health promotion and ethics

8/6/2019 Health Promotion and Ethics

http://slidepdf.com/reader/full/health-promotion-and-ethics 1/22



What ought we to be doing?What ought we to be doing?

What actions are right or wrong?What actions are right or wrong?

A clear definition of health might beA clear definition of health might beusefuluseful

NHS 's aim might be thought to doNHS 's aim might be thought to dowith health care provisionwith health care provision

Need a clear definition of health toNeed a clear definition of health toassess thisassess this

To distinguish health care from socialTo distinguish health care from social

carecare



Philosophical reasons for wantingPhilosophical reasons for wanting

an account of healthan account of health

Philosophers love clarityPhilosophers love clarity

How is health related to diseaseHow is health related to diseaseand illness?and illness?

Is somebody healthy a factualIs somebody healthy a factualquestion?question?

Are you healthy or not depend onAre you healthy or not depend onyour decision, feelings, desires?your decision, feelings, desires?

Is it for society to decide as a wholeIs it for society to decide as a whole

what constitutes health?what constitutes health?



The issue of what health is, hasThe issue of what health is, hasvital ethical implicationsvital ethical implications

Question might not be, but theQuestion might not be, but theanswer very likely to beanswer very likely to be

³Health is a good thing, which ³Health is a good thing, whichought to be promoted´ ought to be promoted´

Actions taken by health careActions taken by health careworkers that promote health areworkers that promote health aremorally good actionsmorally good actions



Health definitionsHealth definitions -- WHOWHO

"Health is a state of complete"Health is a state of complete physical, mental and social well physical, mental and social well--

being and not merely the absencebeing and not merely the absenceof disease;" of disease;"

Confusion of health and welfareConfusion of health and welfare

Is anyone healthy?Is anyone healthy?

Motivational reasonsMotivational reasons



Health definitionsHealth definitions -- SeedhouseSeedhouse'A person's health is equivalent to the'A person's health is equivalent to thestate of the set of conditions which fulfilstate of the set of conditions which fulfilor enable a person to work to fulfil his oror enable a person to work to fulfil his or

her realistic chosen and biologicalher realistic chosen and biologicalpotentials'.potentials'.

Personal involvement to shape healthPersonal involvement to shape health

Different people talk about differentDifferent people talk about differentthings as being healthythings as being healthy

Contributor factors which go towards aContributor factors which go towards a

person's well beingperson's well being



Health definitionsHealth definitions -- IllichIllich

'Health is a task, and as such is not'Health is a task, and as such is notcomparable to physiological balance of thecomparable to physiological balance of thebeasts«Success is in large part the resultbeasts«Success is in large part the result

of self of self--awareness, self awareness, self--discipline and innerdiscipline and innerresources'.resources'.

Focus on the individualFocus on the individualHealth under personalHealth under personalcontrol/responsibilitycontrol/responsibility

Health clearly more than absence of Health clearly more than absence of

diseasedisease



Healthy or not?Healthy or not?

±± A 6 year old with measlesA 6 year old with measles

±± A 42 year old business woman withA 42 year old business woman withmalariamalaria

±± A 28 year old who has been trying toA 28 year old who has been trying to

conceive for six yearsconceive for six years

±± A 19 year old with a fractured hipA 19 year old with a fractured hip



Healthy or not?Healthy or not?

±± A 22 year old suffering from morningA 22 year old suffering from morningsickness during pregnancysickness during pregnancy

±± A 52 year old male, a diabetic sinceA 52 year old male, a diabetic sincechildhood, who complains of erectilechildhood, who complains of erectiledysfunctiondysfunction

±± A 25 year old carrier of the sickle cellA 25 year old carrier of the sickle cellgenegene

±± A 25 year old carrier of theA 25 year old carrier of the

Huntingdon's geneHuntingdon's gene



Blue Layer:Blue Layer:Health care purposesHealth care purposes

Red Layer:Red Layer:Duties & motivesDuties & motives

Green Layer:Green Layer:Consequences & prioritiesConsequences & prioritiesre. proposed outcomesre. proposed outcomes

Black LayerBlack Layer::External environment;External environment;practical considerationspractical considerations

The Ethical Grid The Ethical Grid

Seedhouse, David. (1998).Seedhouse, David. (1998). Ethics: The Heart of HealthEthics: The Heart of Health

CareCare



Internal & external environments

(social, political & economic structures & systems;

psychological and physical conditions)

The roles of v alues. ethics & ev idence in health promotion practice

(Using the Interactiv e Domain Model of Best Practices in Hea lth Promotion)

(Barbara Kahan & Michael Goodstadt, 2001)

HP Evidence

Which issues?

What methodology?

How used?

Whodecides?Underpinnings of BP

in HP

HP Understanding of

Environment

HP Values

HP E THICS

Values-based

decision-making

HP GOALS

HP Best Practices



I ndividual HealthI ndividual Health

Bioethics =Bioethics =

human rights,human rights,

civil libertiescivil liberties

and individualand individual

autonomyautonomyapproachapproachmedicalized systemmedicalized system

Population HealthPopulation Health

Public health =Public health =utilitarian,utilitarian,paternalistic,paternalistic,

socialsocial

responsibility,responsibility,communitariancommunitarianorientationorientation



Moral imperative of health promotion toMoral imperative of health promotion toensure and protect the health of theensure and protect the health of thepopulation and the individualpopulation and the individual

Ethical foundations traditionally implicitEthical foundations traditionally implicitin health promotionin health promotionThe right to health?The right to health?Renewed awareness of conflict betweenRenewed awareness of conflict between

individual rights and community rightsindividual rights and community rightsEffects of doing or not doing healthEffects of doing or not doing healthinterventions or ³best practices´ interventions or ³best practices´



When and when not to actWhen and when not to act

Judgment, experience, evidence, ethicsJudgment, experience, evidence, ethicsExperience of Good Public Health PracticeExperience of Good Public Health PracticeThreat of preventable mortality or riskThreat of preventable mortality or risk

factorfactorWhen dangers/costs of not acting exceedWhen dangers/costs of not acting exceedthose of actingthose of actingPublic right to knowPublic right to knowP

ublic right to protectionP

ublic right to protectionIndividual rightsIndividual rightsBalanceBalanceAccountability, transparencyAccountability, transparency



Many issues of conflict between goodMany issues of conflict between goodof the individual and good of societyof the individual and good of society

Immunization, chlorination,Immunization, chlorination,fluoridationfluoridation

HIV/AIDs, MDRTBHIV/AIDs, MDRTB

Aging and chronic diseasesAging and chronic diseases

Human Genome ProjectHuman Genome ProjectGenetically modified foodsGenetically modified foods

Technology and resource allocationTechnology and resource allocation



Does society¶s responsibilities =Does society¶s responsibilities =paternalism?paternalism?Does freedom of individual = hostilityDoes freedom of individual = hostility

to the state in all it¶s manifestations?to the state in all it¶s manifestations?Do we need informed consent for allDo we need informed consent for allinterventions?interventions?Do individual rights overDo individual rights over--ride socialride social

responsibility? E.g. AIDS contactresponsibility? E.g. AIDS contacttracing?tracing?The ³Precautionary principle´ = mustThe ³Precautionary principle´ = mustprove zero risk of intervention?prove zero risk of intervention?

Equity in health?Equity in health?A e ate f n in an its all cati nA e ate f n in an its all cati n



OldOld--New BattlesNew Battles

UK Variolists oppose vaccination vs. smallpoxUK Variolists oppose vaccination vs. smallpoxC19C19thth

US Opposition to public health departments inUS Opposition to public health departments in

1920s1920sUK GPs oppose immunization with pertussisUK GPs oppose immunization with pertussis(1980s) and MMR (2002)(1980s) and MMR (2002)

AMA opposes to national health insuranceAMA opposes to national health insurance1920s to present1920s to present

Civil rights vs HIV control, 1980s USCivil rights vs HIV control, 1980s US

AntiAnti--fluoridationism 1950s to presentfluoridationism 1950s to present

AntiAnti--food fortification in Europefood fortification in Europe

AntiAnti--genetic engineering of food in Europegenetic engineering of food in Europe



Responsibility to protect societyResponsibility to protect society

Responsibility to the individualResponsibility to the individual

Individual vs community rightsIndividual vs community rightsGovernment responsibilityGovernment responsibility

Corporate responsibilityCorporate responsibility

Right to health careRight to health care

Personal responsibilityPersonal responsibility -- self careself care

Quality of careQuality of care

Freedom of choiceFreedom of choice



IndividualIndividual

Personal hygienePersonal hygiene

ImmunizationImmunization

Right to health careRight to health care

Self careSelf care

Choice of providerChoice of providerRight to knowRight to know

ConfidentialityConfidentiality

PrivacyPrivacy

Informed consentInformed consent

CommunityCommunity

SanitationSanitationHerd immunityHerd immunity

Universal accessUniversal access

EducationEducation

Gatekeeper functionGatekeeper functionMandatory reportingMandatory reporting

Case followCase follow--upup

Resources for healthResources for health

Cost containmentCost containmentEquityEquity

Minority and specialMinority and specialgroupsgroups

High risk groupsHigh risk groups



VALUESVALUES1.1. social justice:social justice:

equity re. the fairequity re. the fairdistribution of distribution of resources; respectresources; respectfor diversityfor diversity

2.2. power sharing:power sharing:empowerment;empowerment;

participationparticipation3.3. health:health: optimaloptimalhealth for allhealth for all, holistic, holistichealthhealth

4.4. the environment:the environment:ecological respect & ecological respect & sensitivitysensitivity

5.5. enrichment of enrichment of individual andindividual andcommunity lifecommunity life::authenticity;authenticity;creativity; criticalcreativity; criticalreflection; joy;reflection; joy;meaningfulness;meaningfulness;

social connectednesssocial connectedness6.6. othersothers

GOALSGOALSto increase overallto increase overall

levels of:levels of:1.1. social justicesocial justice2.2. power sharingpower sharing

3.3. ecological respect & ecological respect & sensitivitysensitivity

4.4. enriched individualenriched individual

and community lifeand community life5.5. health and wellhealth and well--being of being of communities andcommunities andindividualsindividuals

6.6. othersothers

ETHICAL PRINCIPLESETHICAL PRINCIPLES1.1. aim to benefit ratheraim to benefit rather

than harmthan harm2.2. put principles aboveput principles above

self self--interestinterest

3.3. think of thethink of theconsequences of anyconsequences of anyactionaction

4.4. have an explicithave an explicitdecisiondecision--makingmakingstrategy for conflictstrategy for conflictresolutionresolution

5.5. recognize & deal withrecognize & deal withcompeting ethicalcompeting ethicalconsiderationsconsiderations

6.6. consider whether anconsider whether anaction is the best oneaction is the best one7.7. othersothers

Kahan & GoodstadtKahan & Goodstadt

(Best Practices in Health Promotion Workbook)(Best Practices in Health Promotion Workbook)

health promotion and ethics

Documents