Medicine and Public Health, Ethics and Human Rights

1. Medicine and Public Health,Ethics and Human Rights Jonathan Mann

2. Medicine and Public Health • Medicine and public health are complementary and interacting approaches to protecting and enhancing health. • The World Health Organization defines health as physical, mental and social well-being. • Both medicine and public health have share a similar goal, that is, to protect and improve the health of human beings. • However, their approach is different.

3. Medicine and Public Health • (1) Public health concerns populations and medicine concerns individuals. • (2) The settings of medicine and public health are different. • (3) the relationship between the health providers and clients are different.

4. Population vs. Individual Skill Set • Public health focuses on prevention against diseases and other large-scale health problems that affect large populations. • Public health concerns populations and thus requires knowledge of sociology, economics, statistics, epidemiology, policy analysis and other behavior sciences. • Medicine focuses on actual illness of people and thus is more responsive than preventive. • Medicine concerns individuals so the skill set necessary is more focused on biology biochemistry, immunology, pharmacology, pathology, pathophysiology, anatomy and psychology.

5. Settings • Public health takes place in governmental organizations, large-scale public programs and within institutions responsible for implementing public policy. • Medicine takes place in private doctor’s offices, private clinics, and and medical care facilities.

6. Relationship • Public Health comes to you and it services a large number of people, a population. • In medicine, you go to the doctor and the doctor treats you on an individual basis.

7. Public Health • We know that there are some social behaviors that have serious consequences for the health of populations. • For instance, we know that cigarette smoking, lack of physical exercise, bad dietary habits and excessive alcohol have a negative effect on the people’s health. • Public health notes that societal factors and context are primarily responsible for these negative influences.

8. Public Health • Public health programs seem to assume that people have complete control of their lives and that they are only required to provide information and education. • Education about the risk associated with social habits that engender poor health is an indirect way of dealing with the issue. • However, most people know that cigarette smoking is bad for their health and yet many continue to smoke. Thus it seems that information is not enough.

9. Why has Public Health not Dealt Directly with Social Problems? • (1) Public Health lacks a conceptual framework for identifying and analyzing the essential societal factors that represent the “conditions in which people can be healthy.” (What is the problem?) • (2) Public health lacks a vocabulary to articulate these public health issues and problems. (What are we talking about?) • (3) There is no consensus about the nature or direction of societal change that would be necessary to address the societal conditions involved. (Where do we go from here?)

10. Public Health and Language • It is interesting that Mann argues that the central problem with public health and its inability to deal with the central problems affecting the public’s health is the result of a lack of language: a lack of a conceptual framework that would allow us to think and reflect on the issues, a lack of vocabulary that would allow as to talk and discuss the issue, and no plan, course of action or alternative life style to offer people.

11. Medicine • Medicine does have a conceptual framework to deal with medical issues (individual relationships) and that is ethics. • Because the nature of ethics fits well with the nature, setting and relationship of medical care, it can be easily adopted, and the vocabulary of ethics can be used to articulate what ought to be the case in medical care.

12. Why not the Language of Ethics? • The central problem for public health is that it deals with community’s health and well being; and, the language of ethics, which deals with what is right or wrong for individual actions, cannot properly handle questions of public policy.

13. Modern Human Rights • Mann argues that the values and language associated with human rights provides a better suited conceptual framework and vocabulary to deal with public health issues. • The purpose of human rights is to establish the societal pre-conditions for human well-being.

14. Why Human Rights? • First, public health issues are addressed by the state and require state interference. • The question and concern for human rights provides a conceptual framework for this relationship. • We can say that the state has the responsibility to protect and promote public health and to protect and promote human rights.

15. Why Human Rights? • Inadvertent discrimination is a prevalent problem of public health. • Inadvertent discrimination occurs when governmental programs provide services or take action that unintentionally either exclude or have a negative consequence for a segment of the population. • A human rights framework provides us with the conceptual tools to recognize and address this situation.

16. Why Human Rights? • Public health concerns are inherently associated with human rights concerns in a confrontational nature. • For instance, mandatory testing, quarantines, and isolation usually creates clashes with human rights defenders.

17. Why Human Rights? • Violations of human rights are a prevalent cause of public health problems. • For instance, inhumane conditions, torture, right of association can all have important negative health impacts for large numbers of people within a community.

18. Why Human Rights? • Promoting and protecting human rights is inextricably linked to protecting and promoting public health. • That is, you cannot protect human rights without protecting public health. • Moreover, when you protect public health you are also protecting human rights. • Public health is a necessary condition for human rights. Human rights is a sufficient condition for the public’s health.

19. 2 Examples • Reproductive rights: these health issues have been associated with human rights, so that the violation of these health concerns have been identified as violations of human rights. • HIV/AIDS epidemic is now identified as a human rights issue, because of the risk level being associated with certain socio-economic classes of the population in various parts of the world.

20. Human Rights and Ethics • There are common core values that are shared between ethics and human rights. • For instance, both acknowledge the value of life, the value of privacy, the value of autonomy and so on. • However their approach, concepts, vocabularies are very different, because the issues they address manifest themselves differently.

21. Continuum/Map • Mann would like to see the relationship between the field of public health and medicine as a continuum; they are at the ends /extremes but there are degrees and they interact and have important relations. • Likewise, he argues that we should also think of the relationship between ethics and human rights as a continuum and as sharing underlying fundamental values. • Having a map will allow us to identify institutions, programs, and services on this map, along with the proper objectives, ends, goals and approaches of these entities.

22. Ethics in the Profession of Public Health • Every profession as a professional code of ethics. • For instance, doctors, attorneys, accountants, nurses, educators, etc. • Mann argues that the profession of public health providers lacks such a code.

23. Professional Code of Ethics for Public Health • What is needed? • (1) Public health profession needs coherence and identity. • They need to have a clear conception of the following: What are its central issues? What are its major responsibilities? What is its major role? • Mann argues that it has as much to do with “human dignity” (Declaration of Human Rights) as with medicine.

24. Professional Code of Ethics for Public Health • What is needed? • (2) Public health profession needsto adopt a human rights framework. • Issues of respect, beneficence, nonmaleficence, equality and justice should be part of the public health’s agenda, when considering disease and other health related issues.

25. Conclusion • It is the combination, then, of these broader human rights issues (dignity and justice) and concerns with the more technical medical issues (biology, biochemistry, immunology, pharmacology, pathology, anatomy, etc.) that provides for a coherent and comprehensive public health system.