Ethical Issues

A myriad of ethical issues surround health promotion, disease prevention and research as related to public health.  For example, two ethical challenges involve the role of government in health promotion and disease prevention as well as human subjects protection as they pertain to the public health research agenda. According to Callahan and Jennings (2002), public health has dual obligations to the government (which regulates it) and the public (that it serves).  This dichotomy creates special ethical problems for the public health profession. For example, laws such as immunization and seat belt requirements have an explicit normative element: Callahan and Jennings claim that these regulations promote and protect the lives of citizens. The trick is balancing the paternalistic interests of the state with the libertarian notion of freedom.

            While government interference in the health of its citizenry might at first glance be deemed a positive policy, that is not always the case. For example, consider the eugenics sterilization program in America.  According to the documentary "The Lynchburg Story," between 1905 and 1972 over 70,000 Americans were forcibly sterilized because the state deemed them unfit to reproduce.  Not all of these victims were cognitively challenged, rather some were just poor. When discussing governmental human rights violations and health, Farmer (1999) made the following comment, "Social inequalities based on race or ethnicity, gender, religious creed, and – above all – social class are the motive force behind most human rights violations. In other words, violence against individuals is usually embedded in entrenched structural violence" (p. 1488).  Thus a key ethical problem in the public health system remains ensuring the rights of disenfranchised groups.   

            Human rights violations, especially with marginalized groups such as those in Lynchburg or Tuskegee, provide the main rationale for governmental oversight of all research involving human subjects.  This oversight generally follows a biomedical model a model that stringently regulates research.  For example, clinical drug trials require absolute voluntary cooperation and informed consent of research subjects. Participants must be aware of their rights as well as risks and benefits of this study. However, many research interests in public health do not involve invasive procedures. As such, it may be useful to relax research protocols in public health research that deals with large populations or communities. For instance, at ETSU, administrative oversight of research is divided into a campus and medical Institutional Review Board (IRB). This division allows research that is oriented socially and behaviorally, particularly non-manipulative studies, to qualify for exemption from full review.

References

Callahan, D., & Jennings, B. (2002). Ethics and public health: Forging a strong relationship.

American Journal of Public Health, 92(2), 169-176.

Eadie, B. (Producer), & Trombley, S. (1994). The Lynchburg Story [Motion picture]. U.S.:

Worldview Pictures Production.

Farmer, P. (1999). Pathologies of power: Rethinking health and human rights. American Journal

of Public Health, 89(10), 1486-1496.