By Stephanie Massot, Health Nexus
This is the second blog post in a series on public health ethics. This post focuses on differentiating between bioethics, public health ethics, and health promotion ethics.
Perhaps you have been entering in some Socrates-type conversations since reading ‘Public Health Ethics Part 1 of 3: Does Your Philosophical Orientation Matter?’ and now you are feeling ready for some practical ethical frameworks to work through some health-related ethical questions, such as ‘do I prioritize autonomy or community for my program?’ or ‘is my policy paternalistic?’ Just before we start driving down the road of applying ethical frameworks, we need to take a quick pit stop and make sure we are all on the same map and heading in a similar direction as far as how we define different health-related ethics.
Not only are there many definitions for public health and health promotion, but now you may feel as though you are in the weeds trying to differentiate between bioethics, public health ethics, and health promotion ethics. You may not emerge from your rabbit hole of research for days. So why might it be important to spend the time getting to know the difference between these three types of ethics?
Unearthing the origins of words or concepts helps us to appreciate their impact on the present context. For instance, the word ‘gypped’ (often spelled incorrectly as jipped) is still used by folk to refer to instances where they have felt cheated out of something because they do not know that it has a negative connation. It is derived from the word ‘gypsy’ and portrays Romani people in an offensive manner. As a student, I wish I had spent more time tracing the roots of some of my most often referenced journal articles – what was the background of the author? Did their country’s politics impact their writing? Was the methodology of the study strong? Was the sample size robust?
Through the guidance of Dr. Ross Upshur, I did get an opportunity to delve into why there are differences between bioethics, public health ethics, and health promotion ethics. What I came away with is that it really comes down to values.
Public health ethics only became a distinct area in the late 1990s. Prior to this time, Bioethics (considered synonymous with health care ethics) was considered an acceptable theoretical base for ethical issues faced by public health practitioners. Why as members of a public health network (mentioned in Part 1 of this blog series) would it matter what base you are using to discern ethical issues in your field? This table will help you distinguish between different types of health-related ethics:
* Reference: MacDonald, M. (2014). Introduction to Public Health Ethics: Background. Montréal, Québec: National Collaborating Centre for Healthy Public Policy.
** Carter, S., Cribb, A. & Allegrante, J. (2012). How to think about health promotion ethics. Public Health Reviews, 34(1), 1-24.
Check out this short public service announcement on obesity and use each of the different ethical approaches above to see what you perceive as an issue or non-issue. Which of the three health-related ethics comes closest to serving as the basis for the video you just watched? If you are thinking health care ethics, than we are heading in the same direction.
A campaign by the Covenant House called ‘why can’t street kids just get a life?’ takes a more public health ethics approach because it informs the general population in a public spaces, such as the subway, and includes values such as social justice and solidarity in the questions being asked. How could this campaign be changed if a health promotion ethics lens were applied in its creation? It is important to understand the ethical approach that you and your organization take, because whether you know it or not, your approach drives everything you do (e.g. policies, programs, marketing messages), much like your philosophical orientation. ‘Ethical Dilemmas in Health Promotion Practice’ can help you dive deeper into analyzing issues you may be observing in your work.
Although ethical questions such as ‘what is a good society?’ or ‘what should health promotion contribute to a good society?’ can seem daunting, engaging in ethical reflexivity to question our own assumptions can help us to uncover unintended consequences from well-intended health practices. Stay tuned for practical ethical frameworks to apply to your work in health!