In this article Stacy Carter (2014) argues that the ‘most pressing’ issue regarding ethics in health promotion is deciding how to promote good health in communities in a way that both engages with and allocates responsibility to citizens and the state. She highlights the similarities and differences in ethical requirements between bioethical principles, within the medical treatment field, and those in health promotion which are more nuanced and is described as a ‘normative ideal’.
Healthcare professionals have multiple, but closely related, roles in ensuring that good ethical standards are maintained within health promotion across the spectrum. Firstly, they must ensure that any initiative does not cause harm to any citizen and that interventions or practices are made available to all in the community who need them. Secondly, they must ensure that whatever action is taken it is established to be necessary. A third responsibility of the healthcare professional is to ensure that any strategy chosen does not impose undue burden on people and that it is not coercive, and also that both benefits and burdens are equally distributed across those involved. The fourth area of responsibility is in relation to communication with the community and the healthcare professional is expected to communicate honestly and openly and to be transparent in their decision making. In this way they can promote positive relationships with the public and work towards a collaborative approach to improving health and wellbeing amongst those in the community as a whole.
These responsibilities are reflected in a number of international ethical codes set out by the World Health Organisation including the Ottawa Charter for Health Promotion (1986) and the WHO’s global strategy for health published in 1981. These documents outline the role of the citizen as co-creator and active participant in health promotion initiatives and envisions a collaborative and equal distribution of health promotion practices and responsibilities. In light of these charters and guidelines a number of theories have been proposed that outline the role of health promotion from the perspectives of both providers and citizens and how responsibility should (or could) be distributed.
Carter (2014) suggests three of these theoretical frameworks as being relevant to the debate on communication and responsibility sharing within health promotion strategies. These frameworks range from the notion that citizens should have the freedom to impose their own values of a healthy life without state interference (David Seedhouse), to the argument that health promotion should encompass all aspects of wellbeing and citizens should be supported and guided in their health related decision making (David Buchanan) to the stance that health promotion should be strictly defined according to the particular aspect of health it is aimed at improving and that individual’s should not be held responsible for illnesses that have multiple and complex origins and influences (Alan Cribb).
Carter also argues for what health promotion should not be, in light of the theoretical frameworks described and the roles of the healthcare professional as outlined above. In essence she views approaches that are focused only on the individual (not the community) and those that impose personal responsibility only (e.g. weight control as an individual effort not affected by environmental factors) as going against the principles of inclusivity, shared responsibility, holistic approaches, and positive relationship building that should be the focus on health promotion. At heart the argument that Carter makes in support of a normative, procedurally just, approach to health promotion suggests that traditional, mostly statistical, methods of measuring outcomes of initiatives are insufficient to truly reflect the impacts of health promotion as a means of including all members of society in improving their wellbeing and that of other citizens in a collaborative manner.
- Carter, S. (2014). Health promotion: An ethical analysis. Health Promotion Journal of Australia, 25, 19-24. Doi: 10.1071/HE13074
- World Health Organisation (1981). Global strategy for health for all by 2000. Geneva: World Health Organisation
- World Health Organisation (1986). First international conference on health promotion. Ottawa charter for health promotion. Ottawa: World Health Organisation.