Public Health Code of Ethics

By Kayla Blades

Photo by Edward Jenner. [CC0]

The public health system in the United States is responsible for research and education that informs the decisions made regarding the population health of the entire country. Why do we trust the public health system? How do they provide the most unbiased information in a biased environment? What determines the principles by which such an important field abides? How do we fight the inequities faced in this field? Historically, the United States has seen cases of a lack of effectiveness of the public health system and the use of the public health system to abuse the disenfranchised. Instances such as forced sterilization in the U.S., the AIDS epidemic, and the Tuskegee study reveal a transgression pattern in the public health field. Dr. James Thomas is an Associate Professor in the Department of Epidemiology at the University of North Carolina at Chapel Hill. During his epidemiologic Dr. James Thomas research in the 1990s into the syphilis epidemic in Eastern North Carolina, the unethical aspects of the public health field became evident when he witnessed multiple instances of racism and social inequality. In response to the inequities he witnessed in the public health field, Dr. Thomas developed a research interest in health ethics and began studying ethics, philosophy, and theology. Dr. Thomas worked in conjunction with other scholars to establish A Code of Ethics for Public

Health to combat these forces in hopes that it would lead to change and restructuring of the public health field. This code is not an institutionalized code that someone can violate, but rather it provides clarity on the purpose and values of public health. The public health ethics code was widely adopted by the American Public

Health Association, and Dr. Thomas is now a resource for other institutions regarding the role of ethics in the public health field – specifically concerning epidemics and pandemics. Dr. James Thomas discusses how

“a code of ethics is fundamentally about preserving humanity and humanizing people” and can be utilized to prevent such events and further develop and establish the public health field.1 Public health ethics addresses a power imbalance between individuals’ interests with the overall wellbeing of the community. In the United States, attempts to resolve this imbalance often occur in government 18

as they hold a responsibility for the welfare of the population, balancing the individual’s rights and autonomy with collective safety. A Code of Ethics for Public Health predominately focuses on addressing issues of the public field in the United States. It is not entirely applicable to other countries since circumstances and cultural differences often result in different priorities and approaches when it comes to addressing the various issues of the public health field. Twelve main principles inform the ethical code and establish equity through different modes. The central idea running throughout this code of ethics is Figure 1 : Meeting about Ebola in Accra, Ghana. Courtesy of Dr. Thomas. the value of equity in the public health scenario has different characteristics and factors that field and individuals’ willingness to make sacrifices in make it difficult to anticipate ethical issues that will arise pursuit of equity.1 Public health is a community-focused in a public health emergency. Scholars must adjust and discipline that includes all areas of the community, adapt their thinking to compensate for the deviation including the disenfranchised – advocating and from original conjecture. In the case of COVID-19, there working so that public health includes programs and was a lack of understanding of the essential role of resources accessible to all is a key foundation of this service workers in keeping us in a functioning state. code. Establishing policies that are respectful of all There was also the discussion of redistribution based communities and encompasses all values, beliefs, and upon want and predicted needs of the communities.1 cultures is essential to this idea of equity. The public health field has been increasingly A fundamental principle to the code of ethics valued by the public as globalization and the internet is transparency and public health institutions’ allow for greater information exchange about the responsibility to keep the public informed. Transparency overall health of the population and the urgent and not only allows the public to make educated decisions vital issues this field addresses. Dr. Thomas hopes that about the community, but it also builds trust. Trust by bringing ethical issues essential for public health to between the population and public health institutions the forefront of discussion, it will help prepare us for is essential to promoting cooperation.1 Understanding the next public health emergency. He aspires to adapt the interdependence of people is fundamental in public the public health code of ethics to create a standard health, especially in the wake of globalization in where of public health planning in the workplace to address the interconnectedness of society promptly puts many issues specific to their environment. Importantly, Dr. public health issues on a global scale. Thomas hopes to prevent the scramble to adapt to Our awareness of ethical issues in public health emergent public health situations that people in the is under constant revision as scholars learn more U.S. are experiencing now with COVID-19. information to adapt to continually emerging public health issues in society. As a consultant to many institutions, Dr. Thomas has the opportunity to see the application of this ethical code and revise it to better References encompass a wide range of scenarios. In relation to 1. Interview with James Thomas, MPH, Ph.D. epidemics and COVID-19, anticipating the need to 09/08/2020 rethink who is essential or reexamine the allocation of 2. Thomas JC, Sage M, Dillenberg J, Guillory VJ. A scarce resources are just a few examples of the vast array code of ethics for public health. Am J Public Health. of issues this code must encompass. Each public health 2002;92(7):1057-1059. doi:10.2105/ajph.92.7.1057 19