Public Health Ethics

⛑️Public Health Ethics Unit 8 – Global Health Ethics & Policy

Global health ethics and policy address complex challenges in promoting health equity worldwide. This field examines key principles like autonomy, beneficence, and justice, while considering historical context and power dynamics that shape global health inequities. Ethical frameworks guide decision-making in public health interventions, resource allocation, and policy development. The field grapples with issues like cultural relativism, sustainability, and emerging technologies, striving to balance individual rights with collective well-being in an interconnected world.

Key Concepts in Global Health Ethics

  • Autonomy involves respecting individuals' right to make informed decisions about their health and well-being
    • Includes the right to refuse treatment or participate in research
    • Requires providing adequate information and ensuring comprehension
  • Beneficence obligates healthcare providers and policymakers to act in the best interest of individuals and populations
    • Involves promoting health, preventing harm, and maximizing benefits
    • Requires considering both short-term and long-term consequences
  • Non-maleficence is the principle of "do no harm" in healthcare and public health interventions
    • Involves minimizing risks and avoiding unintended negative consequences
    • Requires careful assessment of potential harms and benefits
  • Justice encompasses fair distribution of health resources and opportunities
    • Includes ensuring equitable access to healthcare and addressing social determinants of health
    • Involves considering the needs of vulnerable and marginalized populations
  • Cultural competence is the ability to provide healthcare and implement policies in a manner that respects diverse beliefs, values, and practices
    • Requires understanding and adapting to cultural differences
    • Involves engaging communities and incorporating local knowledge and perspectives
  • Global health diplomacy refers to the use of diplomacy to advance global health goals and foster international cooperation
    • Involves negotiating agreements, mobilizing resources, and building partnerships
    • Requires balancing national interests with global health priorities
  • Solidarity is the recognition of our shared humanity and the commitment to collective action to address global health challenges
    • Involves supporting and empowering communities to improve their health
    • Requires addressing the root causes of health inequities and promoting social justice

Historical Context of Global Health Policy

  • Colonialism and imperialism have shaped global health inequities and power dynamics
    • Involved the exploitation of resources and labor in colonized regions
    • Led to the introduction of infectious diseases and disruption of traditional health systems
  • The World Health Organization (WHO) was established in 1948 as the leading international health agency
    • Aims to promote health, prevent disease, and respond to health emergencies
    • Provides technical assistance, sets global health standards, and coordinates international health efforts
  • The Alma-Ata Declaration of 1978 affirmed health as a fundamental human right and emphasized the importance of primary healthcare
    • Called for community participation, intersectoral collaboration, and equitable access to healthcare
    • Influenced the development of community-based health programs and health system strengthening efforts
  • The HIV/AIDS pandemic in the 1980s and 1990s highlighted global health inequities and the need for international cooperation
    • Disproportionately affected marginalized populations and low- and middle-income countries
    • Led to the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria and other global health initiatives
  • The Millennium Development Goals (MDGs) were adopted in 2000 to address global poverty and health challenges
    • Included targets for reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria, and other diseases
    • Achieved significant progress but fell short of some goals and faced criticism for top-down approach and lack of accountability
  • The Sustainable Development Goals (SDGs) were adopted in 2015 as a more comprehensive and inclusive framework for global development
    • Includes 17 goals and 169 targets across social, economic, and environmental dimensions
    • Emphasizes the interconnectedness of health with other sectors and the need for multi-stakeholder partnerships

Ethical Frameworks in Public Health

  • Utilitarianism seeks to maximize overall welfare and minimize suffering for the greatest number of people
    • Involves weighing the costs and benefits of public health interventions
    • May justify infringing on individual rights for the greater good
  • Deontology emphasizes the inherent rightness or wrongness of actions based on moral rules or duties
    • Holds that certain actions (lying, breaking promises) are inherently wrong regardless of consequences
    • Prioritizes individual rights and autonomy over collective welfare
  • Virtue ethics focuses on cultivating moral character and virtues (compassion, integrity) in individuals and institutions
    • Emphasizes the importance of moral reasoning and practical wisdom in decision-making
    • Requires considering the context and relationships involved in public health practice
  • Principlism is a framework that balances four key ethical principles: autonomy, beneficence, non-maleficence, and justice
    • Provides a structured approach for analyzing and resolving ethical dilemmas
    • Requires weighing and balancing competing principles based on the specific context
  • Casuistry is a case-based approach that draws on analogies and precedents to guide ethical decision-making
    • Involves comparing the current situation to similar cases and applying relevant moral principles
    • Allows for flexibility and adaptation to unique circumstances
  • Feminist ethics emphasizes the importance of relationships, care, and empowerment in moral reasoning
    • Challenges traditional notions of impartiality and universality in ethics
    • Highlights the gendered dimensions of health and the need for inclusive and participatory approaches
  • Capability approach focuses on expanding individuals' freedoms and opportunities to live a life they have reason to value
    • Considers health as a key capability that enables individuals to pursue their goals and well-being
    • Requires addressing social, economic, and political factors that limit health capabilities

Global Health Inequities and Social Justice

  • Health disparities refer to differences in health outcomes and access to healthcare across populations
    • Can be based on factors such as income, race, ethnicity, gender, and geographic location
    • Reflect systemic inequities and social determinants of health
  • Social determinants of health are the conditions in which people are born, grow, live, work, and age that shape health outcomes
    • Include factors such as education, employment, housing, and social support networks
    • Require addressing upstream factors and promoting health equity
  • Health equity is the absence of unfair and avoidable differences in health across populations
    • Involves ensuring that everyone has a fair opportunity to attain their full health potential
    • Requires addressing social, economic, and political inequities that drive health disparities
  • Social justice is the fair and equitable distribution of resources, opportunities, and burdens in society
    • Involves challenging power imbalances and promoting the rights and well-being of marginalized populations
    • Requires addressing the root causes of health inequities and promoting systemic change
  • Structural violence refers to the ways in which social, economic, and political structures harm individuals and communities
    • Includes policies and practices that perpetuate poverty, discrimination, and marginalization
    • Requires addressing the underlying power dynamics and promoting social change
  • Global health governance involves the institutions, processes, and actors that shape global health policies and practices
    • Includes international organizations, governments, civil society, and the private sector
    • Requires inclusive and accountable decision-making processes that prioritize health equity and social justice
  • Decolonizing global health involves challenging the legacies of colonialism and imperialism in global health research and practice
    • Requires shifting power and resources to local communities and institutions
    • Involves valuing indigenous knowledge and promoting community-led approaches to health

International Health Organizations and Governance

  • The World Health Organization (WHO) is the leading international health agency within the United Nations system
    • Sets global health standards, provides technical assistance, and coordinates international health efforts
    • Governed by the World Health Assembly, which includes representatives from all member states
  • The United Nations Children's Fund (UNICEF) focuses on promoting the rights and well-being of children worldwide
    • Provides healthcare, nutrition, education, and protection services to children in need
    • Works with governments and partners to strengthen health systems and promote child-friendly policies
  • The Global Fund to Fight AIDS, Tuberculosis and Malaria is a partnership organization that mobilizes and invests resources to support countries in combating these diseases
    • Operates as a financing mechanism that channels funds to local programs and initiatives
    • Governed by a board that includes representatives from donor and implementing countries, civil society, and affected communities
  • The GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization) is a public-private partnership that aims to increase access to vaccines in low-income countries
    • Provides funding and support for vaccine procurement, delivery, and health system strengthening
    • Governed by a board that includes representatives from donor and implementing countries, civil society, and the private sector
  • The World Bank is an international financial institution that provides loans, grants, and technical assistance to support development efforts in low- and middle-income countries
    • Includes health as a key priority area and supports health system strengthening and disease control efforts
    • Governed by a board of governors that includes representatives from member countries
  • Civil society organizations (CSOs) play a critical role in global health governance and advocacy
    • Include non-governmental organizations, community-based organizations, and advocacy groups
    • Provide services, mobilize communities, and hold governments and international organizations accountable
  • Global health treaties and agreements are legal instruments that establish international norms and standards for health
    • Include the Framework Convention on Tobacco Control and the International Health Regulations
    • Require ratification and implementation by member states to be effective

Ethical Challenges in Global Health Interventions

  • Resource allocation involves deciding how to distribute limited health resources across populations and interventions
    • Requires considering factors such as cost-effectiveness, equity, and urgency of need
    • May involve difficult trade-offs between individual and population-level benefits
  • Informed consent is the process of obtaining voluntary agreement from individuals to participate in research or receive medical treatment
    • Requires providing adequate information, ensuring comprehension, and respecting individual autonomy
    • Can be challenging in contexts with low literacy, language barriers, or power imbalances
  • Cultural relativism is the view that moral beliefs and practices are relative to cultural context and should be respected
    • Challenges the universality of ethical principles and the imposition of Western values
    • Requires balancing respect for cultural diversity with the promotion of fundamental human rights
  • Unintended consequences are the negative or harmful effects that may result from well-intentioned global health interventions
    • Can include disrupting local health systems, exacerbating inequities, or creating dependency on external aid
    • Require careful planning, monitoring, and adaptation to mitigate potential harms
  • Sustainability refers to the ability of global health interventions to maintain their benefits over time
    • Involves building local capacity, ownership, and resources to support long-term impact
    • Requires addressing the underlying social, economic, and political determinants of health
  • Accountability involves ensuring that global health actors are responsible for their actions and responsive to the needs and priorities of affected communities
    • Requires transparent and participatory decision-making processes, monitoring and evaluation, and mechanisms for redress
    • Can be challenging in contexts with weak governance, corruption, or limited civil society engagement
  • Dual loyalty refers to the conflicting obligations that healthcare providers may face between their patients and their employers, funders, or governments
    • Can arise in situations where public health goals or resource constraints conflict with individual patient needs
    • Requires clear ethical guidelines and support for healthcare providers to navigate these tensions

Policy Development and Implementation

  • Evidence-based policymaking involves using the best available scientific evidence to inform policy decisions
    • Requires synthesizing and translating research findings into actionable recommendations
    • Can be challenging in contexts with limited data, political constraints, or competing priorities
  • Stakeholder engagement involves actively involving affected communities, civil society, and other relevant actors in the policy development process
    • Requires creating inclusive and participatory mechanisms for input and feedback
    • Can help ensure that policies are responsive to local needs and priorities
  • Health impact assessment is a tool for evaluating the potential health effects of policies, programs, and projects
    • Involves systematically assessing the direct and indirect health impacts across populations and sectors
    • Can help identify and mitigate potential negative health consequences of non-health policies
  • Policy coherence refers to the alignment and coordination of policies across sectors and levels of government to promote health and well-being
    • Requires breaking down silos and promoting intersectoral collaboration
    • Can help address the social determinants of health and promote health in all policies
  • Implementation science is the study of methods and strategies to promote the uptake and effective implementation of evidence-based interventions
    • Involves identifying and addressing barriers to implementation, such as resource constraints, cultural factors, and health system weaknesses
    • Can help bridge the gap between research and practice and improve the impact of global health interventions
  • Monitoring and evaluation are essential for assessing the effectiveness, efficiency, and equity of global health policies and programs
    • Involves collecting and analyzing data on inputs, outputs, outcomes, and impacts
    • Can help identify areas for improvement, inform resource allocation decisions, and promote accountability
  • Policy advocacy involves using evidence, persuasion, and mobilization to influence decision-makers and promote policy change
    • Requires building coalitions, framing issues, and creating political will for action
    • Can help advance health equity and social justice goals by challenging power imbalances and promoting policy reforms

Future Directions and Emerging Ethical Issues

  • Planetary health is an emerging field that recognizes the interdependence of human health and the health of the planet
    • Requires addressing the environmental and climate-related drivers of health, such as air pollution, deforestation, and biodiversity loss
    • Involves promoting sustainable and equitable development that benefits both people and the planet
  • Artificial intelligence (AI) and big data are transforming global health research and practice
    • Can help improve disease surveillance, diagnosis, and treatment through machine learning and predictive analytics
    • Raise ethical concerns around privacy, bias, and accountability in the use of health data
  • Gene editing technologies, such as CRISPR-Cas9, have the potential to prevent and treat genetic diseases
    • Raise ethical questions around the safety, accessibility, and societal implications of genetic interventions
    • Require robust governance frameworks and public engagement to ensure responsible development and use
  • Pandemic preparedness and response have taken on new urgency in the wake of the COVID-19 pandemic
    • Require strengthening global health security, investing in disease surveillance and response capacities, and ensuring equitable access to vaccines and treatments
    • Raise ethical challenges around resource allocation, individual liberties, and global solidarity in the face of a shared threat
  • Migration and displacement are increasingly recognized as global health challenges
    • Can exacerbate health vulnerabilities and inequities, particularly for refugees, asylum seekers, and migrant workers
    • Require addressing the social, economic, and political drivers of migration and ensuring access to healthcare and social services for displaced populations
  • Mental health is a growing priority in global health, with increasing recognition of the burden of mental disorders and the need for integrated care
    • Requires addressing the social and structural determinants of mental health, such as poverty, discrimination, and violence
    • Involves promoting mental health literacy, reducing stigma, and increasing access to quality mental health services
  • Decolonizing global health research and practice involves challenging the power imbalances and inequities that have shaped the field
    • Requires shifting decision-making power and resources to local communities and institutions
    • Involves valuing diverse forms of knowledge, promoting community-led approaches, and addressing the legacies of colonialism and racism in global health


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© 2024 Fiveable Inc. All rights reserved.
AP® and SAT® are trademarks registered by the College Board, which is not affiliated with, and does not endorse this website.