Health Promotion and Ethics

1. Health Promotion and Ethics

2. What ought we to be doing? What actions are right or wrong? A clear definition of health might be useful NHS 's aim might be thought to do with health care provision Need a clear definition of health to assess this To distinguish health care from social care

3. Philosophical reasons for wanting an account of health Philosophers love clarity How is health related to disease and illness? Is somebody healthy a factual question? Are you healthy or not depend on your decision, feelings, desires? Is it for society to decide as a whole what constitutes health?

4. The issue of what health is, has vital ethical implications Question might not be, but the answer very likely to be “Health is a good thing, which ought to be promoted” Actions taken by health care workers that promote health are morally good actions

5. Health definitions - WHO "Health is a state of complete physical, mental and social well-being and not merely the absence of disease;" Confusion of health and welfare Is anyone healthy? Motivational reasons

6. Health definitions - Seedhouse 'A person's health is equivalent to the state of the set of conditions which fulfil or enable a person to work to fulfil his or her realistic chosen and biological potentials'. Personal involvement to shape health Different people talk about different things as being healthy Contributor factors which go towards a person's well being

7. Health definitions - Illich 'Health is a task, and as such is not comparable to physiological balance of the beasts…Success is in large part the result of self-awareness, self-discipline and inner resources'. Focus on the individual Health under personal control/responsibility Health clearly more than absence of disease

8. Healthy or not? A 6 year old with measles A 42 year old business woman with malaria A 28 year old who has been trying to conceive for six years A 19 year old with a fractured hip

9. Healthy or not? A 22 year old suffering from morning sickness during pregnancy A 52 year old male, a diabetic since childhood, who complains of erectile dysfunction A 25 year old carrier of the sickle cell gene A 25 year old carrier of the Huntingdon's gene

10. The Ethical GridSeedhouse, David. (1998). Ethics: The Heart of Health Care

12. Individual Health Bioethics = human rights, civil liberties and individual autonomy approach medicalized system Population Health Public health = utilitarian, paternalistic, social responsibility, communitarian orientation

13. Moral imperative of health promotion to ensure and protect the health of the population and the individual Ethical foundations traditionally implicit in health promotion The right to health? Renewed awareness of conflict between individual rights and community rights Effects of doing or not doing health interventions or “best practices”

14. When and when not to act Judgment, experience, evidence, ethics Experience of Good Public Health Practice Threat of preventable mortality or risk factor When dangers/costs of not acting exceed those of acting Public right to know Public right to protection Individual rights Balance Accountability, transparency

15. Many issues of conflict between good of the individual and good of society Immunization, chlorination, fluoridation HIV/AIDs, MDRTB Aging and chronic diseases Human Genome Project Genetically modified foods Technology and resource allocation

16. Does society’s responsibilities = paternalism? Does freedom of individual = hostility to the state in all it’s manifestations? Do we need informed consent for all interventions? Do individual rights over-ride social responsibility? E.g. AIDS contact tracing? The “Precautionary principle” = must prove zero risk of intervention? Equity in health? Adequate funding and its allocation

17. Old-New Battles UK Variolists oppose vaccination vs. smallpox C19th US Opposition to public health departments in 1920s UK GPs oppose immunization with pertussis (1980s) and MMR (2002) AMA opposes to national health insurance 1920s to present Civil rights vs HIV control, 1980s US Anti-fluoridationism 1950s to present Anti-food fortification in Europe Anti-genetic engineering of food in Europe

18. Responsibility to protect society Responsibility to the individual Individual vs community rights Government responsibility Corporate responsibility Right to health care Personal responsibility - self care Quality of care Freedom of choice

19. Government obligation to protect health of the population Power of government to legislate, tax, spend, regulate, punish Restriction of personal liberties e.g. seat belt laws or smoking restrictions vs. human rights Economic and social impact of intervention vs. non-intervention Laws enacted by legislative bodies and court decisions

20. Individual Personal hygiene Immunization Right to health care Self care Choice of provider Right to know Confidentiality Privacy Informed consent Community Sanitation Herd immunity Universal access Education Gatekeeper function Mandatory reporting Case follow-up Resources for health Cost containment Equity Minority and special groups High risk groups

21. Kahan & Goodstadt (Best Practices in Health Promotion Workbook)