Question

Competitiveness or a desire for preeminence and public relations advantage may cause agencies providing public health services to act unethically or dishonestly. What is the best way to work to improve public health when this occurs?

Answer 1

Ans) Public policy is based on many factors in addition to public health goals and ethical reasoning.

- Weighing alternatives according to this public health ethics framework should lead to an ethically acceptable option, but it may not lead to the politically preferable option for a given time.

- That politics often takes a divergent and somewhat unpredictable path, however, is not an excuse for abandoning ethics analysis when a public health proposal is up for discussion. An ethics analysis must always be conducted, both because bringing truth, fairness, and respect to our work is right in itself and also because, from a more utilitarian perspective, public health work will be more effective if we do.

- Engaging in the steps of an ethics analysis makes us meticulous in our reasoning, requiring us to advocate interventions on the basis of facts and not merely belief. Further, an ethics analysis holds us to high standards, not only for scientific method but also for how respectfully we communicate with and involve constituent communities. The involvement of communities will help identify the public health threats divergent groups face and will create, if not partnerships, at least—one can hope—a reasonable amount of trust. To succeed, the field of public health must gain the public's trust that the inevitable higher proportions of government involvement and population targeting imposed by public health, relative to other branches of health care, are appropriate and in these various communities' best interests.

- Public health professionals must go through the steps of an ethics analysis to assure the public of their integrity. The public must feel confident that public health professionals will offer only those proposals that will improve the health of the public, that proposed measures are minimally burdensome, and that a fair procedure has determined that the magnitude of the problem and the ensuing benefits justify overriding conflicting moral claims. It is reasonable to assume that the public will be concerned about which functions are necessary and which are overly burdensome, offensive, or simply wasteful. This process, then, must be integrated, constant, and ongoing. The most important asset that public health can have is the public's trust that work is being done on its own behalf. In such a context, public health professionals can and must advocate what they believe, on balance, are the ethically best approaches for furthering social justice and the public's health.