Public health

The goal of the OLBIOS Advisory Group is to help you ask the right questions, raise awareness and inform you on the ethical issues you are confronted with, using ethics not as a constraint machine but as a basis for a stronger, deeper, more conscious and creative approach to your field.

What is the moral foundation of public health? An injunction to maximize welfare or social justice?

How to organize the public health necessities of a modern industrialized society, including protection of such society by a strong medical apparatus, the establishment of a uniform system for public health across such society, and the need to make public health independent from the welfare system?

The effectiveness of institutions depends heavily on the public’s trust – understanding transparency, accountability and reliability.

What are the moral connections of public health to broader questions of justice, poverty, and systematic disadvantage?

Analyzing the four characteristics giving public health its basic structure and orientation: it is a public or collective good; its promotion involves a particular focus on prevention; its promotion often entails government action; and it involves an intrinsic outcome-orientation.

How can one help people become aware of their own health condition? The importance of comprehensive public services.

Benefits present and future – on forgetting about next generations.

How can people learn how to draw the boundary-line between « public » and « private » in affairs of health?

Are national health problems larger than the sum of poor health behaviour of individual citizens, so that the public requires strong medical guidance?

Coercive character of public health measures.
Is a uniform system for every part of a country necessary?

The importance of Collaboration as the key element in public health. The public health infrastructure is comprised of a wide variety of agencies and professional disciplines.

What is the functioning of an Hygienic Rule? The importance of counsels on personal self-government.

Discussing the definition of public health as « what we, as a society, do collectively to assure the conditions in which people can be healthy ».

Why do collective interventions in health services for the broad population involve or require government action?

Health, and its deep moral connections to poverty and systematic disadvantage.

Should the various functions of health departments include the full range of such activities (i.e. from inspection of commercial food services to the collection and use of epidemiological data for population surveillance of disease)?

How to organize collective action to promote and protect population health at the global level?

What are the distinctive challenges of public health ethics and the different justifications for public health interventions, including the role of paternalism? And how do these bear on the permissibility of public health interventions?

The WHO (Worlds Health Organization) understanding of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.

How can we consider the questions of justice and fairness in public health ethics and of priority-setting in public health?

Who is the « public »? In a global world is the usual assumption that the public is a discrete unit that corresponds with state boundaries always plausible? Communicable diseases ignore state boundaries, and prevention measures in one country may be futile if other countries do not follow suit.

What distinguishes public health ethics from medical ethics?

Insofar as diseases cross borders, should public health interventions do the same?

Do wealthier countries have obligations to attend to the public health of less fortunate others?

Each person in a community should have an opportunity to contribute to public discourse. But who contributes to discussions, whose concerns are addressed in the final policy of public health?

Studying the institutions : Food & Drug Administration / Environmental Protection Agency / Consumer Protection Agency.

The core moral challenge of public health: balance between individual liberties and the advancement of good health outcomes.

The difference between immediately securable benefits and prospect of benefits.

How does prevention of disease and injury operate? By eliminating a hazard that already exists or by preventing it from materializing?

Where must funding and support be directed? Priority-setting in public health.

Public sanctions and penalties in an area as deeply personal as individual health choices. Constant trade-off between personal freedom and collective action: concerns about paternalism : the state decides what’s good for you.

Are citizens of the developed world causally connected to some health deprivations in the developing world (by upholding restrictions on the production and distribution of generics, thus hindering the containment of easily treatable diseases in poor countries)?

Claimed under the rubric of public health: crime, war, natural disasters, population genetics, environmental hazards, marketing and corporate practices, political oppression, income inequality, individual behaviour and the impact of all the above on health.

Hiding or telling? Countries report their data about communicable disease outbreaks, burden of disease and other health indicators to global institutions such as the WHO on a voluntary basis.

Although the International Health Regulations to which 194 countries are signatories provide an international structure, enforcement mechanisms are very weak (same structure as for environmental challenges) – consequences.

Reducing violence is critical to population health; should this mean that law enforcement, the criminal justice system, diplomacy and international relations should be considered tools of public health?

The overlapping of effects and justifications in prevention: immunization, water fluoridation, anti-smoking campaigns and motorcycle helmet laws as paradigmatic preventive public health interventions.

How can PH institutions incorporate a variety of approaches that anticipate and respect diverse values, beliefs and cultures in any community given?

The multiple determinants of health and the need for responsiveness to evidence about all such determinants, across the landscape of an interconnected social structure (policies governing education, foreign assistance, agriculture and the environment, and impact of health policies on international relations and national/global economies).

Protection of the confidentiality of information that can cause harm to an individual or a community if made public.

Opposition to powerful corporate economic interests.

How exactly should the mandate of public health authorities be specified so that they do not run afoul of the requirements of legitimacy in a democratic political system?

How to focus on population health if populations are never internally uniform? Who is happy about guidance/laws on healthy eating?

New technologies, new possibilities, new dilemmas and challenges.

Case studies: Infectious Diseases / Obesity / Alcohol / Water Fluoridation.

Difference of goals in PH : reducing risks or protecting people from other people’s actions?

Appropriate access to medical services and tighting against health inequalities.

The right to health as a basic human right – But on whom fall the duties generated by this right? Governments, private sector institutions, individuals?

The reality of disparities in life expectancy and child survival. How to redress health injustice? Which inequalities are the most egregious?

Prevention versus treatment.

Health and safety schemes for application at the work-place.

Promoting health for children and vulnerable groups. Should the State help to overcome addictions?

Uneven research focus. Undue health-related burdens as imposed by a shared world order. Which disease has the priority?

Underserved countries and compensatory claims: remedial justice.