A Framework for Ethical Health Promotion Will Beer Joint Chair SHEPS Cymru

Workshop Objectives Values underpinning Ethical Health Promotion (pg. 5-6) Conflicts in ethical Health Promotion practice (pg.7) Individual-state relationship (pg.8) Stewardship Model (pg. 8) Intervention Ladder (pg. 9)

Ice Breaker What do you think are some of the values underpinning Health Promotion practice?

General Ethical Principles Doing Good (Beneficence) act in people’s best interest Avoid Doing Harm (Non-Maleficence ) act in a way that minimises harm Respect Autonomyact so as to maximise freedom & self-governance Justiceact fairly

Ultimate Goals of Health Promotion Basic human right a resource to satisfy needs & realise aspirations Holistic well-being with physical, mental and social dimensions Equity avoiding unfair or unjust inequalities in health Empowerment enabling individuals & community to increase control over health determinants

Ways of Working in Health Promotion Capacity Building Trust Needs Led Anti Discrimination Partnership Responsibility Sustainability

Individual-State Relationship Bioethics focus on individual-clinician relationship Health promotion focus is on populations Responsibility and authority of the state Libertarian versus collectivist perspective Victim-blaming, paternalism, nanny state Liberal state in Western societies

Ethical Conflicts Simultaneously doing good and avoiding harm State responsibility and protection of personal autonomy Sacrificing rights of some in the interest of welfare overall Greatest good for the greatest number or reducing health inequalities

Workshop Activity (1) Individual-State Relationship

Nuffield Council on Bioethics Stewardship Model: Reduce risks people pose to each other Ensure environments help sustain good health Special attention to children & vulnerable groups Programmes, not just information and advice Ensure healthy choices are the easy choices Appropriate access to health services Reduce unfair health inequalities

Intervention Ladder Eliminate choice e.g. ban smoking in public places, drink-driving laws, fluoridation of water Restrict choice e.g. industry limits on the fat, salt and sugar content of processed food Guide choice through disincentives e.g. tax on cigarettes, congestion charges, car parking fees Guide choice through incentives e.g. tax-breaks on the purchase of bicycles to promote green travel plans Guide choice through changes in policy e.g. local planning authorities policies on transport, school catering policies Enable choice e.g. stop smoking clinics, cycles routes, fruit tuck shops in schools Provide information e.g. sex education in schools, mass-media campaigns Do nothing or monitor the situation e.g. surveillance of population health

Workshop Activity (2) Ethical Dilemmas

Conclusion Scientific paradigm and evidence-based practice is dominant in public health Science tells the things that can be done & ethics tells us what should be done In practice we often rely on ethical principles and theory Need to think about ethical practice in job descriptions, induction, academic courses, registration/regulation, training, reflective practice, etc, etc.