Class 10 - Public Health Ethics Flashcards
Midwifery to Inuit, Metis and First Nations Communities
Women in community and indigenous midwives were the first caring for public health/community health
Mary Seacole 1850s (Link to Crimean War)
Contemporary from florence nightingale
Context of conflict and war
Opened british coffee shop during crimean war
She did less training and righting than F.N
Mary Mohoney 1879
First African nurse 1879
A lot of nursing were done by those that did not hold a degree
1920s: black cross nursing → many did not have nursing degrees because not allowed; but many black woman came together at the time to take care of their own (started in the States then progressed to Canada)
Engaging in healthcare
Jean Goodwill (1928-1997)
One of the first indigenous nurses in Canada
Jean got TB when she was young
Link to video screencast (she went to Sanatorium and lived there for 3 years) → made her want to be a nurse
Canadian indigenous nursing association founder (CINA)
Advocated for TRC
Midwifery Now - Tia Felix
Contemporary of ours
Sustainable community health goals
- We have overmedicalized maternal healthcare
- Indigenous communities were flown away for delivery → advocacy to bring back midwifery to bring back to indigenous healthcare lens
Indigenous midwife
A Community Health Nurse
“works with people where they live, work, learn, worship, and play to promote health”
Public Health
The organized efforts of society to keep people healthy and prevent injury, illness, and premature death. It is a combination of programs, services, and policies that protect and promote the health of all Canadians.
“What we, as a society, do collectively to assure the conditions in which people can be healthy”
Public Health
why was SARS important for public health
SARS was important for public health because it created the PHAC (public health agency of Canada)
does the healthcare system help in public health?
Most of the improvements of public health DO NOT come from the healthcare system
This is Public Health: 12 Great Achievements
(Canada)
- Safe and healthier foods
- Control of Infectious Diseases
- Healthier Environments
- Recognition of Tobacco Use as a Health Hazard
- Decline in Deaths from - Coronary Heart Disease and Stroke
- Universal Policies
- Family Planning
- Safer Workplaces
- Acting on the Social Determinants of Health
- Healthier Mothers and Babies
- Motor Vehicle Safety
- Vaccination
why is it important to make the public aware of ROI
ROI is important because the public may falsely believe that public health puts a drain on our budget (when actually its the opposite)
public health purpose
achieve optimal health and well being for all people living in canada
aims of public health (3)
enhance the health status of populations
protect against health emergencies and mitigate the impacts
achieve equitable health outcomes
essential public health functions (6)
- health promotion
- health surveillance
- health protection
- population health assessment
- disease and injury prevention
- emergency preparedness and response
why is PH inherently political
Need to convince them it is financially worth it (or else governments and politics wont on invest)
1.Health Protection
Actions to ensure water, air, and food are safe
A regulatory framework to control infectious diseases
Protection from environmental threats (ex: air quality)
Expert advice to food and drug safety regulators (high safety legislations for drugs and any type of product for health care)
what is the nemesis of Public Health
Success is sometimes the nemesis of Public Health
If we are successful = nothing happens → people say, why are we investing
2.Health Surveillance
The ongoing, systematic use of routinely collected health data for the purpose of tracking and forecasting health events or health determinants
Health Surveillance
(4 ethical questions)
privacy and confidentiality
stigma and discrimination
ownership
informed consent
3.Population Health Assessment
Produce better policies and services based on an understanding of:
The health of communities or specific populations
Factors that underlie good health or pose potential risks
Looks broader, looks at determinants across dimensions
Wants to look at health disparities in a population
Want to better align the health needs
Same ethical issues of health surveillance, but looking as smaller groups (ex: montreal)
Ownership, privacy, health needs.
4.Disease and Injury Prevention
Reduce risk of infectious disease emergence, outbreaks and, preventable illness and injury through:
Investigation, contact tracing, preventive measures
Activities to promote safe, healthy lifestyles (ex: masks, helmets)
Disease and Injury Prevention
(4 ethical issues)
victim blaming
social control
harm principle
paternalism
- Health Promotion
- Preventing disease and encouraging safe behaviors
- Looking much broader, various domains, healthy public policies, healthy environments, not just health domains
- Improving health through public policy, community-based interventions, active public participation
- Advocacy or action on environmental and socio-economic determinants of health
Health Promotion
(5 ethical issues)
Infringing on the freedom of citizens
What goods and benefits are valued?
Victim blaming
Stigmatization
Distribution of benefits
6.Emergency Preparedness & Response
Planning for both natural disasters and man-made disasters to minimize serious illness, overall deaths, and social disruption
Mtl: floods, snow storms, verglas (ice storm), epidemics and infectious disease, metro and car crashes, fires in hospital, mass shootings
Requires planning and preparedness
Emergency Preparedness & Response
(4 ethical issues)
resource allocation
vulnerability
distributive justice
tragic decisions
Public Health Interventions to Control Obesity
(ethical issues)
- Effectiveness of programs (benefits)
- Potential harms
- Widening inequity
- Paternalism
- Weight stigma in healthcare
2 important public health values
social justice and health equity
Social Justice
- Fair distribution of society’s benefits and responsibilities, and focuses on eliminating the root causes of inequities (CNA, 2010)
- Leads to degree of equality of opportunity for health that a society provides for the population
Not equal care but opportunity for health - Involves the political, social, and economic structures of a society
Health Equity
Fair distribution of resources for health
Absence of systematic disparities in health between groups with different levels of wealth, power or prestige
Ethical principle, closely related to human rights
Comes back to ethics…
- Is it avoidable?
- Is it unfair?
- Is it unjust?
Broad Approaches for Health Equity
(3)
- Improvement of daily living conditions = very important
- Tackling inequitable distribution of resources
- Increasing public’s awareness of, and health professionals’ training in, the SDoH as foundational to good health and the structural action necessary to address them
“How we, collectively as a society, use the law to ensure that conditions exist for people to be healthy”
Public Health Law
examples of public health law
- signs about pedestrian crossing
- making workers wear protective equipment to work
- keeping alcohol and cigarettes in different sections in the store
Public Health Act (Quebec- Provincial)
(examples)
- National Programming & Surveillance
- Health Promotion & Prevention
- Vaccination
-Compulsory Treatment or prophylaxis - Reporting
- Powers in situation of threat –> Public health can take over and exert power in certain situations (ex: pandemic)
Etc…
MADO
maladie à déclaration obligatoire
rabies, chlamydia, syphillis, lyme disease, amiantosis, HIV (only if gave or received blood, organ or tissue), Hep B and C, gonorrhoea, giardia, measles, TB (not all), carbon monoxide poisoning, accidental poisoning
clinal and public health ethics is part of what sphere of ethics
both are part of bioethics, which is part of the normative
difference between public health ethics and clinical ethics
- community setting (vs not clinical setting)
- can be hard to opt out of (vs the pt can reject advice in clinical ethics)
- may not be in the best interest of some individuals (vs should be in the best interest of the patient)
- focus on populations (vs focus on individuals)
4 perspectives on public health ethics
professional ethics
applied ethics
advocacy ethics
critical public health ethics
(please refer to image in our notes)
mission of public health to protect and promote health and focuses on the virtues or professional character
professional ethics
(a PH ethics perspective)
applied ethics
(a PH ethics perspective)
seeks to develop general principles that can be applied to practical situations to guide ethical practice
advocacy ethics
(a PH ethics perspective)
involves taking a stand for the goals, interventions, and reforms that are most likely to achieve the moral aims of public health
critical public health ethics
(a PH ethics perspective)
- historically informed, practically oriented
- considers social values and trends in analyzing and understanding both the public health situation at hand and the moral problems it raises
- it asks us ‘to question the taken for granted and think about how power relations are represented’ in a particular public health concerns
PH ethics framework (4) from MacDonald
name and describe them
harm principle
least restrictive or coercive means
reciprocity principle
transparency principle
**refer to image in notes and reading for description
what is an alternative way to look at how individuals make decisions?
Some theorists advocate that we should try and advocate more from a relationship theory
Refers to feminist ethics lens, looks at relational personhood, and relational solidarity
Many of the decisions we make (ex: deciding to become a nurse, take a new job, etc) are not decisions you make only considering yourself, you consider other people and relationships
Describe relational personhood using its 3 components
relational autonomy (Embraces the fact that we are socially, political and economically dependent on others; not entirely independent)
social justice (move away from distributive justice, and look at access to rights, dignity, access to power; broadening the lens)
relational solidarity (comes up in global health; instead of us and them we want to think of solidarity of all; ex infectious disease)
what has contributed to vaccination hesitancy
Media, AI = ability to shift the message and create misinformation at a large scale
what is the nurse’s responsibility with vaccination hesitancy
Nurses have moral and ethical responsibility to build critical knowledge
what is the ethical principles at play for the ethical question “Should primary schools require mandatory vaccinations?”
Parents autonomy vs benefits to public health
The Case of Environment + Health
4 features
Risks to health
Differential need for evidence
- For public health, actions are taken even if the evidence is uncertain but in the case of climate change evidence is clear
Precautionary principle
- When an activity raises a threat to human health or the environment, precautions should be put into place EVEN with little/direct links.
Facing pushback
- The youth that are going to court are able to showcase a clear link between health and climate health due to risk of harm yet they are still facing pushback
Critical Role of Health Professionals
- Be informed
- Recognize exposure and related health conditions
Ex: implications of climate changes (heat waves and elderly) - Research, publish, and disseminate knowledge
- Prescribe solutions, and educate families and communities
Social prescription: join a group (ex: for loneliness) - Educate colleagues and students
- Advocate solutions to other sectors, policy and decision makers
Achieving planetary health will require what?
Achieving planetary health will require a Great Transition where we all learn to do nearly everything differently, such as:
- How we produce and consume food, manufactured products, and energy
- How we construct and live in our cities
- How we manage our natural landscapes and resources
- And the stories we tell ourselves about our place in the world, our relationship to Nature, and what it means to live a good life (ex: think back to the inidegnous populations)
