The Ethical Commitments of Health Promotion Practitioners: An Empirical Study from New South Wales, Australia

Abstract

In this article, we provide a description of the good in health promotion. This description comes from an empirical study of health promotion practices in New South Wales, the most populous state in Australia. Through analysis of interviews and observations, we found that practitioners were unified by a vision of the good in health promotion that had substantive and procedural dimensions. Substantively, the good in health promotion was teleological: the good inhered in meliorism, an intention to promote health, which was understood holistically and situated in places and environments, a commitment to primary rather than secondary prevention, and engagement with communities more than individuals. Procedurally, the good in health promotion arose from qualities of practices: that they developed over time in respectful relationships, were flexible and responsive to communities, built capabilities in communities, and were sustainable. We discuss our findings with reference to Martha Nussbaum's normative list of functional capabilities for a good human life, David Buchanan's vision for health promotion ethics, and common concerns in health promotion ethics regarding the relationship between paternalism and freedom. Our thick, vague conception of the good in health promotion, founded in the values and practical reason of people engaged daily in health promotion work, makes an important contribution to the development of a more complete theory of health promotion ethics.

Community pharmacy as a setting for public health nutrition action: Australian nutritionists’ perspectives

“…The present study highlights, as others have, that practitioners are familiar with the complexities and challenges of settings-based PHN actions (30) . The PHN perspective was assumed to prioritize best-practice maternal and infant nutrition and was explored to provide a 'PHN' perspective of the CP setting.…”

“…Participants considered both evidence-based and ethical values in identifying potential opportunities, scope and feasibility of PHN action in CP. Carter et al discussed the need for a framework for health promotion practice which incorporates an iterative approach to decision making that incorporates a 'both-and' process -valuing both evidence as well as also considering adequately ethics and values at the same time (30,40) . A purely evidencebased decision-making approach largely neglects the political and social context within which decisions are made.…”

How to Think about Health Promotion Ethics

“…iii,34 Although this will at times overlap with risk reduction strategies, it emphasises primary prevention: promoting health for everyone, whether they are at low or high risk of developing disease. 43 On this idealised account, health promotion becomes 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.…”

“…26,43,44 Because practice cannot be predicted from the ideal, health promotion ethics needs to engage the diversity of health promotion practices. Thus, in the latter part of the paper, we ask a third question: What ethical issues arise in activities intended to promote health?…”

“…However, because ideals and practices are not always aligned, none of these values can be taken for granted in practice. 42,43 …”