Public Health Ethics

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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.

Check out our NACCHO University offerings on public health ethics here.

*NEW* Ethics Resources:

An Ethics Deliberation on Offering Financial Incentives for Receiving COVID-19 Vaccines in Multnomah County: In late 2017, the Multnomah County Public Health Division (MCPHD) partnered with the Multnomah County Public Health Advisory Board (MCPHAB) to house the public health ethics committee within the advisory board structure. The purpose was to have broad community representation and input on all public health ethics deliberations, in addition to a formal, transparent process for decision making. Read about how the ethics committee took an equity approach to determine the best use of State funds to increase vaccine rates among residents, and providing gift cards as an incentive for getting vaccinated.

Assuring Equitable Access for Young People to Comprehensive Reproductive Health Services in School-Based Settings: Developing a robust public health infrastructure to embed ethical decision making in local public health produces multiple benefits to the organization and the public. read about how Pima County used an ethical lens to provide accessible sexual and reproductive health services, including education and contraception, in school-based and community settings.

NACCHO’s 2022 Local Public Health Ethics Capacity Assessment examined the current state of public health ethics practice in local health departments (LHDs). This infographic highlights the strengths and gaps the 79 local health department respondents (27% response rate) reported in the survey, including opportunities for national organizations to strengthen LHD public health ethics capacity.

COVID-19 Response Resources:

Explore the Pandemic Ethics Dashboard, developed by the University of North Carolina at Chapel Hill for examples of ethics in action during the COVID response

View this recorded webinar on NACCHO University on the role of ethics in community trust building- The Role of Public Health Ethics in COVID-19: Building Public Trust

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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

Public Health Infrastructure

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.

Public Health Infrastructure

So You Want to Start an Ethics Committee...

Public Health Infrastructure

Fact Sheet: Selecting Ethical Issues for Deliberation

This resource aims to provide guidance around the identification of public health issues and tips to ensure a judicious process.

Public Health Infrastructure

Fact Sheet: Selecting Ethical Issues for Deliberation

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.

NACCHO University webinars

Introduction to Ethical Decision Making

Public Health Ethics Peer Learning Forum: Public Health Ethics in Action

NACCHO 360: Raising the Reach of Public Health - Workshop: Intentional Ethics: Enriching Local Public Health Department Ethical Analyses

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.

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.

Public Health Infrastructure and Systems

Ashley Edmiston

Director, Workforce Development

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