Public Policy Research Articles

The Honest Broker versus the Epistocrat: Attenuating Distrust in Science by Disentangling Science from Politics

ABSTRACT People’s trust in science is generally high. Yet in public policy disputes invoking scientific issues, people’s trust in science is typically polarized, aligned with their political preferences. Theorists of science and democracy have reasoned that a polarization of trust in scientific information could be mitigated by clearly disentangling scientific claims from political ones. We tested this proposition experimentally in three German public policy disputes: a) school closures versus openings during the COVID-19 pandemic, b) a ban on versus a continuation of domestic air traffic in view of climate change, and c) the shooting of wolves in residential areas or their protection. In each case study, we exposed participants to one of four versions of a news item citing a scientist reporting their research and giving policy advice. The scientist’s quotes differed with regard to the direction and style of their policy advice. As an epistocrat, the scientist blurs the distinction between scientific and political claims, purporting to “prove” a policy and thereby precluding a societal debate over values and policy priorities. As an honest broker, the scientist distinguishes between scientific and political claims, presenting a policy option while acknowledging the limitations of their disciplinary scientific perspective of a broader societal problem. We find that public policy advice in the style of an honest broker versus that of an epistocrat can attenuate political polarization of trust in scientists and scientific findings by enhancing trust primarily among the most politically challenged.

The Advancement of 4IR Technologies and Increasing Cyberattacks in South Africa

The fourth industrial revolution (4IR) is an era characterised by accelerated technological progress. Even though access to 4IR technologies is not yet widespread, in the current era, 4IR technologies affect socio-economic activities and digital business. The pace of digital transformation also has some implications for cybersecurity. The purpose of this study was to assess the impact of these 4IR technologies on cyberattacks in South Africa. The study used qualitative data collection methods, namely, interviews and document collection. Purposive and convenience sampling were used to select the study participants. An analysis of the collected data yielded four major findings. A major tenet of these findings was that there is a correlation between the advancement of 4IR technologies and the rapid increase in cyberattacks in South Africa. The study has made theoretical and practical contributions as well as some essential contributions to digital transformation and cybersecurity theories. The findings and recommendations of the study can be used in other countries in southern Africa. One recommendation is for business executives to implement certain measures to strengthen cybersecurity in their organisations. Further, policymakers in South Africa are advised to ensure that public policies and law enforcement agencies are able to use advanced technologies to prevent and deal with cyberattacks.

Nutrients and environmental toxicants: effect on placental function and fetal growth

Understanding the mechanisms by which environmental factors impact reproductive health is crucial for informing public health interventions and policy decisions. By elucidating the pathways through which environmental stressors exert their effects, we can develop targeted strategies to mitigate risks and promote reproductive well-being. In this lecture, we will delve into the latest research findings and emerging trends in the field of environmental reproductive health. By exploring the intricate interplay between environmental exposures and reproductive outcomes, we aim to broaden our understanding of this complex relationship and its implications for human health. Through collaborative efforts across disciplines, we can work towards safeguarding reproductive health for current and future generations.

Ending 1990s Law and Development Ideas, Paradox of Path Dependence In Economic Planning Institutions Under Covid-19: SA’s Response

Abstract This paper argues that the COVID-19 pandemic can and should be understood as a form of creative destruction (Schumpeter’s gale), at a hyper level owing to its biological/medical dimension. Therefore, the critical response to such a hyper force is to rethink how institutions administer Public Policy in South Africa (Path Dependency), most importantly economic development planning institutions and Covid-19 responses, in the form of ‘The Economic Reconstruction and Recovery Plan’. It’s the contention of this paper that the reason why Covid-19 continues to impact the South African government’s economic planning ethos is anchored in its developmental orientation, particularly how constitutional legalism has impaired economic development planning. This could impart be due to the unaddressed influences of the initial waves of Law and Development post-1994. The South African experience with the initial waves of Law and Development were muted owing to the problematic nature of the 1994 transition which sought peace at all costs without necessary addressing substantive economic development reform considerations. Therefore, using the policy experiences of Covid-19 and Lee’s, General Theory of Law and Development, particularly the aspects of Development and State Capacity and Political Will, a revision of the South African Constitution will be called on, principally chapter’s 2 and 6 (Bill of Rights) and (Province).

The Perception of the Biocentric Tourist Landscape in “Pueblos Mágicos” According to Inhabitants

The “Pueblos Mágicos” program designation, given by the Mexican government to towns that have kept their cultural heritage, as a local public policy makes changes to residents, the economy, and the space. Consequently, it creates a new landscape. To explain the repercussions on the population, their perception is analyzed, a process that allows judgments to be made about the environment. Therefore, the objective is to explain the changes in the perception of the biocentric tourist landscape according to the inhabitants of the “Pueblo Mágico” of Jiquilpan, Michoacán. For the methodology, a quantitative approach was chosen, through a survey on the topics of residents, the economy, and space in the area where tourist goods and services are concentrated. The analysis used was multivariate with a multiple correspondence analysis method. The results are shown through dimension graphs showing the iterations and their contributions, and topics and questions are displayed by their contribution value through centrality schemes. Among the findings, there is a negative perception of the biocentric landscape among the residents of the historic center in Jiquilpan. However, they are in favor of coexisting with tourists and the improvement of public services as well as with good restaurants and hotels. Conversely, they are against the actions that were carried out by public administrations.

UTERINE FIBROIDS AND THE CORRELATION WITH BLACK WOMEN

Uterine fibroids are common benign tumors in the uterus of women of reproductive age and can cause symptoms such as heavy menstrual bleeding, pelvic pain and increased abdominal volume. Studies have shown a higher prevalence of uterine fibroids in black women compared to women of other ethnicities. Understanding the causes of this disparity is fundamental to developing more effective prevention and treatment strategies. Investigating the relationship between the incidence of uterine fibroids and black ethnicity, analyzing the genetic and social factors that may contribute to this correlation and proposing measures to reduce the incidence of uterine fibroids in black women are the aims of this study. This is a systematic literature review using an exploratory and narrative method, with qualitative and quantitative premises. The databases used were PubMed, Scielo, Scopus, Web of Science and the Virtual Health Library. The articles analyzed were selected by exclusion and inclusion criteria, which are set out here, using the health sciences descriptors “uterine fibroids”, “black women and uterine fibroids”, “genetic factors and uterine fibroids” and “environmental factors and uterine fibroids”, reaching a total of 617 articles searched and 9 used in this study. Genetic studies have suggested a genetic predisposition to the development of uterine fibroids in black women, with the identification of genetic variants associated with a higher risk. In addition, social factors such as limited access to quality healthcare, socioeconomic inequalities and exposure to psychosocial stressors may also play an important role. Lack of access to preventive healthcare and unequal access to effective treatments may contribute to a higher prevalence of uterine fibroids in black women. Measures to reduce this disparity include promoting equitable access to healthcare, reproductive health education and public policies that address the underlying causes of health inequalities. The correlation between uterine fibroids and black women highlights the need for integrated approaches that consider both genetic and social factors. Promoting equity in access to health care and implementing public policies aimed at women’s health are key to reducing the incidence of uterine fibroids and improving the quality of life of black women.

“We call it soul food”: Inuit women and the role of country food in health and well-being in Nunavut

Indigenous knowledge is central to understanding environment and health sciences in the Arctic, yet limited research in these fields has explored the human–animal–environment interface from the unique perspectives of Inuit women. Using a community-led, Inuit-centred research approach, we characterized the use and meaning of country food in the context of community well-being for Inuit women in Nunavut, Canada. In-depth conversational interviews and focus groups ( n = 16) were held with Inuit women ( n = 10) who are knowledge holders in the Qikiqtani region that hold decades of country food knowledge. Data were analyzed using thematic analysis and constant comparative methods. Inuit women described country food in the context of (1) well-being, connection, and identity, (2) hunger, craving, and healing, (3) food security and nourishment, and (4) change and adaptation. Inuit women described a wide range of country food as central to physical and mental health, food security, identity, culture, healing and medicine. Adaptive strategies were discussed, such as eating more fish when caribou were scarce. This research highlights the critical role of country food for health and well-being for Inuit women and shares knowledgeand perspective that is relevant to wildlfe and environment researchers, public health practitioners, policy makers, and others interested in advancing health, well-being, and food sovereignty in Inuit communities.

EU AI sovereignty: for whom, to what end, and to whose benefit?

ABSTRACT EU policy emphasises the need for digital sovereignty, also in artificial intelligence (AI). But because such ‘AI sovereignty’ could be used for diverse and even conflicting goals, it obscures the tensions that actual EU AI strategy entails. Conceptually, this article proposes three central trade-offs: first, does AI sovereignty pit the EU against other major AI powers, or rather citizens against large tech companies? Second, is AI sovereignty meant to boost the EU’s position in a putative AI race, or is it a means to defy this competitiveness-logic, instead? And third, is EU AI sovereignty primarily meant to benefit European citizens, or does it embrace a global responsibility? The empirical analysis then maps the EU Commission’s AI strategy since 2018 and the EU AI Act negotiations onto these three dimensions. It reveals that EU AI policy prioritises jurisdictional independence over citizens sovereignty, that it embraces a global AI race logic, and that it largely neglects its impact on people beyond the EU. This orientation of EU AI sovereignty resonates with and feeds into rising geo-economic tensions. But it would underestimate the importance of public policy to assume that it flowed naturally from technological transformations, rather than from political choices.

Trust in Government in a Changing World: Shocks, Tax Evasion, and Economic Growth

Abstract Governments are always dealing with unexpected shocks, like wars, terrorism, financial crises, natural disasters, and the like. A recent prominent example is the SARS-CoV-2 pandemic. Since early 2020, governments around the world have enacted a range of unprecedented measures in an attempt to protect their citizens, with quite mixed results. This varied record has in turn had dramatic effects on peoples’ perceptions of their government, especially on their trust in government and so on their willingness to obey the many government mandates generated by the pandemic. This willingness to obey government mandates extends well beyond pandemic policies to all other dimensions of government laws and regulations. An important dimension of individual compliance with government mandates is tax evasion. What will be the effects of the pandemic and the associated government policies on post-pandemic tax evasion and economic growth, especially via the effects of government policies on “trust” in the government? In this paper we incorporate both tax evasion and trust in an endogenous growth model in order to examine the short and long run impacts on tax evasion of various shocks – a pandemic shock, a government policies shock, and a tax morale shock (and the resulting impact on trust in government). We then use real data on 11 representative economies to simulate these effects, economies representing developed and developing countries as well as economies representing governments that opted for various policy responses to COVID-19, modelled as a labor productivity shock. We find that varied public policy responses to the pandemic have immediate and persistent impacts on tax evasion in the short and long run, largely via their effects on trust in government. We also find that these evasion impacts vary in important and predictable ways that depend especially on whether government dealt effectively or not with the pandemic. Our methodology is readily adapted to examine the effects of other shocks and their respective policy responses on trust in government, tax evasion, and economic growth.

Oxy-biodegradable plastics in freshwater environments: degradation and biofouling

Growing concern about the impact of plastic pollution on the environment has led to the creation of global public policies and the consumption of “environmentally friendly” products, such as oxy-biodegradable plastics. In this context, “greenwashing” practices can arise, i.e., the product promises more environmental benefits than it actually offers, which can lead to superfluous use, inappropriate disposal, and the generation of microplastics (MPs). However, the scientific literature lacks studies that evaluate the behavior of oxy-biodegradable plastic when exposed to the freshwater environment. In this respect, the aim of the current study was to evaluate the degradation process of oxy-biodegradable plastic bags made from high-density polyethylene (HDPE) in river water. To this end, the current study aimed to assess whether these bags actually meet the label information (which corresponds to the complete degradation of material) or whether they correspond to greenwashing practices. The physical and chemical alterations, and the formation of biological communities that occurred on the surface of the plastic material when exposed to natural aging and submerged in freshwater were monitored using mid-infrared absorption spectroscopy with attenuated total reflectance (FTIR-ATR) and scanning electron microscopy (SEM). The characterization of the samples after 180 days of exposure showed that the oxy-biodegradable bags were not completely degraded, with only fragmentation of the material and generation of MPs. In addition, it was also observed that microorganisms present in the water easily colonized the plastic surface from the start of the experiment. In this way, the oxy-biodegradable bags analyzed correspond to a greenwashing practice, which is extremely harmful, since it can influence the increase in consumption of these products, generating greater improper disposal of these materials, and consequently the generation of MPs and the formation of biofilms, which can carry pathogenic microorganisms to the aquatic biota and to humans.

Challenges and Opportunities for the Development of Inland Waterway Transport in Brazil

Despite the presence of numerous navigable rivers in Brazil, they remain underutilized for Inland Waterway Transport (IWT). Given the recent changes in transport systems which aim to reduce reliance on highways due to their high cost and lack of sustainability, it becomes crucial to explore new transport models in Brazil, shifting part of the transport from roads to railways and mainly to waterways. To fill this gap in Brazil’s transport system, it was decided to check why waterways are little used and what challenges cause them to be underutilized and, additionally, what opportunities could leverage their use in the country. In this sense, in this study, we identify the biggest challenges and opportunities faced by IWT in Brazil. To achieve this objective, interviews were conducted using content analysis with managers who work in public and private IWT organizations active in Brazil. Results show that IWT has seen a recovery in interest in recent years due to the need for cheaper and greener logistics. It was also found that the main challenges that IWT faces are a lack of public policies followed by precarious infrastructure of waterways, ports and locks, as well as modest integration with other transport modes. Conversely, the most significant opportunity lies in the potential reduction in transport costs, coupled with the enhanced sustainability of transport activities via the utilization of IWT, thereby fostering greener transport practices. These results can contribute to a better understanding of practical and theoretical approaches related to IWT in Brazil, and they can serve as a reflection for new research focusing on the development of IWT especially in other emerging countries facing similar issues.

Implementation Dynamics of Passport Service Policy for Dual Nationality Child Subjects in Indonesia

Abstract 
 This article is a study of the implementation of passport service policies for children with dual citizenship in Indonesia. The implementation of this policy is the implementation of Permenkumham Number 18 of 2022, one of the points of which regulates the application of passport validity periods for children with dual citizenship. Regulations regarding the validity period of passports for children with dual citizenship are a form of policy that is in direct contact with Government Regulation Number 21 of 2022, although in its application to passport services at the Immigration Office, sometimes there is still no continuity between the two regulations. This then results in an analysis of the implementation of the passport service policy for children with dual citizenship which boils down to 3 decisions, namely first, namely providing a passport with a validity period up to the age limit for choosing the nationality of the passport applicant, postponing the passport application until the passport applicant completes the process of filing his/her citizenship selection, or refusing passport application because the passport applicant cannot complete the documents verifying the validity of his or her citizenship status by the previously determined time limit. The analysis used in this research uses Public Policy theory with the concept of Open Government and Public Policy Implementation in government institutions in Indonesia. It is hoped that this research will be able to provide an overview of the implementation of passport services for children with dual citizenship and provide the best solution for implementing this policy in the future.

Burden of Ischemic and Hemorrhagic Stroke Across the US From 1990 to 2019

Stroke is a leading cause of death and disability in the US. Accurate and updated measures of stroke burden are needed to guide public health policies. To present burden estimates of ischemic and hemorrhagic stroke in the US in 2019 and describe trends from 1990 to 2019 by age, sex, and geographic location. An in-depth cross-sectional analysis of the 2019 Global Burden of Disease study was conducted. The setting included the time period of 1990 to 2019 in the US. The study encompassed estimates for various types of strokes, including all strokes, ischemic strokes, intracerebral hemorrhages (ICHs), and subarachnoid hemorrhages (SAHs). The 2019 Global Burden of Disease results were released on October 20, 2020. In this study, no particular exposure was specifically targeted. The primary focus of this analysis centered on both overall and age-standardized estimates, stroke incidence, prevalence, mortality, and DALYs per 100 000 individuals. In 2019, the US recorded 7.09 million prevalent strokes (4.07 million women [57.4%]; 3.02 million men [42.6%]), with 5.87 million being ischemic strokes (82.7%). Prevalence also included 0.66 million ICHs and 0.85 million SAHs. Although the absolute numbers of stroke cases, mortality, and DALYs surged from 1990 to 2019, the age-standardized rates either declined or remained steady. Notably, hemorrhagic strokes manifested a substantial increase, especially in mortality, compared with ischemic strokes (incidence of ischemic stroke increased by 13% [95% uncertainty interval (UI), 14.2%-11.9%]; incidence of ICH increased by 39.8% [95% UI, 38.9%-39.7%]; incidence of SAH increased by 50.9% [95% UI, 49.2%-52.6%]). The downturn in stroke mortality plateaued in the recent decade. There was a discernible heterogeneity in stroke burden trends, with older adults (50-74 years) experiencing a decrease in incidence in coastal areas (decreases up to 3.9% in Vermont), in contrast to an uptick observed in younger demographics (15-49 years) in the South and Midwest US (with increases up to 8.4% in Minnesota). In this cross-sectional study, the declining age-standardized stroke rates over the past 3 decades suggest progress in managing stroke-related outcomes. However, the increasing absolute burden of stroke, coupled with a notable rise in hemorrhagic stroke, suggests an evolving and substantial public health challenge in the US. Moreover, the significant disparities in stroke burden trends across different age groups and geographic locations underscore the necessity for region- and demography-specific interventions and policies to effectively mitigate the multifaceted and escalating burden of stroke in the country.

Firearm Access and Gun Violence Exposure Among American Indian or Alaska Native and Black Adults

American Indian or Alaska Native and Black adults experience elevated rates of firearm injury and death, but both groups are severely underrepresented in research on firearm exposure and behaviors. To explore geodemographic differences in firearm behaviors and violence exposure among American Indian or Alaska Native and Black adults in the US. In this survey study, nationally representative samples of American Indian or Alaska Native and/or Black adults recruited from KnowledgePanel were surveyed cross-sectionally. Surveys were administered online between April 12 and May 4, 2023. Firearm access, storage, and carrying behaviors and lifetime firearm violence exposure were the primary outcomes. Demographic factors such as age, geographic location, and political affiliation were considered. Data were weighted to geodemographic distributions from the US Census Bureau's 2022 Current Population Survey. Of 3542 participants, 527 (14.9%) were American Indian or Alaska Native (280 [53.1%] female) and 3015 (85.1%) were Black (1646 [54.6%] female). Both groups exhibited high firearm access rates (American Indian or Alaska Native adults: 238 [45.4%; 95% CI, 39.4%-51.7%]; Black adults: 909 [30.4%; 95% CI, 28.0%-32.9%]), predominantly owning handguns for home protection. The groups demonstrated similar firearm storage patterns, and a substantial proportion endorsed always or almost always carrying firearms outside the home (American Indian or Alaska Native adults: 18.9%; Black adults: 15.2%). Self-protection was a common reason for carrying a firearm (American Indian or Alaska Native adults: 104 [84.9%; 95% CI, 74.1%-91.7%]; Black adults: 350 [88.3%; 95% CI, 82.3%-92.4%]), and a minority of participants cited lack of faith in the police (American Indian or Alaska Native adults: 19 [15.2%; 95% CI, 8.2%-26.7%]; Black adults: 61 [15.4%; 95% CI, 10.3%-21.2%]), indicating potential shifts in public safety dynamics. In this survey study of American Indian or Alaska Native and Black US adults, a substantial percentage of both groups reported living in homes with firearms, storing firearms loaded and unlocked, frequently carrying firearms outside the home, and having been exposed directly and indirectly to gun violence. These findings underscore the need for nuanced public health campaigns and policies and highlight challenges for law enforcement in contexts of racial disparities and changing legal frameworks.

Game changers or money pits? Asymmetric impact of sports facilities investment on football revenue

AbstractOur investigation explores the asymmetric association between sports facilities investment and football revenue in the top 10 nations with the highest sports facilities investment. This study employs a distinctive methodology, “Quantile‐on‐Quantile,” to probe the interconnectedness of time series within each country. The findings reveal that investments in sports facilities have a predominantly positive impact on football revenue in the selected economies, particularly in various segments of the data distribution. It underscores the importance of implementing policies that maximize the effect of sports facilities investment on football revenue and inform public policy decisions.

Determinants of obesity in Latin America.

Obesity rates are increasing almost everywhere in the world, although the pace and timing for this increase differ when populations from developed and developing countries are compared. The sharp and more recent increase in obesity rates in many Latin American countries is an example of that and results from regional characteristics that emerge from interactions between multiple factors. Aware of the complexity of enumerating these factors, we highlight eight main determinants (the physical environment, food exposure, economic and political interest, social inequity, limited access to scientific knowledge, culture, contextual behaviour and genetics) and discuss how they impact obesity rates in Latin American countries. We propose that initiatives aimed at understanding obesity and hampering obesity growth in Latin America should involve multidisciplinary, global approaches that consider these determinants to build more effective public policy and strategies, accounting for regional differences and disease complexity at the individual and systemic levels.

Geospatial-based decision support system for prioritizing road segments for maintenance and rehabilitation

Given the growing demand for moving goods and people and the escalating number of vehicles on highways, issues related to road safety have become common concerns. Additionally, the aging of the road infrastructure and the intensification of climatic change effects reinforce the problem of road pavement serviceability. However, accessing funds for road maintenance and having the autonomy for pure technical decisions remain significant challenges for transport authorities. Thus, this paper addresses developing a geospatial-based systematic process for prioritizing highway segment candidates for maintenance and rehabilitation. The investigation was designed to facilitate the decision-making process for the state transportation authority to allocate funds over the 20.315 km of major highways in Minas Gerais, Brazil. The method consisted of ranking the highway segments regarding the geographic context to which each segment belongs, as well as the operational characteristics of the highways. The approach meets the United Nations Sustainable Development Goals by considering socio-economic and demographic perspectives along with other traditional engineering characteristics such as the available transport infrastructure, the traffic volume, the highway capacity, the pavement serviceability and the potential for deterioration, the condition of the surface drainage, and weather-related data. Transportation practitioners with expertise in pavement maintenance and rehabilitation and transportation managers contributed to the development by weighting the factors according to the best possible technical judgment regarding prioritizing funds. The GIS-oriented Delphi framework resulted in a priority index. The index allowed the elaboration of a ranking of priorities, which is vital information regarding public policies and the transparent use of public money for road maintenance and rehabilitation within the State of Minas Gerais. The model is robust and outputs geoinformation and tabular data to feed the decision-making process in an organized and transparent manner. Therefore, the core methodology can be easily transferable to other jurisdictions.

A fractional stochastic SPEIQR epidemic model in switching network for COVID-19

The rapid spread of COVID-19 globally is the cause of panic and billions of dollars in losses and some public policies have been implemented to contain the spread of the virus. It is highly significant to establish mathematical models to describe the spread of the pandemic. In this paper, a fractional stochastic susceptible–protected–exposed–infected–quarantined–recovered (SPEIQR) epidemic model in switching network is proposed to investigate COVID-19 and other diseases in the future, in which the switching connections in the propagation network of viruses based on a Bernoulli random variable are given to represent the policy change during COVID-19. The effects of environmental fluctuations are also considered by introducing the multiplicative noise terms into the disease transmission coefficient to obtain a more realistic mathematical model. Furthermore, the Riemann–Liouville fractional derivative is used to describe the dynamics of disease transmission process which is dependent on the history information of the stochastic system. Some qualitative properties of the model are derived and some sufficient conditions are obtained to ensure the local extinction with probability one of the disease. Finally, we use the epidemic data of three countries (Italy, Germany and Switzerland) and three cities in China (Hubei, Hunan and Henan) from January 22 to July 20 to demonstrate the validity of the derived results and the availability of the proposed models. This work provides some theoretical results to deeply understand the dynamics of COVID-19 and regulate the disease dynamics.

Aerial Video Surveillance in a Megacity: A Case Study in Santiago, Chile

ABSTRACT The growth of gated communities and the omnipresence of video surveillance have changed urban life considerably in the last decades. Especially in cities governed by neoliberal public policies and widespread fear of crime, residents search for security, social status, and shared services in fortified enclaves where video cameras watch everybody who enters their premises. These developments are not restricted to private space, and affluent neighborhoods in megacities are eager to adopt a wide range of surveillance technology to protect their citizens. Eight years ago, the affluent municipality of Lo Barnechea in the metropolitan region of Santiago, Chile, installed a surveillance balloon in a residential area. The local security forces currently operate six balloons, and residents have become accustomed to the ever-present gaze of aerial video cameras. This article contrasts the presence of this technology in a megacity against different perspectives on surveillance and urbanism. A consideration of its panoptic features leaves an unsatisfactory explanation. Citizens actively participate in generating public policies and smart technology for public safety, as is characteristic of a maximum security society. The surveillance balloons have become a sustainable element in the urban landscape and an appreciated part of the social fabric of the residential neighborhoods.

Contact investigation in multidrug-resistant tuberculosis:ethical challenges.

Contact investigation is an evidence-based intervention of multidrug-resistant tuberculosis (MDR-TB) to protect public health by interrupting the chain of transmission. In pursuit of contact investigation, patients' MDR-TB status has to be disclosed to third parties (to the minimum necessary) for tracing the contacts. Nevertheless, disclosure to third parties often unintentionally leads the MDR-TB patients suffered from social discrimination and stigma. For this reason, patients are less inclined to reveal their MDR-TB status and becomes a significant issue in contact investigation. This issue certainly turns into a negative impact on the public interest. Tension between keeping MDR-TB status confidential and safeguarding public health arises in relation to this issue. Regarding MDR-TB management, patient compliance with treatment and contact investigation are equally important. Patients might fail to comply with anti-TB therapy and be reluctant to seek healthcare due to disclosure concerns. In order to have treatment adherence, MDRTB patients should not live through social discrimination and stigma arising from disclosure and TB team has a duty to support them as a mean of reciprocity. However, implementation of contact investigation as a public health policy can still be challenging even with promising reciprocal support to the patients because MDR-TB patients are living in different contexts and situations. There can be no straight forward settlement but an appropriate justification for each distinct context is needed to strike a balance between individual confidentiality and public interest.