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Public health ethics and practice

Public health ethics and practice

Stephen Peckham
Alison Hann
Copyright Date: 2010
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  • Book Info
    Public health ethics and practice
    Book Description:

    Ethical dilemmas are not new in the area of health care and policy making, but in recent years, their frequency and diversity have grown considerably. All health professionals now have to consider the ethical implications of an increasing array of treatments, interventions and health promotion activities on an almost daily basis. This goes hand in hand with increasing medical knowledge, and the growth of new and innovative medical technologies and pharmaceuticals. In addition, the same technology and knowledge is increasing professional and public awareness of new potential public health threats (e.g. pandemic influenza). At the level of public policy, concerns over the rising costs of health care have led to a more explicit focus on 'health promotion', and the surveillance of both 'patients' and the so-called 'worried well'. Health professionals and policy makers also have to consider the implications of managing these risks, for example restricting individual liberty through enforced quarantine (in the wake of SARS and more recently swine flu) and the more general distribution of harms and benefits. Balancing the rights and responsibilities of individuals and wider populations is becoming more complex and problematic. This book will play a key role in opening out a discussion of public health ethics. It examines the principles and values that support an ethical approach to public health practice and provides examples of some of the complex areas which those practising, analysing and planning the health of populations have to navigate. It will therefore be essential reading for current practitioners, those involved in public health research and a valuable aid for anyone interested in examining the tensions within and the development of public health.

    eISBN: 978-1-84742-104-3
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iii)
  2. Acknowledgements
    (pp. iv-iv)
  3. Table of Contents
    (pp. v-vi)
  4. List of figures, tables and boxes
    (pp. vii-vii)
  5. Notes on contributors
    (pp. viii-xii)
  6. ONE Introduction: Why public health ethics?
    (pp. 1-14)
    Stephen Peckham and Alison Hann

    While ethics has been a central consideration of medical research and healthcare delivery, the application of ethics to public health policy and practice is less well developed. There is, however, an increasing interest in public health ethics, reflecting a renewed international policy emphasis on public health, debates about the effectiveness of public health interventions and discussions at a global level about public health risks and action. Public health ethics is now part of mainstream public health training in the US and there is interest in developing ethical frameworks for public health policy and practice in the UK. For example, the...

  7. Part One: Public health:: contexts

    • TWO Why ethics? What kind of ethics for public health?
      (pp. 17-32)
      Alan Cribb

      It would be very odd to insist that clinical health professionals should be mindful of, and conscientious about, the ethical issues raised in their one-to-one clinical encounters without setting similar expectations for those who work with whole populations. But – as I will suggest (and indeed this book shows more generally) – public health ethics raises many deep-seated and testing philosophical and practical challenges and those who work in, and are concerned with, public health have plenty of important things to be getting on with, without getting bogged down in an academic ethics seminar. So can we develop the field...

    • THREE Public health ethics: what it is and how to do it
      (pp. 33-48)
      Stephen Holland

      This chapter is in two parts. The first asks what public health ethics is, and defends a conception of the subject. The second asks how we should go about doing public health ethics, and presents two lines of thought about methodologies.

      Public health ethics centres on a problematic triad. The members of the triad are governments, populations and individuals. The triad is problematic because populations and individuals sometimes clash: the rights and freedoms of individuals can come into tension with the need to protect and promote the health of the population. In such circumstances, the government has the role of...

  8. Part Two: Ethics and public health practice

    • FOUR What does it mean to ‘know’ a disease? The tragedy of XDR-TB
      (pp. 51-64)
      Ross Upshur

      Although unpalatable to consider, we are at a watershed in the history of the control of tuberculosis (Fauci, 2007). The progressive increase of resistance of tuberculosis (TB) to pharmacotherapy has raised the possibility of a response to tuberculosis without medications, in essence returning us to the situation as it was in the 19th century or, as some have posited, the dawn of the post-antibiotic age (Raviglione, 2006). The combination of high rates of TB infection with high seropositivity rates for HIV in sub-Saharan Africa has raised the ante of global tuberculosis control.

      It is instructive to note that from almost...

    • FIVE The evaluation of public health education initiatives on smoking and lung cancer: an ethical critique
      (pp. 65-82)
      Peter Allmark, Angela Tod and Jo Abbott

      This chapter considers the way in which public health education initiatives are evaluated. In particular, our concern is with such evaluation when it is done in terms of behavioural outcomes, such as how many people give up smoking. Our main claim is that this method of evaluation is scientifically and ethically flawed. We use the example of initiatives on smoking and lung cancer. This is because smoking is known to be a hugely important contributor to illness and to health inequality, and because there have been many such initiatives. However, the criticisms we make of initiatives relating to smoking and...

    • SIX Relevance of primary care bioethics committees in public health ethical practice in the community: an experience in an area of extreme poverty in Santiago, Chile
      (pp. 83-100)
      Marla Solari and Tatiana Escobar-Koch

      Bioethics is perceived as applied ethics, in other words, the place of interaction between ethical concern and a specific sphere of practice characterised by the prefix ‘bio’ (Ladrière, 2000). Thus, bioethics applies to dilemmas of value which arise in particular spheres of action in relation to the phenomenon of life, its manifestations and interactions. However, bioethics has not been sufficiently explored from the perspective of primary healthcare, where significant ethical conflicts and dilemmas occur. The variety and complexity of ethical dilemmas in primary healthcare derive from the continuous, bio-psychosocial interaction of the healthcare teams and the community, and they imply...

    • SEVEN Unlinked anonymous blood testing for public health purposes: an ethical dilemma?
      (pp. 101-116)
      Jessica Datta and Anthony Kessell

      In this chapter we describe unlinked anonymous blood testing for human immunodeficiency virus (HIV) and other diseases, and examine the ethical issues associated with this system of seroprevalence testing. We argue that the views of participants have been missing from ethical debates about seroprevalence monitoring, and propose that the issue of informed consent for inclusion in such programmes should be revisited. We introduce our own current scientific research which explores this issue.

      A discussion about the ethics of unlinked anonymous testing of blood should be placed within wider contemporary debates in the arenas of public health, clinical medicine and medical...

    • EIGHT Constructing the obesity epidemic: loose science, money and public health
      (pp. 117-136)
      Alison Hann and Stephen Peckham

      According to the World Health Organization, we are in the grip of “globesity” that is “taking over” the world (WHO, 2008). The language used here is both interesting and typical of the language used in many official (and unofficial) documents discussing obesity. Obesity is often presented as a crisis for the economy and well-being of states, as well as a very serious health risk to the individual.¹ It would be difficult to miss the note of panic that invariably creeps in. WHO claims that obesity will overwhelm both developed and underdeveloped countries and that unless immediate action is taken “millions...

    • NINE Politics, ethics and evidence: immunisation and public health policy
      (pp. 137-154)
      Alison Hann and Stephen Peckham

      Public health interventions are rarely without harmful as well as beneficial effect. As Kenny and Giacomini (2005) argue:

      when many people – as well as societal constructs such as institutions and economies – are affected in many ways by every decision, the moral quandaries arise not in the question ofwhetherto harm or benefit buthowto harmandbenefit: whom, how much, how certainly, in what ways, and so forth ... The quintessential ethical problem of the public policy maker is how to define, identify, justify, and distribute inevitable benefits and harms, rather than simply striving to ensure...

    • TEN Avoiding mixed messages: HPV vaccines and the ‘cure’ for cervical cancer
      (pp. 155-170)
      Alison Hann and Stephen Peckham

      In the autumn of 2008 the UK government commenced the first wave of HPV vaccinations as part of a national programme aimed at 12- and 13-year-old girls. This is to be supplemented with a programme aimed at 18-year-old women. The instigation of the UK programme follows the lead of other countries – specifically the US and Canada – as part of a campaign to tackle cervical cancer. Since the announcement that the UK’s Joint Committee on Vaccination and Immunisations recommended a vaccination programme, there has been extensive media coverage aimed at promoting the vaccine in the UK. While the programme...

    • ELEVEN A call for clearer vaccine exemption typology to improve population health
      (pp. 171-188)
      Erica Sutton and Ross Upshur

      Eradicating communicable diseases has been a primary public health goal for centuries, and vaccination programmes comprise a significant part of that population health effort. To achieve community health, public health authorities are bestowed with policing powers whereby individual rights may be sacrificed for the greater good of the population (Mann et al, 1999; Gostin, 2004). However, healthcare providers and scholars are encouraging public health programmes to attain their community health goals through the least coercive and intrusive means possible (Gostin, 2004). The coercive strategies implemented by public health authorities in the past are discouraged today (Mann et al, 1999). Public...

  9. Part Three: Public health ethics:: developing a basis for practice

    • TWELVE Theory and practice in public health ethics: a complex relationship
      (pp. 191-210)
      Angus Dawson

      It is an exciting time in the nascent field of public health ethics. This feeling seems to exist among those approaching these issues from a more theoretical perspective as well as those with a more practical or practitioner point of view. The thing that unites us is a sense that there is something missing from traditional medical ethics. This feeling may in turn be explained in three possible ways. First, many topics central to public health are missing from the list of issues tackled in mainstream medical ethics. Second, there is concern about the adequacy of the theoretical approach or...

  10. THIRTEEN Conclusion: taking forward the debate
    (pp. 211-218)
    Stephen Peckham and Alison Hann

    Every day public health practitioners are faced by many dilemmas in their practice. The discussions in the chapters in this book have addressed some of the old and new areas of ethical debate in public health. Developing coherent and effective health promotion messages is clearly important, as is thinking about how we should respond to new technologies such as new vaccines, and potential public health threats such as pandemic flu and resistant strains of TB. There are also difficult debates about the nature of evidence in public health and the extent to which evidence can and even should be the...

  11. Index
    (pp. 219-224)
  12. Back Matter
    (pp. 225-225)