“The health equity curse”: ethical tensions in promoting health equity

Abstract Background Public health (PH) practitioners have a strong moral commitment to health equity and social justice. However, PH values often do not align with health systems values, making it challenging for PH practitioners to promote health equity. In spite of a growing range of PH ethics frameworks and theories, little is known about ethical concerns related to promotion of health equity in PH practice. The purpose of this paper is to examine the ethical concerns of PH practitioners in promoting health equity in the context of mental health promotion and prevention of harms of substance use. Methods As part of a broader program of public health systems and services research, we interviewed 32 PH practitioners. Results Using constant comparative analysis, we identified four systemic ethical tensions: [1] biomedical versus social determinants of health agenda; [2] systems driven agendas versus situational care; [3] stigma and discrimination versus respect for persons; and [4] trust and autonomy versus surveillance and social control. Conclusions Naming these tensions provides insights into the daily ethical challenges of PH practitioners and an opportunity to reflect on the relevance of PH frameworks. These findings highlight the value of relational ethics as a promising approach for developing ethical frameworks for PH practice.

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“The Health Equity Curse”: Ethical Tensions in Promoting Health Equity

10.21203/rs.3.rs-76616/v1 ◽

2020 ◽

Author(s):

Bernie Pauly ◽

Tina Revai ◽

Lenora Marcellus ◽

Wanda Martin ◽

Kathy Easton ◽

...

Keyword(s):

Public Health ◽

Health Systems ◽

Health Equity ◽

Ethical Challenges ◽

Services Research ◽

Ethical Concerns ◽

Ethical Frameworks ◽

Ph Values ◽

Constant Comparative Analysis ◽

Health Agenda

Abstract Background: Public health (PH) practitioners have a strong moral commitment to health equity and social justice. However, PH values often do not align with health systems values, making it challenging for PH practitioners to promote health equity. In spite of a growing range of PH ethics frameworks and theories, little is known about ethical concerns related to promotion of health equity in PH practice. The purpose of this paper is to examine the ethical concerns of PH practitioners in promoting health equity in the context of mental health promotion and prevention of harms of substance use.Methods: As part of a broader program of public health systems and services research, we interviewed 32 PH practitioners. Results: Using constant comparative analysis, we identified four systemic ethical tensions: [1] biomedical versus social determinants of health agenda; [2] systems driven agendas versus situational care; [3] stigma and discrimination versus respect for persons; and [4] trust and autonomy versus surveillance and social control.Conclusions: Naming these tensions provides insights into the daily ethical challenges of PH practitioners and an opportunity to reflect on the relevance of PH frameworks. These findings highlight the value of relational ethics as a promising approach for developing ethical frameworks for PH practice.

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Pandemic Disease, Public Health, and Ethics

The Oxford Handbook of Public Health Ethics ◽

10.1093/oxfordhb/9780190245191.013.69 ◽

2019 ◽

pp. 796-811 ◽

Cited By ~ 1

Author(s):

Maxwell Smith ◽

Ross Upshur

Keyword(s):

Public Health ◽

Ethical Issues ◽

Ethical Challenges ◽

Pandemic Preparedness ◽

Scarce Resources ◽

Ethical Frameworks ◽

Health Measures ◽

Care Workers ◽

The Face ◽

Conducting Research

Infectious disease pandemics raise significant and novel ethical challenges to the organization and practice of public health. This chapter provides an overview of the salient ethical issues involved in preparing for and responding to pandemic disease, including those arising from deploying restrictive public health measures to contain and curb the spread of disease (e.g., isolation and quarantine), setting priorities for the allocation of scarce resources, health care workers’ duty to care in the face of heightened risk of infection, conducting research during pandemics, and the global governance of preventing and responding to pandemic disease. It also outlines ethical guidance from prominent ethical frameworks that have been developed to address these ethical issues and concludes by discussing some pressing challenges that must be addressed if ethical reflection is to make a meaningful difference in pandemic preparedness and response.

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The Ethics of AI in Biomedical Research, Patient Care, and Public Health

The Oxford Handbook of Ethics of AI ◽

10.1093/oxfordhb/9780190067397.013.45 ◽

2020 ◽

pp. 702-718 ◽

Cited By ~ 1

Author(s):

Alessandro Blasimme ◽

Effy Vayena

Keyword(s):

Public Health ◽

Patient Care ◽

Biomedical Research ◽

Disease Surveillance ◽

Ethical Issues ◽

Ethical Review ◽

Ethical Challenges ◽

Healthcare Provision ◽

Social Scientists ◽

Ethical Frameworks

This chapter explores ethical issues raised by the use of artificial intelligence (AI) in the domain of biomedical research, healthcare provision, and public health. The litany of ethical challenges that AI in medicine raises cannot be addressed sufficiently by current regulatory and ethical frameworks. The chapter then advances the systemic oversight approach as a governance blueprint, which is based on six principles offering guidance as to the desirable features of oversight structures and processes in the domain of data-intense biomedicine: adaptivity, flexibility, inclusiveness, reflexivity, responsiveness, and monitoring (AFIRRM). In the research domain, ethical review committees will have to incorporate reflexive assessment of the scientific and social merits of AI-driven research and, as a consequence, will have to open their ranks to new professional figures such as social scientists. In the domain of patient care, clinical validation is a crucial issue. Hospitals could equip themselves with “clinical AI oversight bodies” charged with the task of advising clinical administrators. Meanwhile, in the public health sphere, the new level of granularity enabled by AI in disease surveillance or health promotion will have to be negotiated at the level of targeted communities.

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Measuring and Combatting Health-Related Inequalities

10.1093/oso/9780192844057.003.0009 ◽

2021 ◽

pp. 184-204

Author(s):

James Wilson

Keyword(s):

Public Health ◽

Lived Experience ◽

Health Systems ◽

Health Equity ◽

Power Structures ◽

Health Related ◽

Break Up ◽

Pluralist Approach

This chapter examines how health systems should measure, and respond to, health-related inequalities. Health equity is often taken to be a core goal of public health, but what exactly health equity requires is more difficult to specify. There are indefinitely many health-related variables that can be measured, and variation in each of these variables can be measured in a number of different ways. Given the systemic interconnections between variables, making a situation more equal in some respects will tend to make it less equal in others. The chapter argues for a pluralist approach to health equity measurement, which takes its cue from the lived experience of individuals’ lives. Reflection on the deepest and most resilient causes of health-related inequalities shows that they are often the result of intersecting structural concentrations of power—structures which it is vital, but very difficult, to break up.

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Public Health Systems and Services Research: Building the Evidence Base to Improve Public Health Practice

Public Health Reviews ◽

10.1007/bf03391693 ◽

2013 ◽

Vol 35 (1) ◽

Cited By ~ 4

Author(s):

F. Douglas Scutchfield ◽

Richard C. Ingram

Keyword(s):

Public Health ◽

Health Systems ◽

Public Health Practice ◽

Evidence Base ◽

Health Practice ◽

Services Research ◽

Public Health Systems

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Public Health Systems and Services Research: Dataset Development, Dissemination, and Use

Public Health Reports ◽

10.1177/003335490912400305 ◽

2009 ◽

Vol 124 (3) ◽

pp. 372-377 ◽

Cited By ~ 10

Author(s):

F. Douglas Scutchfield ◽

Nikki Lawhorn ◽

Rick Ingram ◽

Debra Joy Pérez ◽

Rick Brewer ◽

...

Keyword(s):

Public Health ◽

Health Services ◽

Health Systems ◽

Easy Access ◽

Public Health Services ◽

Services Research ◽

Data Resource ◽

Public Health Systems ◽

The Impact ◽

Research Resources

Public health systems and services research (PHSSR) is defined as “a field of study that examines the organization, financing, and delivery of public health services within communities and the impact of those services.” PHSSR is a relatively young field and suffers from a paucity of research resources. In this article, we describe the development and utility of a data resource, housed on the Health Services and Sciences Research Resources website maintained by the National Library of Medicine, which provides easy access to instruments, indices, and datasets that are relevant to PHSSR researchers. We also investigate efforts to promote the use and dissemination of these data resources, including the awarding of research grants and the organization of a PHSSR conference.

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Comment on Iavicoli et al. Ethics and Occupational Health in the Contemporary World of Work. Int. J. Environ. Res. Public Health 2018, 15, 1713

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15122654 ◽

2018 ◽

Vol 15 (12) ◽

pp. 2654

Author(s):

Ming-Jui Yeh ◽

Hsi-Chen Liu

Keyword(s):

Public Health ◽

Occupational Health ◽

Health Professionals ◽

Historical Development ◽

Narrative Review ◽

Ethical Challenges ◽

Ethical Concerns ◽

Contemporary World

In their recent paper, Iavicoli and colleagues provided a narrative review on the historical development of ethics in occupational health and discussed several ethical concerns; they also hinted the “next step” for resolving the ethical challenges that occupational health professionals (OHPs) will encounter [...]

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Ethical challenges experienced by public health nurses related to adolescents’ use of visual technologies

Nursing Ethics ◽

10.1177/0969733018779179 ◽

2018 ◽

Vol 26 (6) ◽

pp. 1822-1833 ◽

Cited By ~ 2

Author(s):

Hilde Laholt ◽

Kim McLeod ◽

Marilys Guillemin ◽

Ellinor Beddari ◽

Geir Lorem

Keyword(s):

Public Health ◽

Focus Group ◽

Child Neglect ◽

Ethical Issues ◽

Public Health Nurses ◽

Ethical Challenges ◽

Focus Group Discussions ◽

Group Discussions ◽

Ethical Concerns ◽

Visual Technologies

Background: Visual technologies are central to youth culture and are often the preferred communication means of adolescents. Although these tools can be beneficial in fostering relations, adolescents’ use of visual technologies and social media also raises ethical concerns. Aims: We explored how school public health nurses identify and resolve the ethical challenges involved in the use of visual technologies in health dialogues with adolescents. Research design: This is a qualitative study utilizing data from focus group discussions. Participants and research context: We conducted focus group discussions using two semi-structured discussion guides with seven groups of public health nurses (n = 40) working in Norwegian school health services. The data were collected during January and October 2016. Discussions were audio recorded, transcribed, and coded into themes and subthemes using systematic text condensation. Ethical considerations: The leader of the public health nursing service who agreed to provide access for the study and the Norwegian Center for Research Data that reviewed and approved the study. All participants gave informed consent. Findings: In adolescents’ use of visual materials with public health nurses, ethical concerns were raised regarding suicide ideations, socially unacceptable content, violation of privacy, and presentations of possible child neglect. The nurses utilized their professional knowledge and experience when identifying and navigating these ethical dilemmas; they resolved ethical uncertainties through peer discussion and collaboration with fellow nurses and other professionals. Discussion: We discussed the findings in light of Annemarie Mol’s interpretation of the ethics of care. Mol expands the notion of ethical care to include the action of technologies. Conclusion: Although the increasing use of visual technologies offered benefits, school nurses faced ethical challenges in health dialogues with adolescents. To address and navigate these ethical issues, they relied on their experience and caring practices based on their professional ethics. Uncertainties were resolved through peer dialogue and guidance.

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