The evolution of public health ethics frameworks: systematic review of moral values and norms in public health policy
- 1.1k Downloads
Given the evolution of the public health (PH) and the changes from the phenomenon of globalization, this area has encountered new ethical challenges. In order to find a coherent approach to address ethical issues in PH policy, this study aimed to identify the evolution of public health ethics (PHE) frameworks and the main moral values and norms in PH practice and policy. According to the research questions, a systematic search of the literature, in English, with no time limit was performed using the main keywords in databases Web of Science (ISI) and PubMed. Finally, the full text of 56 papers was analyzed. Most of the frameworks have common underpinning assumptions and beliefs, and the need to balance PH moral obligation to prevent harm and health promotion with respect for individual autonomy has been specified. As such, a clear shift from liberal values in biomedical ethics is seen toward the community’s collective values in PHE. The main moral norms in PH practice and policy included protecting the population against harm and improving PH benefits, utility and evidenced-based effectiveness, distributive justice and fairness, respect for all, privacy and confidentiality, solidarity, social responsibility, community empowerment and participation, transparency, accountability and trust. Systematic review of PHE frameworks indicates utilization of the aforementioned moral norms through an practical framework as an ethical guide for action in the PH policy. The validity of this process requires a systematic approach including procedural conditions.
KeywordsPublic heath Health policy Morals/ethics Justice
This study is part of PhD thesis in the field of Bioethics that funded by Shahid Beheshti University of Medical Sciences. Authors express their appreciation to the scholars who contributed to this study and for their valuable comments.
- Abbasi, Mahmoud, Mehran Seif-Farshad, and Mehrzad Kiani. 2015. Moral Aspects of the Laws and Regulations Governing the Health System in Iran. Trends in Life Sciences 4 (3): 145–153.Google Scholar
- Akrami, Forouzan, Mahmoud Abbasi, Abbas Karimi, Reza Majdzadeh, Akbar Shahrivari, and Alireza Zali. 2017. Analyzing the Politico-Moral Foundations of the Iran Health System Based on the Theories of Justice. Journal of Medical Ethics and History of Medicine 10: 4.Google Scholar
- Annas, George J., and Wendy K. Mariner. 2016. (Public) Health and Human Rights in Practice. Journal of Health Politics, Policy and Law 41 (1): 129–139.Google Scholar
- APHA. 2014. 10 Essential Public Health Services. http://www.apha.org/about-apha/centers-and-programs/quality-improvement-initiatives/national-public-health-performance-standards-program/10-essential-public-health-services. Accessed 08 Sept 2014.
- APHA. 2015. Policy Statement: Public Health Opportunities to Address the Health Effects of Climate Change. Policy Number: 20157. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2015/12/03/15/34/public-health-opportunities-to-address-the-health-effects-of-climate-change. Accessed 03 Nov 2015.
- APHA. 2017. 2017 Theme—Creating the Healthiest Nation: Climate Changes Health. https://www.apha.org/events-and-meetings/annual/why-attend/annual-meeting-theme. Accessed 03 May 2017.
- Babu, Giridhara R., Sathyanarayana Tn, Anant Bhan, and J.K. Lakshmi, and Megha Kishore. 2014. An Appraisal of the Tuberculosis Programme in India Using an Ethics Framework. Indian Journal of Medical Ethics 11 (1): 11–15.Google Scholar
- Baum, Nancy M., Sarah E. Gollust, Susan D. Goold, and Peter D. Jacobson. 2007. Looking Ahead: Addressing Ethical Challenges in Public Health Practice. Los Angeles, CA: SAGE Publications Sage CA.Google Scholar
- Bull, Susan, Phaik Yeong Cheah, Spencer Denny, Irene Jao, Vicki Marsh, Laura Merson, Neena Shah More, David Osrin Le Nguyen Thanh Nhan, Decha Tangseefa, and Douglas Wassenaar. 2015. Best Practices for Ethical Sharing of Individual-Level Health Research Data from Low-and Middle-Income Settings. Journal of Empirical Research on Human Research Ethics 10 (3): 302–313.CrossRefGoogle Scholar
- Childress, James F. 2015. Moral Considerations: Bases and Limits for Public Health Interventions. In Essentials of Public Health Ethics, eds. Ruth Gaare Bernheim, James F. Childress, Aalan L. Melnick, and Richard J. Bonnie, 21–43. Burlington: Jones & Bartlett Learning, LLC, an Ascend Learning Company.Google Scholar
- Childress, James F., and Ruth Gaare Bernheim. 2015. Introduction: A Framework for Public Health Ethics. In Essentials of Public Health Ethics, eds. Ruth Gaare Bernheim, James F. Childress, Aalan L. Melnick, and Richard J. Bonnie, 1–20. Burlington: Jones & Bartlett Publishers.Google Scholar
- Childress, James F, Ruth R. Faden, Ruth D. Gaare, Lawrence O. Gostin, Jeffrey Kahn, Richard J. Bonnie, Nancy E. Kass, Anna C. Mastroianni, Jonathan D. Moreno, and Phillip Nieburg. 2002b. Public Health Ethics: Mapping the Terrain. Journal of Law, Medicine & Ethics 30 (2): 170–178.CrossRefGoogle Scholar
- Daniels, N. 2008. Just Health: Meeting Health Needs Fairly. 1st Aufl. Cambridge: Cambridge University Press.Google Scholar
- Daniels, Norman, J. Bryant, R.A. Castano, O.G. Dantes, K.S. Khan, and S. Pannarunothai. 2000. Benchmarks of Fairness for Health Care Reform: A Policy Tool for Developing Countries. Bulletin of the World Health Organization 78 (6): 740–750.Google Scholar
- Faden, Ruth, and Sirine Shebaya. 2016. The Stanford Encyclopedia of Philosophy: Public Health Ethics. Stanford: Metaphysics Research Lab, Stanford University.Google Scholar
- Fox, Brion J. 2005. Framing Tobacco Control Efforts Within an Ethical Context. Tobacco Control 14 (Suppl 2): ii38–ii44.Google Scholar
- Health Council of the Netherlands. 2007. The Future of the National Immunisation Programme: Towards a Programme for all Age Groups. The Hague: Health Council of the NetherlandsGoogle Scholar
- Hofrichter, R. 2003. Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease. San Francisco: Wiley.Google Scholar
- Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington: National Academy Press.Google Scholar
- Kenny, Nuala P, Susan B. Sherwin, and Françoise E. Baylis. 2010. Re-Visioning Public Health Ethics: A Relational Perspective. Canadian Journal of Public Health/Revue Canadienne de Sante’e Publique 101: 9–11.Google Scholar
- Levine, Mark A., Matthew K. Wynia, Paul M. Schyve, J. Russell Teagarden, David A. Fleming, Sharon King Donohue, Ron J. Anderson, James Sabin, and Ezekiel J. Emanuel. 2007. Improving Access to Health Care: A Consensus Ethical Framework to Guide Proposals for Reform. Hastings Center Report 37 (5): 14–19.CrossRefGoogle Scholar
- MacDonald, Melanie. 1999. Resource Allocation in Integrated Delivery Systems and Healthcare Networks: A Proposed Framework to Guide Ethical Thinking. Healthcare Management Forum 12 (4): 24–29.Google Scholar
- McGill, Natalie. 2015. APHA Section Creates Task Force to Revise Public Health Code of Ethics. The Nation’s Health 45 (8): 17–17.Google Scholar
- Nuffield Council On Bioethics. 2007. Public Health: Ethical Issues. London, England: Nuffield Council.Google Scholar
- Petricca, Kadia, and Asfaw Bekele. 2017. Conceptualizations of Fairness and Legitimacy in the Context of Ethiopian Health Priority Setting: Reflections on the Applicability of Accountability for Reasonableness. Developing World Bioethics 00: 1–8.Google Scholar
- Petrini, Carlo, and Gualtiero Ricciardi. 2015. Ethical Issues in Public Health Surveillance: Drawing Inspiration from Ethical Frameworks. Annali dell’Istituto Superiore di Sanità 51 (4): 270–276.Google Scholar
- Powers, Madison, and Ruth R. Faden. 2006. Social Justice: The Moral Foundations of Public Health and Health Policy. 1st Aufl. Oxford: Oxford University Press.Google Scholar
- Prainsack, Barbara. 2013. Taking Solidarity Seriously—Can it Help? In Justice & Solidarity in Priority Setting in Healthcare. Brussels: Brussels Joint Initiative of the King Baudouin Foundation and the Belgian Advisory Committee on Bioethics.Google Scholar
- Prainsack, B., A. Buyx, and Nuffield Council on Bioethics Staff. 2011. Solidarity: Reflections on an Emerging Concept in Bioethics. London: Nuffield Council on Bioethics.Google Scholar
- Rajabi, Fateme, Hamid Esmailzadeh, Narges Rostamigooran, and Reza Majdzadeh. 2013. What must be the Pillars of Iran’s Health System in 2025? Values and Principles of Health System Reform Plan. Iranian Journal of Public Health 42 (2): 197.Google Scholar
- Shickle, Darren, Erica Richardson, Fiona Day, Christian Munthe, Albert Jovell, Heta Gylling, Rein Vos, Tuija Takala, Carlo Petrini, and Gaetano Torlone. 2006. Public Policies, Law and Bioethics: A Framework for Producing Public Health Policy Across the European Union. EuroPHEN: European Public Health Ethics Network. http://eprints.whiterose.ac.uk/100247/1/EuroPHENfullreport_libre.pdf
- Swain, G. R., K. A. Burns, and P. Etkind. 2008. Preparedness: Medical Ethics Versus Public Health Ethics. Journal of Public Health Management and Practice 14 (4): 354–357. https://doi.org/10.1097/01.phh.0000324563.87780.67.CrossRefGoogle Scholar
- Tiong, Wei Wei, and Gerald C.H. Koh. 2013. Ethical Considerations in the Review of Singapore’s H1N1 Pandemic Response Framework in 2009. Annals of the Academy of Medicine, Singapore 42 (5): 246–250.Google Scholar
- Torda, Adrienne. 2006. Ethical Issues in Pandemic Planning. Medical Journal of Australia 185 (10): S73.Google Scholar
- Upshur, Ross E.G. 2002. Principles for the Justification of Public Health Intervention. Canadian Journal of Public Health/Revue Canadienne de Sante’e Publique 93: 101–103.Google Scholar
- Wilcox, David. 1994. Community Participation and Empowerment: Putting Theory into Practice. London: RRA Notes.Google Scholar