Let's get ethical

Public health is getting a new code of ethics.

Researchers announced the release of the new APHA Public Health Code of Ethics during a Monday session at APHA’s 2019 Annual Meeting and Expo in Philadelphia. The release marks the first update of the ethics document since 2002, when health researchers working with the Public Health Leadership Society released the original principles for ethical public health practice. APHA adopted the code’s principles and published them in its American Journal of Public Health.

So why does public health need a new ethics code? What was wrong with the old one? Well, some professionals complained that the previous version lacked vision, but the big reason is that approaches and issues have changed dramatically in public health, and a code of ethics 2.0 was needed to address those changes.

Over the last two decades, greater understanding has developed involving the social determinants of health, structural racism, and racial and gender bias. Addressing those issues is a big part of public health today.

Moreover, social inequity has ballooned since the Great Recession of 2007, creating more hardship for low-income people and minorities, Amy Fairchild, dean of the Ohio State University College of Public Health, told session attendees.

Job descriptions of public health workers have also changed, as many take positions in the private sector. The days when most new graduates joined a state or federal health agency with specific and similar tasks and challenges are gone.

Seeing the changes, leaders formed an APHA task force in 2014 — led by the APHA Ethics Section — to develop a code in line with the evolving public health landscape.

The new APHA Public Health Code of Ethics has four sections that list and discuss shared foundational values and offers ethical guidance for actions and implementation strategies. The code can help professionals address a number of squirmy ethical issues.

For example:

• How far should “tough love” go when trying to change unhealthful behavior in a marginalized group? Should a successful health program be scrapped because aspects of it might be interpreted as demeaning or disrespectful to individuals or communities?
• Do public health researchers do enough to offset potential negative outcomes after implementing a program? Are public health workers using their power and authority judiciously and with humility?
• Where should lines be drawn?

The APHA Public Health Code of Ethics aims to help health workers and researchers grapple with complex situations that butt heads with ethics.

“It is meant to stimulate a conversation about ethics that might not otherwise have occurred,” said Bruce Jennings, an adjunct associate professor in the Center for Biomedical Ethics and Society at the Vanderbilt Medical Center.

The code is not a disciplinary or regulatory document, speakers at the session emphasized. Its purpose is not to impact disciplinary proceedings or sanction professional misconduct.

“The document is a statement to the public about who we are” in public health, said Lisa Lee, associate vice president for research and innovation at Virginia Tech.

“I hope that the new code encourages and inspires people to engage in difficult conversations," Selena Ortiz, an assistant professor of health policy and administration at Penn State, said in an interview Monday. "[People can] look to the code as a resource or as a tool to help frame those discussions.”