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Thursday 19 April 2012


James Thomas, PhD, MPH
Associate Professor, Department of Epidemiology
Director, Program in Public Health Ethics
University of North Carolina, Chapel Hill
Public Health Leadership Society

A number of skills are foundational to public health ethics. Essentially all of the principles of the Code
of Ethics assume or rely upon these skills. Rather than list them repeatedly under each principle, we
have separated them out to highlight them as foundational skills. They are as follows:
1. The ability to identify an ethical issue.
2. Ethical decision-making. This is a skill both for individuals and agencies (where it would be a
group process). One component of the decision-making process is an identification and weighing
of harms and benefits of the potential actions. In economics this is a cost-benefit analysis, but in
ethics harms that defy financial quantification must also be included among the costs.
3. Understanding the full spectrum of the determinants of health. This understanding is necessary to
identify the best means of prevention. Thus a biologist needs to understand social factors affecting
health and a sociologist needs to have a basic understanding of biological processes.
4. Understanding basic ethical concepts such as justice, virtue, and human rights.
5. Building and maintaining public trust. Public health agencies cannot function well in the absence of
public trust. Many of the individual ethical skills function to maintain that trust. Yet, in some instances,
one may be ethically justified to take a particular course of action that won’t build public
trust. Thus, what a person or agency ethically can do may be different from what it should do to cultivate
Resources for teaching the skills
The list of skills is an instrument that most students or employees are unlikely to ever see. Rather it is
meant to guide decisions in what they do see, hear, or experience when teachers or supervisors are planning
what will be taught about ethics in public health. What, then, are the study aids for teaching the
ethics skills? We provide along with the skills an annotated list of resources. In contrast to the list of
skills, the resources are organized according the public health competencies. This was done because
when presented by the principals in the Code of Ethics, some skills appear under more than one principal;
but when organized by the competencies, each skill appears only once. However, we needed to add
another competency focusing expressly on public health ethics, which you will find towards the end of
the resources document. This new competency category is composed of skills that did not apply directly
to the other competencies.
Foundational Ethical Skills
© 2004 Public Health Leadership Society
􀂙 A new skill
􀁽 An edited skill from the Core Competencies (edits in italics)
• A skill from the Core Competencies
1. Public health should address principally the fundamental causes of disease and requirements for
health, aiming to prevent adverse health outcomes.
􀂙 Recognizes the ethical value the public health community gives to prevention.
􀂙 Considers the full spectrum of the determinants of health.
􀂙 Identifies the range of options for interventions that correspond to the full spectrum of determinants
of health.
2. Public Health should achieve community health in a way that respects the rights of individuals in
the community.
􀂙 Recognizes the tension between community health and rights of individuals.
􀂙 Identifies the various conceptions of human rights, including those of the community.
􀂙 Defines the legal authority of public health agencies.
􀁽 Articulates the health, fiscal, administrative, legal, social and political implications of each
policy for vulnerable populations.
3. Public health policies, programs and priorities should be developed and evaluated through processes
that ensure an opportunity for input from community members.
􀂙 Considers the values of diverse stakeholders when conducting needs assessments and
• Utilizes appropriate methods for interacting sensitively, effectively, and professionally with
persons from diverse cultural, socioeconomic, educational, racial, ethnic and professional
backgrounds, and person of all ages and lifestyle preference.
• Solicits input from individuals and organizations.
• Attitude: Understands the dynamic forces contributing to cultural diversity.
• Identifies the role of cultural, social and behavioral factors in determining the delivery of
public health services.
4. Public health should advocate and work for the empowerment of disenfranchised community
members, aiming to ensure that the basic resources and conditions necessary for health are accessible
to all.
􀂙 Recognizes the ways that advocacy and empowerment can be done.
􀂙 Represents the needs and perspectives of all relative stakeholders with particular attention
to the disenfranchised.
Skills for the Ethical Practice of Public Health
© 2004 Public Health Leadership Society
􀂙 Describes issues of access and barriers to public health services.
􀂙 Recognizes the ethical priority the Public Health community gives to the health of the disenfranchised.
• Solicits input from individuals and organizations.
• Partners with communities to attach meaning to collected quantitative and qualitative data.
• Collaborates with community partners to promote the health of the population.
• Advocates for public health programs and resources.
• Identifies community assets and available resources.
5. Public health should seek the information needed to implement effective policies and programs
that protect and promote health.
􀂙 Determines research priorities with an understanding of areas of the community that have
been underserved.
􀁽 Articulates the health, fiscal, administrative, legal, social and political implications of each
policy for vulnerable populations.
• Collects, summarizes, and interprets information relevant to an issue.
• Develops mechanisms to monitor and evaluate programs for their effectiveness and quality.
• Defines, assesses, and understands the health status of populations, determinants of health
and illness, factors contributing to health promotion and disease prevention, and factors
influencing the use of health services.
• Identifies and applies basic research methods used in public health.
• Applies the basic public health sciences including behavioral and social sciences, biostatistics,
epidemiology, environmental public health and prevention of chronic and infectious
diseases and injuries.
• Identifies and retrieves current relevant scientific evidence.
• Identifies the limitations of research and the importance of observation and interrelationships.
6. Public health institutions should provide communities with the information they have that is
needed for decisions on policies or programs and should obtain the community’s consent for their
􀂙 Specifies the meaning of consent at the individual and group level.
􀂙 Identifies the range of options for obtaining consent at the individual and group level.
􀂙 Recalls historical abuses of informed consent.

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