The Lancet
Nov 22, 2014 Volume 384 Number 9957 p1821 – 1900
http://www.thelancet.com/journals/lancet/issue/current

Ethical considerations of experimental interventions in the Ebola outbreak
Dr Annette Rid MD a, Prof Ezekiel J Emanuel MD b
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Background
The outbreak of Ebola virus raging in west Africa is special in two respects. First, with more than 2100 infections and 1100 deaths,1 it has already become the most severe and largest documented Ebola outbreak. It is also occurring in some of the world’s least developed countries,2 and is therefore extremely complex to address. Second, experimental interventions that are still in the preclinical trial phase—and hence untested in human beings—were first given to health-care workers from high-income countries, focusing extensive attention and controversy on investigational treatments and vaccines for Ebola.3—5
The rapidly evolving situation raises three fundamental questions: how much emphasis should the international community place on experimental interventions in response to the Ebola epidemic; what are the ethical considerations if experimental treatments or vaccines are deployed; and if any interventions prove safe and effective, how can they be made more widely available?…

For debate: a new wave in public health improvement
Sally C Davies MBChB a, Eleanor Winpenny PhD b, Sarah Ball PhD b, Tom Fowler PhD a c d, Jennifer Rubin PhD b, Dr Ellen Nolte PhD b
Summary
The rising burden of chronic disease poses a challenge for all public health systems and requires innovative approaches to effectively improve population health. Persisting inequalities in health are of particular concern. Disadvantage because of education, income, or social position is associated with a larger burden of disease and, in particular, multimorbidity. Although much has been achieved to enhance population health, challenges remain, and approaches need to be revisited. In this paper, we join the debate about how a new wave of public health improvement might look. We start from the premise that population health improvement is conditional on a health-promoting societal context. It is characterised by a culture in which healthy behaviours are the norm, and in which the institutional, social, and physical environment support this mindset. Achievement of this ambition will require a positive, holistic, eclectic, and collaborative effort, involving a broad range of stakeholders. We emphasise three mechanisms: maximisation of the value of health and incentives for healthy behaviour; promotion of healthy choices as default; and minimisation of factors that create a culture and environment which promote unhealthy behaviour. We give examples of how these mechanisms might be achieved.