Health Promotion and Ethics

1. Health Promotion and Ethics

2. In order to promote health – need to understand different concepts of health. A clear definition of health might be useful NHS 's aim might be thought to do with health care provision Need a clear definition of health to assess this

3. How is health related to disease and illness? Who should decide what constitutes health? Are you healthy or not depend on your decision, feelings, desires? Is it for society to decide as a whole what constitutes health? Lay concept of health part of cultural heritiage and concepts may differ between cultural groups. Disease – existence of pathology/abnormality, capable of detection. Illness – loss of health, e.g aches and pains. However, can be diagnosed with a disease through screening but no illness. It is a subjective experience. Ill Health – Umbrella term for both. (Naidoo and Wills 2000) “Lay view of health shaped by experiences, knowledge, values, expectations and daily role and fitness.” (Ewles and Simnet 2003) Disease – existence of pathology/abnormality, capable of detection. Illness – loss of health, e.g aches and pains. However, can be diagnosed with a disease through screening but no illness. It is a subjective experience. Ill Health – Umbrella term for both. (Naidoo and Wills 2000) “Lay view of health shaped by experiences, knowledge, values, expectations and daily role and fitness.” (Ewles and Simnet 2003)

4. Health definitions - WHO "Health is a state of complete physical, mental and social well-being and not merely the absence of disease;“ (WHO 1946) Is anyone healthy? Motivational reasons Ewles and Simnet (2003) Unrealistic and idealistic i.e “complete.” Implies also a static position. However, embraces a notion of positive health, rather than just the absence of disease (Western scientific model of health (Naidoo and Wills 2000).Ewles and Simnet (2003) Unrealistic and idealistic i.e “complete.” Implies also a static position. However, embraces a notion of positive health, rather than just the absence of disease (Western scientific model of health (Naidoo and Wills 2000).

5. Health definitions - Seedhouse 'A person's health is equivalent to the state of the set of conditions which fulfil or enable a person to work to fulfil his or her realistic chosen and biological potentials'. Personal involvement to shape health Different people talk about different things as being healthy Contributor factors which go towards a person's well being This definition implies that health is a dynamic state – each persons health needs are different. Highlights the changing perspectives in healthcare: Focus on person-centred care Recognition of social and environmental determinants of health 3. Notion of health and well being. (Cribb and Duncan 2003) Therefore, need to assess persons concept of health before considering a HP/HE intervention, otherwise ethical conflict may arise. Smoking cessation and weight reducing diets are classic examples of these. E,gs from Endoscopy? Alcohol intake, adherence to medication regimes, smoking in IBD (conflicting issues!) This definition implies that health is a dynamic state – each persons health needs are different. Highlights the changing perspectives in healthcare: Focus on person-centred care Recognition of social and environmental determinants of health 3. Notion of health and well being. (Cribb and Duncan 2003) Therefore, need to assess persons concept of health before considering a HP/HE intervention, otherwise ethical conflict may arise. Smoking cessation and weight reducing diets are classic examples of these. E,gs from Endoscopy? Alcohol intake, adherence to medication regimes, smoking in IBD (conflicting issues!)

6. Healthy or not? A 6 year old with measles A 42 year old business woman with malaria A 28 year old who has been trying to conceive for six years A 19 year old with a fractured hip

7. Healthy or not? A 22 year old suffering from morning sickness during pregnancy A 52 year old male, a diabetic since childhood, who complains of erectile dysfunction A 25 year old carrier of the sickle cell gene A 25 year old carrier of the Huntingdon's gene

8. The issue of what health is, has vital ethical implications “Health is a good thing, which ought to be promoted” Actions taken by health care workers that promote health are morally good actions Who`s health should be promoted? Is HP good for everyone? Is HP good for everyone?

9. Proactive V`s Reactive Healthcare (Cribb and Duncan 2003) Healthcare generally reactive – a response to something we start. Challenge to professionaL ethics e.g attempting to intervene earlier in the causal chain or disease process. E.g Issue of priority setting for HP, how should efforts be allocated? equal access? Resources available? Students to consider issues of priority setting for HP related to their own area of practice. E.g screeningStudents to consider issues of priority setting for HP related to their own area of practice. E.g screening

10. Need rigorous ethical assessment of our work to provide us with an essential way of reflecting on what we and others do. Need to reflect on aims, approaches and effectiveness of HP. Can use ethical principles to guide our work in healthcare. Danger of conflict between principles e,g smoke free zones People who do not want to give up smoking are being forced to behave in a certain way, removing their autonomy. May also not be in their interests as used as a form of stress relief, also nicotine withdrawal symptoms can be seen as harmful. Not considered just and fair. Ask students to consider ethical People who do not want to give up smoking are being forced to behave in a certain way, removing their autonomy. May also not be in their interests as used as a form of stress relief, also nicotine withdrawal symptoms can be seen as harmful. Not considered just and fair. Ask students to consider ethical

11. The Ethical GridSeedhouse, David. (1998). Ethics: The Heart of Health Care Can use Seedhouse ethical grid to help resolve ethical conflict Can use Seedhouse ethical grid to help resolve ethical conflict

13. Individual Health Bioethics = human rights, civil liberties and individual autonomy approach medicalized system Population Health Public health = utilitarian, paternalistic, social responsibility, communitarian orientation

14. Moral imperative of health promotion to ensure and protect the health of the population and the individual Ethical foundations traditionally implicit in health promotion The right to health? Renewed awareness of conflict between individual rights and community rights Effects of doing or not doing health interventions or “best practices”

15. When and when not to act Judgment, experience, evidence, ethics Experience of Good Public Health Practice Threat of preventable mortality or risk factor When dangers/costs of not acting exceed those of acting Public right to know Public right to protection Individual rights Balance Accountability, transparency

16. Many issues of conflict between good of the individual and good of society Immunization, chlorination, fluoridation Smoking ban in public places Health screening programmes e.g Bowel screening Compulsory seat belt law. Relaxation in availability of alcohol in public places. Cheap alcohol from supermarkets.

17. Responsibility to protect society Responsibility to the individual Individual vs community rights Government responsibility Corporate responsibility Right to health care Personal responsibility - self care Quality of care Freedom of choice

18. Kahan & Goodstadt (Best Practices in Health Promotion Workbook)