Te Ture
Whakaruruhau
Code of Ethical Principles for
Public Health in Aoteroa in
New Zealand
August 2012
Structure of presentation
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Why are ethical principles for public health important?
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Examples of ethical issues in public health practice
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Public health ethics in New Zealand
•
Te Ture Whakaruruhau: PHA Code of Ethical Principles for
Public Health in Aoteroa New Zealand
•
Starting conversations about public health ethics in New
Zealand
Public health ethics
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Measures to protect and promote public health often raise
questions about the complex relationship between the state and
the lives of individuals and communities.
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There is a substantial body of work about the relationship
between the state and the individual, e.g. libertarian or
collective political philosophies.
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The field of bioethics has also become increasingly important,
but much of this work discusses ethics at the individual level.
Public health ethics
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Public health measures are directed at the population level, and
require special consideration.
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Public health practice must balance:
 Actions to improve public health such as education, surveillance,
interventions and regulations; with
 Actions that might restrict the freedoms of individuals and communities.
Examples of ethical issues in
public health
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Communicable disease
 Reconciling individual consent with community benefits, e.g. vaccination,
surveillance and treatment
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Non-communicable disease
 Policies and interventions with long-term benefits are sometimes difficult to
match with shorter-term government priorities
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Alcohol and tobacco
 Societal interventions can be introduced to address the substantial harm to
the community caused by people who drink excessive amounts of alcool
 A range of interventions are available to reduce the harm from regular
smoking to individuals and those around them
Examples of ethical issues in
public health
•
Community-water fluoridation
 Water fluoridation has been in place for over 50 years in many
countries
 The benefits of fluoridation have been difficult to quantify because
of residential movement and the use of other sources of fluoride
•
Ethical issues associated with community-water fluoridation
 Balancing risks and benefits
 Are there other interventions (e.g. improved dental care) that
achieve the same outcome
 The role of consent
PHA Code of Ethical Principles for
Public Health
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The PHA has recently developed a ‘living’ Code of Ethical
Principles for Public Health.
•
The Code has been developed to help public health
practitioners consider ethical issues relevant to public health in
NZ.
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The Code includes ethical principles for public health practice in
New Zealand.
•
The Code also includes a list of questions to consider when
developing a policy, programme or project.
Principles in the PHA Code
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Maori-specific principles
 Manaakitanga (respect for
others)
 Rangatiratanga (selfdetermination for Māori)
 Whanaungatanga (obligations of
being part of a collective)
 Kotahitanga (unity of purpose
and direction)
•
Generic principles
 Solidarity/social capital
 Acting for the benefit for others
 Social justice
 Honesty
Questions to ask in policy,
programme and project planning
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What is the evidence that the policy, programme or project will
improve public health and reduce ethnic and socioeconomic
health inequalities?
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How does the policy, programme or project reflect the
aspirations of Māori?
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What are the ethical principles (both Māori-specific and general)
raised by the policy, programme and project planning?
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How can these ethical issues be addressed?
Four ways to start the
conversation about public health
ethics
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How do we weave together general and Māori-specific public
health ethical principles?
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How do we collect the evidence on how we consider public
health ethics in New Zealand?
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How can we think systematically about including public health
ethical principles we make decisions about new policies,
programmes or projects?
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How can we integrate public health ethics into organisational
practices?
Contact
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keriata@pha.org.nz