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The Ethics of Ethics Reviews in Global Health Research: Case Studies Applying a New Paradigm

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Abstract

With increasing calls for global health research there is growing concern regarding the ethical challenges encountered by researchers from high-income countries (HICs) working in low or middle-income countries (LMICs). There is a dearth of literature on how to address these challenges in practice. In this article, we conduct a critical analysis of three case studies of research conducted in LMICs. We apply emerging ethical guidelines and principles specific to global health research and offer practical strategies that researchers ought to consider. We present case studies in which Canadian health professional students conducted a health promotion project in a community in Honduras; a research capacity-building program in South Africa, in which Canadian students also worked alongside LMIC partners; and a community-university partnered research capacity-building program in which Ecuadorean graduate students, some working alongside Canadian students, conducted community-based health research projects in Ecuadorean communities. We examine each case, identifying ethical issues that emerged and how new ethical paradigms being promoted could be concretely applied. We conclude that research ethics boards should focus not only on protecting individual integrity and human dignity in health studies but also on beneficence and non-maleficence at the community level, explicitly considering social justice issues and local capacity-building imperatives. We conclude that researchers from HICs interested in global health research must work with LMIC partners to implement collaborative processes for assuring ethical research that respects local knowledge, cultural factors, the social determination of health, community participation and partnership, and making social accountability a paramount concern.

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Notes

  1. The Inuit people are one of Canada’s First Nations, or indigenous peoples. In this article we use the terms “aboriginal”, “indigenous” and “First Nations” essentially interchangeably.

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Acknowledgments

The authors wish to thank Canadian, Honduran, South African and Ecuadorean colleagues, staff, students and communities who are participating with us in this undertaking. Funding/Support: Our work was funded in part through the Peter Wall Institute for Advanced Studies at the University of British Columbia who recognized Dr. Breilh as an International Visiting Research Scholar; Dr. Dharamsi via the Teaching and Learning Enhancement Fund to study the ethical implications of international engagement and service learning; the research capacity-building program in South Africa was funded by the Global Health Research Initiative in Canada (a collaboration of the Canadian Institutes for Health Research, the Canadian International Development Agency [CIDA], the International Development Research Centre, and Health Canada); the project in Ecuador was supported by CIDA; and the Canada Research Council provides salary support for Dr. Yassi.

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Authors and Affiliations

  1. School of Population and Public Health (SPPH) in the Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Annalee Yassi, Karen Lockhart & Jerry M. Spiegel

  2. Department of Health, University of Andina Simon Bolivar (UASB), Quito, Ecuador

    Jaime Breilh

  3. Department of Family Practice in the Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Shafik Dharamsi

  4. Liu Institute for Global Issues, University of British Columbia, Vancouver, Canada

    Shafik Dharamsi & Jerry M. Spiegel

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  1. Annalee Yassi
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  2. Jaime Breilh
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  4. Karen Lockhart
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Correspondence to Karen Lockhart.

Appendix 1. The 15 questions to be asked to assess research projects within the new ethical review board in Ecuador

Appendix 1. The 15 questions to be asked to assess research projects within the new ethical review board in Ecuador

Academia Ecuatoriana de Medicina

Research Ethics Committee

GUIDE TO ETHICS OF NON-EXPERIMENTAL RESEARCH PROJECT EVALUATION

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Yassi, A., Breilh, J., Dharamsi, S. et al. The Ethics of Ethics Reviews in Global Health Research: Case Studies Applying a New Paradigm. J Acad Ethics 11, 83–101 (2013). https://doi.org/10.1007/s10805-013-9182-y

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