A Framework for Ethical Health Promotion

1
A Framework for Ethical Health Promotion

• Will Beer
• Joint Chair SHEPS Cymru

2
Workshop Objectives

• Values underpinning Ethical Health Promotion (pg.
  5-6)
• Conflicts in ethical Health Promotion practice
  (pg.7)
• Individual-state relationship (pg.8)
• Stewardship Model (pg. 8)
• Intervention Ladder (pg. 9)

3
Ice Breaker

• What do you think are some of the values
  underpinning Health Promotion practice?

4
General Ethical Principles
5
Ultimate Goals of Health Promotion

• Basic human right
• a resource to satisfy needs realise aspirations
• Holistic well-being
• with physical, mental and social dimensions
• Equity
• avoiding unfair or unjust inequalities in health
• Empowerment
• enabling individuals community to increase
  control over health determinants

6
Ways of Working in Health Promotion
7
Individual-State Relationship

• Bioethics focus on individual-clinician
  relationship
• Health promotion focus is on populations
• Responsibility and authority of the state
• Libertarian versus collectivist perspective
• Victim-blaming, paternalism, nanny state
• Liberal state in Western societies

8
Ethical Conflicts

• Simultaneously doing good and avoiding harm
• State responsibility and protection of personal
  autonomy
• Sacrificing rights of some in the interest of
  welfare overall
• Greatest good for the greatest number or reducing
  health inequalities

9
Workshop Activity (1)

• Individual-State Relationship

10
Nuffield Council on Bioethics

• Stewardship Model
• Reduce risks people pose to each other
• Ensure environments help sustain good health
• Special attention to children vulnerable groups
• Programmes, not just information and advice
• Ensure healthy choices are the easy choices
• Appropriate access to health services
• Reduce unfair health inequalities

11
Intervention Ladder

• Eliminate choice
• e.g. ban smoking in public places, drink-driving
  laws, fluoridation of water
• Restrict choice
• e.g. industry limits on the fat, salt and sugar
  content of processed food
• Guide choice through disincentives
• e.g. tax on cigarettes, congestion charges, car
  parking fees
• Guide choice through incentives
• e.g. tax-breaks on the purchase of bicycles to
  promote green travel plans
• Guide choice through changes in policy
• e.g. local planning authorities policies on
  transport, school catering policies
• Enable choice
• e.g. stop smoking clinics, cycles routes, fruit
  tuck shops in schools
• Provide information

12
Workshop Activity (2)

• Ethical Dilemmas

13
Conclusion

• Scientific paradigm and evidence-based practice
  is dominant in public health
• Science tells the things that can be done
  ethics tells us what should be done
• In practice we often rely on ethical principles
  and theory
• Need to think about ethical practice in job
  descriptions, induction, academic courses,
  registration/regulation, training, reflective
  practice, etc, etc.