Public Health Ethics

Given the array of stakeholders and issues dealt with by local health departments (LHDs), health officials and their staff must be ready to handle ethical dilemmas that arise in day-to-day practice. Ethical considerations underlie numerous aspects of public health practice, ranging from staffing decisions at LHDs to distribution of vaccines during pandemics to media strategies related to sensitive subjects such as obesity. 

Tension often emerges as LHD staff try to find balance between individual rights or preferences and a community’s claims to health and safety. Since 2010, NACCHO has partnered with the CDC Public Health Ethics Unit to provide public health ethics education and training for local health departments. The following resources include products and information resulting from the NACCHO-CDC ethics partnership, as well as related tools and content.

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Applying the Good Decision Making eLearning in Your LHD

Hear how the Good Decision Making in Real Time ethics eLearning course can benefit your LHD!

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Applying the Good Decision Making eLearning in Your LHD

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So You Want to Start an Ethics Committee…

View this webpage to learn how to start an ethics committee, which can help meet PHAB standards.

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So You Want to Start an Ethics Committee…

Good Decision Making in Real Time: Practical Public Health Ethics for Local Health Officials

A NACCHO representative and two local health directors provided input into public health ethics training developed by the Centers for Disease Control and Prevention (CDC) - Good Decision Making in Real Time: Public Health Ethics Training for Local Health Departments training course. The training has been presented at several conferences and is now available as an eLearning course on NACCHO University. The course provides public health professionals with tools and practical examples to address ethical challenges that commonly arise in the practice of public health. After introducing the basics of public health ethics, this course will discuss the importance of using case studies to practice applying an ethical analysis framework to address issues that public health practitioners are likely to face. The course also explores the overlap between ethics and law.

Click here to access the online course.

CDC Public Health Ethics Training Materials

The Public Health Ethics Unit of the CDC of the CDC provides training materials online, including a downloadable version of the Student's Manual for the Good Decision Making in Real Time ethics training course. The Facilitator's Manual is also available from CDC upon request.

A Guide for Ethics Champions

As an increasing number of LHDs seek accreditation, LHDs need resources and advocates to handle public health ethics issues effectively. The Public Health Accreditation Board requires LHDs to document processes for dealing with ethical concerns. This fact sheet will help accreditation coordinators and LHD practitioners understand and promote the importance of public health ethics.

Ethics Considerations for Accreditation

NACCHO served on the Public Health Accreditation Board (PHAB) Ethics Think Tank planning committee, which made recommendations on how to incorporate public health ethics into the PHAB Standards & Measures, Version 1.5 guidance document for LHDs seeking accreditation. The requirements specific to public health ethics are found in Measure 11.1.2 A (p. 235) and focus on LHD strategies for resolving ethical issues and documentation demonstrating such problems have been considered and addressed.

Journal Article: Public Health Accreditation Metrics for Ethics

In 2013, the Journal of Public Health Management and Practice released the article, "Public Health Accreditation and Metrics for Ethics: A Case Study on Environmental Health and Community Engagement." The authors of this article, most of whom have been involved with NACCHO's work on public health ethics, provide a crosswalk showing linkages between the Public Health Accreditation Board's Standards and Measures, the Principles of the Ethical Practice of Public Health, and the 10 Essential Public Health Services.

CDC and NACCHO Resources


Building a Formal Ethics Infrastructure at Local Health Departments

Developed by an ad hoc NACCHO committee, this report identifies recommendations for how NACCHO, LHDs, and other key stakeholders may work together to develop the infrastructure needed to respond effectively to public health ethics issues. This report was made possible through the support of the Centers for Disease Control & Prevention's Public Health Ethics Unit.

Building an Ethics Infrastructure in Local Health Departments: A Guide for Ethics Champions

As an increasing number of LHDs seek accreditation, LHDs need resources and advocates to handle public health ethics issues effectively. The Public Health Accreditation Board requires LHDs to document processes for dealing with ethical concerns. This fact sheet will help accreditation coordinators and LHD practitioners understand and promote the importance of public health ethics.

CDC Guiding Principles for Public-Private Partnerships

This guide promotes ethical practices for engaging in public-private partnerships to support positive public health outcomes.

CDC Health Policy Website

This website provides information and resources related to important policies impacting public health.

CDC Public Health Ethics Training Materials

The Public Health Ethics Unit of the Centers for Disease Control and Prevention (CDC) provides training materials online, including a downloadable version of the Student's Manual for the Good Decision Making in Real Time ethics training course. (The Facilitator's Manual is also available from CDC upon request.) Additionally, the website offers a Public Health Ethics Case Repository.

CDC Public Health Ethics Website

The Centers for Disease Control and Prevention (CDC) has a Public Health Ethics Unit housed within its Office of Science Integrity, which is part of the Office of the Associate Director for Science.

NACCHO Ethics Policy Statement

NACCHO’s Policy Statement on the Code of Public Health Ethics affirms NACCHO’s support of the Public Health Leadership Society’s code of ethics. The statement can be found in the Public Health Infrastructure section (under Workforce) on NACCHO’s Policy and Advocacy Activities webpage.

NACCHO Public Health Law Website

NACCHO's public health law website contains valuable information and resources related to the legal aspects of local public health practice. 

General Resources


Principles of the Ethical Practice of Public Health

The Principles of the Ethical Practice of Public Health are known by many as the public health code of ethics and were prodcued by the Public Health Leadership Society with oversight from the American Public Health Association (APHA).

Public Health Ethics Advisory Committee

Developing an ethics advisory committee including key stakeholders can help LHDs build an infrastructure and process for addressing ethical issues that arise in local public health practice. Learn more about case examples and committee launch processes by visiting the websites of these pioneering LHDs:

Hastings Center

The Hastings Center is a bioethics research institute focusing on both the private and public sectors.

Health Care Decisions in Disasters

Visit NACCHO's Model Practices database to obtain insights from Seattle and King County's model practice on "Health Care Decisions in Disasters: Public Engagement on Medical Service Prioritization During an Influenza Pandemic." 

International Society of Environmental Epidemiology Ethics Guidelines

Visit the NACCHO Toolbox to learn about these ethical guidelines from the Society of Environmental Epidemiology (ISEE).

Network for Public Health Law

The Network for Public Health Law offers a variety of resources such as webinars, fact sheets, and a public health lawyer directory.

Standards for Excellence: An Ethics and Accountability Code for the Nonprofit Sector

The Standards for Excellence® Institute provides a variety of resources related to maintaining operational integrity. The Institute offers its own code - Standards for Excellence: An Ethics and Accountability Code for the Nonprofit Sector - that organizations may use to help build components of an ethical infrastructure.

Literature


An Ethics Framework for Public Health

"An Ethics Framework for Public Health" was published in the American Journal of Public Health in 2001.

Introduction to Public Health, Ethics, and Equity

Visit the NACCHO Toolbox to read about and access the recommended book, Introduction to Public Health, Ethics, and Equity. 

Looking Ahead: Addressing Ethical Challenges in Public Health Practice

"Looking Ahead: Addressing Ethical Challenges in Public Health Practice" was published in the Journal of Law, Medicine & Ethics in 2007.

Principled Leadership in Public Health: Integrating Ethics Into Practice and Management

 "Principled Leadership in Public Health: Integrating Ethics Into Practice and Management" was published in the Journal of Public Health Management and Practice in 2008.

Public Health Ethics in Action: Flu Vaccine and Drug Allocation Strategies

"Public Health Ethics in Action: Flu Vaccine and Drug Allocation Strategies" was published in the Journal of Law, Medicine & Ethics in 2005.

Using the Code of Ethics in Crisis Management

"Using the Code of Ethics in Crisis Management Involving Complex Political Environments: Determining Ventilator Allocation During an Influenza Pandemic" was published in Philosophy of Management in 2009.

When Parents Reject Interventions to Reduce Postnatal Human Immunodeficiency Virus Transmission

"When Parents Reject Interventions to Reduce Postnatal Human Immunodeficiency Virus Transmission" was published in the Archives of Pediatric and Adolescent Medicine in 2001.

Public Health Ethics: Cases Spanning the Globe

This book includes overviews of 7 topics relevant to public health practice, an introduction to the field of public health ethics, a discussion of historical influences that have shaped the field, and 40 cases. You can download the book for free online.

Training

Association of Schools and Programs of Public Health (ASPPH) Model Ethics Curriculum

This curriculum, created in 2003, stemmed from collaboration between ASPPH, the Health Resources and Services Administration (HRSA) and The Hastings Center.

Ethics Modules from UNC Gillings School of Public Health

This 8-module course is offered through the Gillings School of Public Health at the University of North Carolina.

University at Albany Course on Public Health Ethics and Terrorism

This online course, Ethics and Public Health in an Age of Terrorism, derives from a program at the University of South Carolina Center for Public Health Preparedness and is offered through the University at Albany.

Visit this webpage to view a step-by-step guide to establishing an ethics committee. In addition to the guide, printable job aids are available that will help make the case for an ethics committee and provide ethics training resources to your LHD. Establishing an ethics committee can help work towards the Public Health Accreditation Board's ethics requirement.

Ashley Edmiston, MPH
Director, Workforce Development

Geoffrey Mwaungulu
Senior Program Analyst, Public Health Preparedness & Law