Ethical dilemmas are not new in the area of health care and policy making, but in recent years, their frequency and diversity have grown considerably. All health professionals now have to consider the ethical implications of an increasing array of treatments, interventions and health promotion activities on an almost daily basis. This goes hand in hand with increasing medical knowledge, and the growth of new and innovative medical technologies and pharmaceuticals. In addition, the same technology and knowledge is increasing professional and public awareness of new potential public health threats (e.g. pandemic influenza).
At the level of public policy, concerns over the rising costs of health care have led to a more explicit focus on 'health promotion', and the surveillance of both 'patients' and the so-called 'worried well'. Health professionals and policy makers also have to consider the implications of managing these risks, for example restricting individual liberty through enforced quarantine (in the wake of SARS and more recently swine flu) and the more general distribution of harms and benefits. Balancing the rights and responsibilities of individuals and wider populations is becoming more complex and problematic.
This book will play a key role in opening out a discussion of public health ethics. It examines the principles and values that support an ethical approach to public health practice and provides examples of some of the complex areas which those practising, analysing and planning the health of populations have to navigate. It will therefore be essential reading for current practitioners, those involved in public health research and a valuable aid for anyone interested in examining the tensions within and the development of public health.
"The papers in this collection illustrate the diversity of ethical issues associated with public health initiatives. The book should stimulate thinking about the development and application of ethical considerations in public health policy and practice." Vikki Entwistle, Professor of Values in Health Care, University of Dundee
'This is a book that should be widely read and which should both provoke and shape debate in any future context concerned with the future of UK public health, and public health training.' Sociology of Health and Illness
"Exploring tensions at the very heart of public health - between community needs and individual freedom and from philosophical concepts to everyday dilemmas - this book sheds welcome light on a much neglected aspect of the field." Prof Alan Maryon-Davis, President, UK Faculty of Public Health
"Through bridging the foundational ethical underpinnings with the practice-oriented nature of public health, this important book introduces and articulates the interdisciplinary space that is public health ethics." Ryan Melnychuk, Senior Policy Analyst, Public Health Ethics
Stephen Peckham is a Reader in Health Policy at the London School of Hygiene & Tropical Medicine and was previously at Oxford Brookes University. He has been involved in health and social policy research and teaching since 1991 and previously worked in the voluntary and local government sectors. He has written widely on public health and primary care and is currently involved in research on public health in general practice and patient choice.
Alison Hann is a Lecturer in Public Health and Health Policy at the University of Wales Swansea. She has published three books and many book chapters on public health, ethics and politics, and articles in journals including Critical Social Policy, Critical Public Health, International Journal of Health Planning and Management and Public Health. Alison is also Convenor of the Health Policy and Politics Network.
Introduction: Why public health ethics? ~ Stephen Peckham and Alison Hann; Part one: Public health ethics: contexts: Why ethics? What kind of ethics for public health? ~ Alan Cribb; Public health ethics: what it is and how to do it ~ Stephen Holland; Part two: Ethics and public health practice: What does it mean to 'know' a disease? The tragedy of XDR-TB ~ Ross Upshur; The evaluation of public health initiatives on smoking and lung cancer: an ethical critique ~ Peter Allmark, Angela Tod and Jo Abbott; Relevance of primary care bioethics committees In public health ethical practice in the community: an experience in an area of extreme poverty in Santiago, Chile ~ Marla Solari and Tatiana Escobar-Koch; Unlinked anonymous blood testing for public health purposes: an ethical dilemma? ~ Jessica Datta and Anthony Kessell; Constructing the obesity epidemic: loose science, money and public health ~ Alison Hann and Stephen Peckham; Politics, ethics and evidence: immunisation and public health policy ~ Alison Hann and Stephen Peckham; Avoiding mixed messages: HPV vaccines and the 'cure' for cervical cancer ~ Alison Hann and Stephen Peckham; A call for clearer vaccine exemption typology to improve population health ~ Erica Sutton and Ross Upshur; Part three: Public health ethics: developing a basis for practice: Theory and practice in public health ethics: a complex relationship ~ Angus Dawson; Conclusion: taking forward the debate ~ Stephen Peckham and Alison Hann.