Global Development, Global Public Health, and Ethics

Rapid development has brought significant economic and health benefits, but it has also exposed populations to new health risks. Public health as a scientific discipline and major government responsibility developed during the nineteenth century to help mitigate these risks. Public health actions need to take into account large inequalities in the benefits and harms associated with development between countries, between social groups, and between generations. This is especially important in the present context of very rapid change. It is important to acknowledge the global nature of the challenges people face and the need to involve countries with different cultures and historical legacies in arriving at consensus on an ethical basis for global cooperation in addressing these challenges. This chapter provides an analysis of these issues, using examples on the management of health risks associated with global development and rapid urbanization and on the emergence of organisms that are resistant to antibiotics.

Pandemic Disease, Public Health, and Ethics

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.

Biosecurity and Public Health Ethics Issues Raised by Biological Threats

This chapter introduces ethical issues that arise in the context of biosecurity: policies and actions intended to prevent the development or emergence, or mitigate the consequences, of serious biological threats. These threats could include deliberate biological weapon attacks (bioterrorism), pandemics, emerging infectious diseases, or major laboratory accidents. The basic values that underpin these public health concerns are first introduced. Ethical issues that arise before, during, and following a biosecurity crisis are then examined, including issues of resource allocation, dual-use research, and the possibility of quarantine. Their resolution requires trade-offs among different ethical values, including utility, fairness, and liberty.

Environmental Health Research and Ethics

This chapter discusses some of the key ethical issues that arise in environmental health research involving human subjects, including returning individualized research results, protecting privacy and confidentiality, research on environmental interventions, intentional exposure studies, research regulations, autonomy, beneficence, informed consent, payments to subjects, and protecting vulnerable human subjects. The chapter will discuss issues that are common to all research designs, as well as those unique to certain types of designs, such as intentional exposure studies. It will also address ethical issues that arose in two important cases, the Kennedy Krieger Institute lead abatement study, and the Children’s Environmental Exposure Research Study.

An Overview of Ethics and Environmental Health

This chapter provides an overview of the ethics of environmental health, and it introduces five chapters in the related section of The Oxford Handbook of Public Health Ethics. A wide range of ethical issues arises in managing the relationship between human health and the environment, including regulation of toxic substances, air and water pollution, waste management, agriculture, the built environment, occupational health, energy production and use, environmental justice, population control, and climate change. The values at stake in environmental health ethics include those usually mentioned in ethical debates in biomedicine and public health, such as autonomy, social utility, and justice, as well as values that address environmental concerns, such as animal welfare, stewardship of biological resources, and sustainability. Environmental health ethics, therefore, stands at the crossroads of several disciplines, including public health ethics, environmental ethics, biomedical ethics, and business ethics.

Navigating the Ethics of Big Data in Public Health

“Big data,” which encompasses massive amounts of information from both within the health sector (such as electronic health records) and outside the health sector (social media, search queries, cell phone metadata, credit card expenditures), is increasingly envisioned as a rich source to inform public health research and practice. This chapter examines the enormous range of sources, the highly varied nature of these data, and the differing motivations for their collection, which together challenge the public health community in ethically mining and exploiting big data. Ethical challenges revolve around the blurring of three previously clearer boundaries: between personal health data and nonhealth data; between the private and the public sphere in the online world; and, finally, between the powers and responsibilities of state and nonstate actors in relation to big data. Considerations include the implications for privacy, control and sharing of data, fair distribution of benefits and burdens, civic empowerment, accountability, and digital disease detection.

An Overview of Ethics, Public Health Policy, and Politics

An understanding of what influences policy decisions, what determines investments for specific public health interventions, and how agreements are made regarding new programs in public health is crucial for helping navigate the ethical implications of public health programs and interventions. This chapter provides an overview of the Public Health Policy and Politics section of The Oxford Handbook of Public Health Ethics. The section’s overall goal is to highlight ethical issues emerging from the work in, and study of, politics and policy development in public health, both within countries and globally. The chapters in this section analyze a set of ethical issues related to politics and public health policies, interventions, and programs, and emphasize the importance of communication among various disciplines, such as bioethics, political science, and development studies.

Industrial Chemicals, Pesticides, Public Health, and Ethics

This chapter provides an overview of ethical issues related to the development of industrial chemicals. While they do contribute to advancements in agriculture, medicine, transportation, hygiene, and human leisure, these chemicals can concomitantly pose serious threats to human and environmental health. The chapter examines the public health cost-benefit of environmental chemicals and the regulatory frameworks for human health protection in various countries, focusing on evidence-based decision-making, risk analysis, a precautionary approach, and international consensus. Specific ethical concerns discussed relate to the impacts and lasting effects of pesticides, the influence of economic stability and profit derived from industrial chemicals, conflicts between public health priorities and environmental protections, and inequities and injustices in the distribution of risks and burdens associated with industrial chemicals.

Environmental Justice, Ethics, and Public Health

Environmental problems raise important issues of justice when these problems affect people’s health prospects in systematically uneven ways, when people contribute to the problems in substantially unequal ways, and when the people who are affected by the problems have not been empowered to participate meaningfully and equally in the decisions that affect their lives. This chapter shows how these aspects of justice are relevant to waste disposal, air pollution, climate change, ecological footprints, and other environmental problems. After discussing how issues of justice arise, the chapter explores the work of environmental justice: ways to articulate, guide, and justify judgments of justice; ways to articulate and foster forms of responsibility; and ways to change social institutions and individual conduct to respond more adequately to environmental injustices.

Eugenics and Public Health: Historical Connections and Ethical Implications

This chapter details historical points of connection between the field of public health and the eugenics movement in the United States, and explores the ethical significance of public health genetics in light of that history. It explains how attention to both eugenics and public health grew simultaneously in the twentieth-century United States, and how both fields contributed to the growth of laws that emphasized the use of the police power to constrain reproduction and immigration among certain groups as a means to advance efficiency and social progress. The chapter suggests that an emphasis on the prevention of problematic hereditary conditions supplies a similar motive for a new public health genetics today.