How to Think about Health Promotion Ethics

Abstract

Health promotion ethics is moral deliberation about health promotion and its prac tice. Although academics and practitioners have been writing about ethics, and especially values, in health promotion for decades, health promotion ethics is now regaining attention within the broader literature on public health ethics. Health promotion is difficult to define, and this has implications for health promotion ethics. Health promotion can be approached in two complementary ways: as a normative ideal, and as a practice. We consider the normative ideal of health promotion to be that aspect of public health practice that is particularly concerned with the equity of social arrangements: it imagines that social arrangements can be altered to make things better for everyone, whatever their health risks, and seeks to achieve this in collaboration with citizens. This raises two main ethical questions. First: what is a good society? And then: what should health promotion contribute to a good society? The practice of health promotion varies widely. Discussion of its ethical implications has addressed four main issues: the potential for health promotion to limit or increase the freedom of individuals; health promotion as a source of collective benefit; the possibility that health promotion strategies might "blame the victim" or stigmatise those who are disabled, sick or at higher risk of disease; and the importance of distributing the benefits of health promotion fairly. Different people will make different moral evaluations on each of these issues in a way that is informed by, and informs, their vision of a good society and their understanding of the ends of health promotion. We conclude that future work in

Ethics and health promotion practice: exploring attitudes and practices in Western Australian health organisations

“…Ethics in the field of health promotion (referred to as 'ethics in practice' in this paper) encompasses both ethics approval as well as explicit consideration of ethical principles in day-to-day work. 6,[17][18][19][20] This research aimed to explore a range of attitudes, practices, enablers and barriers related to Western Australian health organisations, including the process of obtaining HREC approval and the publishing of findings.…”

Policy is political; our ideas about knowledge translation must be too

“…Furthermore, some (usually lower socio-economic status) groups tend to be characterised as deviant because they do not adopt behaviours to maximise their health; they become subjects for monitoring, including through research studies, and are helped to behave more ‘normally’ by health professionals 17. These groups can be stigmatised as being irresponsible or flawed and as a result can incur harms such as stress 15 21. Dominant economic interests, such as ways in which employing organisations might cause ill-health, receive less attention 13…”

“…Researchers are caught up in systems of knowledge and power: the ‘ seemingly obvious assumptions—atheoretical, simplistic, descriptive ’ (p. 981)14 adopted in research are an element of societal power and our dissemination of knowledge also has a socio-political effect. We should therefore be sensitive to the concepts in our fields and those underpinning policies, especially with respect to marginalised groups 15 17 21

With respect to knowledge translation itself there is a critical question to consider: why do we have such technocratic concepts as ‘knowledge translation’ and ‘evidence-based policy’ for what are essentially political processes; why are the political implications of this area of work obscured by our language?

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“…Researchers are caught up in systems of knowledge and power: the ‘ seemingly obvious assumptions—atheoretical, simplistic, descriptive ’ (p. 981)14 adopted in research are an element of societal power and our dissemination of knowledge also has a socio-political effect. We should therefore be sensitive to the concepts in our fields and those underpinning policies, especially with respect to marginalised groups 15 17 21…”

Editorial: Why a Theme Issue on Public Health Ethics?

“…24 Reverby discusses the infamous Tuskegee and Guatemala syphilis experiments which cast a pall over the US Public Health Service until the present time for experimentation on humans in the Tuskegee case without adequately informing participants of their disease status and denying them life saving treatment when it became available; and in the Guatemala case where researchers actually actively infected unknowing subjects. 25 Carter et al address issues of ethics in health promotion, 26 Coughlin et al consider scientifi c integrity in research in public health, 27 Teutsch and Rechel explore ethics of resource allocation in times of economic austerity, 28 Gray discusses issues of ethics of publication, 29 Edwards et al recount challenges of their experiences with ethical clearance in international health policy and social sciences research 30 and Aceijas argues the ethics of substitution therapy in harm reduction for drug addiction. 31 Legal and ethical issues of mandatory fl uoridation are highlighted by Zusman with Israel as a case study.…”