Ethical dilemma in public health

Ethical dilemma in public health

Ethical dilemma in public health

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Discussion: “Current event” ethical dilemma in public health

Focus on a “current event” ethical dilemma in public health. Apply the principles of the ethical practices of public health to resolve the issue (see page 125 of the textbook). You may integrate recommendations based on conclusions from public health acts and principles to support your position. Select three other peers’ postings and provide feedback on the presented resolution. Offer further suggestions, details, or examples.

Background

Emergencies and disasters impact population health, as we face diverse hazards influenced by complexities in our environment, demographics and social constructs. Novel and re-emerging infectious diseases continue to cause morbidity and mortality and can rapidly spread beyond borders. In Canada, wildfires have resulted in large population evacuations, air pollution and deaths [1–3]; floods are an annual risk causing displacement of Indigenous communities, urban infrastructure damage and adverse health impacts [4–6]. The 2013 Lac-Mégantic train derailment and explosion resulted in 47 deaths, environmental contamination, and adverse mental health impacts [7, 8]. Reducing risks and the short and long-term impacts of all-hazards emergencies on population health is a key responsibility for the public health sector [9, 10]. Public health plays a critical role in working with health and non-health sectors responsible for preparing for and responding to emergencies, yet have limited resources and competing priorities in delivering community health protection and promotion programs. While emergencies tend to raise awareness about the significance of being prepared, public health agency readiness activities operate largely in the background until an event occurs. Despite the importance of upstream readiness, a persistent challenge for public health practitioners is defining what it means to be prepared [11–14].

Defining preparedness using an evidence-informed approach is challenging, due to the general lack of evidence to inform disaster risk reduction (DRR) for public health [15]. To our knowledge, there are few published frameworks for public health emergency preparedness (PHEP) or DRR which used empirical methods in derivation [11, 16–20]. Some frameworks reflect authors’ opinion [11], others describe some form of stakeholder consultation process; however, the methodology used to achieve consensus lacks detail [17, 21] and there is no widely accepted framework that can be used to guide and compare efforts.

In reviewing the extant literature, we note most country-specific PHEP frameworks were developed in the United States (US) and have unclear relevance to other settings with substantially different health systems and governance structures [16, 22, 23]. Outside the US, the European Centres for Disease Control has adapted a US model [19, 24] in considering core competencies for cross-border threats across the European Union [20, 25]. Globally, there are a number of frameworks and initiatives that have relevance to PHEP and DRR [26–28]. The World Health Organization (WHO) framework to inform emergency preparedness is based on consultation with global stakeholders and lessons learned [28]. The framework is designed to be relevant to health systems globally and emphasizes national, subnational and local connections. The United Nations Sendai Framework for DRR has four key priorities and takes a whole-of-society approach [27]. It expands on its predecessor, the Hyogo Framework, with specific reference to the health impacts of disasters and reducing risks. These frameworks highlight the importance of national action and global collaboration to improve health system preparedness and reduce disaster risks; however, empirically-derived and contextually-relevant evidence to inform public health actions for local/regional public health agencies remains a knowledge gap.