethical aspects and the use of fluoride products in the viewpoint of health leaders

O flúor tem sido empregado na prevenção da cárie dentária, principalmente em águas de abastecimento e dentifrícios. Um efeito indesejável, a fluorose leve, tem suscitado preocupações entre especialistas. Este trabalho descreve as percepções dos delegados na 13ª Conferência Nacional de Saúde no que se refere aos aspectos éticos relacionados ao uso de substâncias e produtos fluorados. Realizou-se pesquisa exploratória, descritiva, com abordagem qualitativa, utilizando-se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo (DSC). A população de estudo foi definida por conveniência, e o critério de escolha foi participar da Conferência como delegado. Ao todo, foram 310 respondentes. Os dados foram coletados por meio de questionários semiestruturados e analisados pela análise do discurso. Nos discursos dos participantes da pesquisa, estiveram presentes aspectos éticos relacionados à falta de liberdade de escolha, à falta de informação disponível aos usuários sobre os produtos fluorados e sobre o controle dos níveis de flúor nesses produtos. Houve também quem acreditasse que o custo-benefício da fluoretação supera qualquer aspecto ético que possa estar presente. Questões éticas são frequentemente vistas pelos participantes da pesquisa como algo desconhecido ou complexo. Existe a crença de que a população em geral está despreparada para discutir o assunto com propriedade, já que este é mais bem compreendido pela parcela da sociedade composta por gestores e profissionais de saúde. Não houve consenso quanto à presença ou não de fatores éticos no uso de produtos fluorados...

Fluoride has been used in the prevention of dental caries, especially in drinking water and toothpaste. An undesirable effect, mild fluorosis, has raised concerns among experts. This paper describes the perceptions of the delegates at the 13th Brazilian National Health Conference concerning ethical issues related to the use of substances and fluorinated products. We conducted exploratory, descriptive study with a qualitative approach, using as processing technique testimonials the Collective Subject Discourse (CSD). The study population was defined by convenience, and the choice criterion was attending the conference as a delegate. In all, there were 310 respondents. Data were collected through semi-structured questionnaires and analyzed by discourse analysis. In the speeches of participants, there were ethical aspects related to the lack of freedom of choice, the lack of information available to users on fluorinated products and the control of fluoride levels in these products. Also there were people who believed that the cost-effectiveness of fluoridation outweighs any ethical aspect that may be present. Ethical issues are often seen by the research participants as something unknown or complex. There is the belief that the general population is unprepared to discuss it properly, as this is best understood by managers and health professionals. There was no consensus as to the presence or absence of ethical factors in the use of fluorinated products...

[The global and national context regarding the challenges involved in ensuring adequate access to water for human consumption]. / O contexto global e nacional frente aos desafios do acesso adequado à água para consumo humano.

The scope of this article is to analyze the challenges involved in ensuring access to water for human consumption taking the international and national context into consideration. Based on the UN declaration that access to safe and clean drinking water is a fundamental human right, vulnerabilities are identified that can consist in restrictions to access to adequate supplies. The distribution of water and the population across the planet, pollution, inadequate policies and management lead to environmental injustice. The iniquity of access to water constitutes the contemporary water crisis. From the 1980s onwards, the transnational water market emerged for private control that occurs at three main levels: surface and underground water sources; bottled water; and public water supply services. The conflicts of the multiple uses of water resources, the market and environmental problems have contributed to rendering the health of the population and ecosystems vulnerable. Adequate public policies are essential to ensure the basic human right to access to safe and clean drinking water.

The impact of cost recovery and sharing system on water policy implementation and human right to water: a case of Ileje, Tanzania.

In Tanzania, the National Water Policy (NAWAPO) of 2002 clearly stipulates that access to water supply and sanitation is a right for every Tanzanian and that cost recovery is the foundation of sustainable service delivery. To meet these demands, water authorities have introduced cost recovery and a water sharing system. The overall objective of this study was to assess the impact of cost recovery and the sharing system on water policy implementation and human rights to water in four villages in the Ileje district. The specific objectives were: (1) to assess the impact of cost recovery and the sharing system on the availability of water to the poor, (2) to assess user willingness to pay for the services provided, (3) to assess community understanding on the issue of water as a human right, (4) to analyse the implications of the results in relation to policies on human rights to water and the effectiveness of the implementation of the national water policy at the grassroots, and (5) to establish the guidelines for water pricing in rural areas. Questionnaires at water demand, water supply, ability and willingness to pay and revenue collection were the basis for data collection. While 36.7% of the population in the district had water supply coverage, more than 73,077 people of the total population of 115,996 still lacked access to clean and safe water and sanitation services in the Ileje district. The country's rural water supply coverage is 49%. Seventy-nine percent of the interviewees in all four villages said that water availability in litres per household per day had decreased mainly due to high water pricing which did not consider the income of villagers. On the other hand, more than 85% of the villagers were not satisfied with the amount they were paying because the services were still poor. On the issue of human rights to water, more than 92% of the villagers know about their right to water and want it exercised by the government. In all four villages, more than 78% of the interviewees are willing to payforwater provided that the tariffs are affordable. Water policy implementation continues slowly: regardless of the fact that more than five years have passed since policy inception, 60% of the villagers in Itumba still have no water services at all. The study shows that government fulfilment of human rights to water has a long way to go, especially in rural areas where people cannot afford to pay for water and some of the villages still depend on water from wells and seasonal rivers.

Inequality and polarization analysis of urban water use in the Yangtze River Delta area, China.

Inequality and polarization are terms usually used to describe the overall dispersion of income distribution and the phenomenon of a divided society with a disappearing middle class and increasing rich and poor populations. However, these terms have seldom been used in water sciences. In this paper, the concepts of inequality and polarization are employed to analyze the distribution of urban water use of different cities. Using for reference the conception of Gini coefficient, the EUWU (Equality of Urban Water Use) model is built to analyze the equality of urban water use. And, the PUWU (Polarization of Urban Water Use) model based on exponential functions, which can limit the index of polarization to the range (0, 1) effectively, is built to analyze the polarization of urban water use. Inequality and polarization of resident, industrial and commercial water use in 16 cities in the Yangtze River Delta, the fastest growing region of China, are evaluated using the EUWU model and PUWU model, respectively. The results show that inequality of residential, industrial and commercial water use has decreased by 6.5%, 11.2% and 8.4%, while the index of polarization has increased by 3.9%, 3.8% and 0.1% in Yangtze River Delta area from 2001 to 2006.

Integrated method in international development for water solutions using the rights-based approach.

The introduction of the rights-based approach to International Development has presented a new set of challenges to those working for the water and sanitation sectors in developing countries. This introduction of this additional pressure on both State and Non-State Actors working in the field has necessitated an overhaul of the existing needs based responses. The engineering solutions and intermediate technology currently available often fail to address the complex requirements of the recipients. This study addresses the change that is required and suggests an integrated engineering approach that will be capable of responding accurately to the requirements of the beneficiary. It proposes an 'integrated method', a way of combining technology, community participation and education.

Fieldwork and social science research ethics.

Fieldwork as a part of social science research brings the researcher closest to the subject of research. It is a dynamic process where there is an exchange between the researcher, participants, stakeholders, gatekeepers, the community and the larger sociopolitical context in which the research problem is located. Ethical dilemmas that surface during fieldwork often pose a unique challenge to the researcher. This paper is based on field experiences during an action research study conducted with a human rights perspective. It discusses the role conflict that researchers face during fieldwork in a situation of humanitarian crisis. It raises issues pertaining to the need to extend the ethical decision-making paradigm to address ethical dilemmas arising during the course of fieldwork.

Agua: sabor, ética y estética / Water: state, ethics and aestetics

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Water stress, water transfer and social equity in Northern China--implications for policy reforms.

Water stress in Northern China is characterized with major, inefficient irrigation water use and rapidly growing non-agricultural water demands, as well as limited water quantity and declining water quality. Water use in the region is undergoing transfer from agricultural to municipal and industrial sectors. Currently, part of the economic loss and environmental damage due to water stress can be considered as a consequence of water transfer failures, including the current transfers, which hurt farmers' livelihood and income, and the needed transfers, which industry and cities have been waiting for but have not received. This paper starts with a discussion of the causes of water stress in Northern China, which is fundamental to understand the necessity and complexity of agricultural water transfers. Following that, it reviews water transfers in Northern China as a cause for concern over the social stability, economy and environment of the region. Based on an integrated analysis of economic, environmental, fiscal and social implications, this paper begins by identifying critical barriers to smooth water redistribution; and ends with implications for policy reforms, ensuring that farmers can and will save water. It is concluded that the decisions of water reallocation under water stress should be shared by communities at all levels, from the local to the national, to ensure equal access of water, especially the availability of the basic water need for all groups.

Ethical considerations of the short-term and long-term health impacts, costs, and educational value of sustainable development projects.

There are over 800 seventh to tenth grade students at the College d'Enseignment Generale (CEG) School in Azové, Benin. Like most children in the developing world, these students lack access to clean water and basic sanitation facilities. These students suffer from parasitic infection and health ailments which could be directly offset with short term aid to supply water and medical aid. Promoting proper sanitation and providing the technology to implement water and wastewater treatment in the community will decrease childhood and maternal disease and mortality rates in Azové. However, these measures may take several years to implement and will require a significant investment in the infrastructure of the school. Is it ethical to spend 10,000 dollars towards the long-term goals of providing water and sanitation to the students of CEG Azové, compared to spending the same amount on short-term relief efforts? This paper addresses the ethical dilemma of dealing with immediate medical needs in developing countries while trying to implement sustainable technologies. The views and frustration of students working on the project are discussed, as they realize the monetary and short-term impacts on human health when implementing sustainable technologies. The opportunity costs associated with the education principles of sustainable development were also considered. The anticipated costs and health impacts in the short-term and long-term will be evaluated for a period of 1, 2, 5 and 10 years. Sustainable development requires a new way of thinking, and a long-term approach. These problems will require the dedication of a new generation of engineers, working hand-in-hand with local communities and governments, social scientists, economists, businesses, human rights organizations, other non-government organizations, and international development organizations. Design projects encourage the professional and ethical development of engineers through hands-on involvement in national and international development projects.

Agua: qualidade de vida. O desafio do século / Water - Quality of Life. The Challenge of the Century

Não é por acaso que a UNESCO pôs os problemas da água entre suas prioridades, a ponto de declarar 2003 o Ano Internacional da Água Doce, este líquido que representa apenas 2, 5 por cento da água deste planeta. O Terceiro Fórum Mundial da Água ocorreu em março de 2003 em Kyoto, com cem chefes de Estado, delegações de 170 países e mais de dez mil especialistas, com contracúpula alternativa em Florença. Os peritos o declaram um fiasco ( O Estado de São Paulo, de 26/3/2003). Não será o último simpósio sobre água neste século. O presente artigo começa por relacionar a água e a saúde, como convém nesta revista. Em seguida alarga-se o horizonte de modo a fazer adivinhar as muitas conexões que a água tem com nossa vida, nessa história, nesse planeta e para toda a humanidade. No mundo, um quinto da população (1, 1 bilhão de pessoas) não têm acesso à água pótavel. Constatou-se em Kyoto o fracasso das promessas internacionais (homologas notadamente em Johannesburgo, em 2002) em vista de reduzir pela metade, até o ano 2015, as carências em água pótavel.

[The bioethics of protection and the state's role: moral problems in unequal access to drinking water]. / Bioética da proteção e papel do Estado: problemas morais no acesso desigual à água potável.

The aim of this study is to examine unequal access to drinking water as a public health problem in terms of normative and analytical tools in the bioethics of protection. Therefore, we analyze both the moral implications of unequal treatment of primary needs, such as situations of vulnerability and threat to population groups, and the public sector's responsibility in supplying safe water. In addition, solutions are proposed for the protection of public health and the promotion of legitimate personal development projects. The bioethics of protection reaffirms the state's role in maintaining the drinking water supply and recommends avoiding a policy of privatization of this public good, meanwhile justifying public policies to correct situations of social injustice.