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Ethical Analysis of Public Health Programmes: What Does It Entail?

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Ethics in Public Health Practice in India

Abstract

While several professions have ethical guidelines set by their own professional bodies, such guidance is often not available for implementation of public health programmes. Therefore, very often, ethical perspectives involving the public health programmes (PHPs) are neglected. As a result, several ethical issues arise during the implementation phase. This chapter examines three key principles, namely, respect to persons, beneficence, and justice, and explores its applicability to public health practice. It analyse this framework using three case studies: the Revised National Tuberculosis Control Program (RNTCP), introduction of Human Papilloma Virus (HPV) vaccines in India, and polio eradication (PE) programme. We used the published literature, reports of ongoing national programmes, and documents outlining ethical principles published by national and international organizations to analyse the components of the framework. Each case study informs the multifaceted dimensions of ethical issues and challenges associated with a specific programme. In the absence of clearly developed guidance, we illustrate how using our proposed framework can identify and resolve ethical issues in the existing public health programmes.

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Notes

  1. 1.

    The population in the age group was estimated from the data available from http://mhrd.gov.in/sites/upload_files/mhrd/files/statistics/PopulationProjection2016%20uated.pdf.

References

  • Aneja, H., & Puliyel, J. (2009). Selling vaccines: Deciding on who can afford HPV. Indian Pediatrics, 46(7), 647.

    Google Scholar 

  • Association WM. (1964). Declaration of Helsinki. Ethical principles for medical research involving human subjects. Adopted by the 18th world medical association general assembly. Helsinki, Finland.

    Google Scholar 

  • Attaran, A. (2005). An immeasurable crisis? A criticism of the millennium development goals and why they cannot be measured. PLoS Medicine, 2(10), e318.

    Article  Google Scholar 

  • Babu, G. R. (2008). Comment on ‘From risk factors to explanation in public health’. Journal of Public Health.

    Google Scholar 

  • Babu, G. R. (2009). Response to ‘Cancer incidence rates among South Asians in four geographic regions: India, Singapore, UK and US’. International Journal of Epidemiology, 38(4), 1157–1158. https://doi.org/10.1093/ije/dyn119.

    Article  Google Scholar 

  • Babu, G. R. (2012a). Evidence for health policy in India: Do we have enough data? Journal of Royal Society of Medicine, 105(9), 365–365.

    Article  Google Scholar 

  • Babu, G. R. (2012b). Evidence for health policy in India: Do we have enough data? Journal of the Royal Society of Medicine, 105(9), 365.

    Article  Google Scholar 

  • Babu, G. R., & Laxminarayan, R. (2012). The unsurprising story of MDR-TB resistance in India. Tuberculosis, 92(4), 301–306. https://doi.org/10.1016/j.tube.2012.02.009.

    Article  Google Scholar 

  • Babu, G. R., & Murthy, G. (2011). “To use or not to use”-dilemma of developing countries in introducing new vaccines. Journal of Global Infectious Diseases, 3(4), 406.

    Article  Google Scholar 

  • Babu, G. R., Tn, S., Bhan, A., Lakshmi, J., & Kishore, M. (2014). An appraisal of the tuberculosis programme in India using an ethics framework. Indian Journal of Medical Ethics, 11(1), 11–15.

    Google Scholar 

  • Basu, M. (2006). The relevance of cervical cancer screening and the future of cervical cancer control in India in the light of the approval of the vaccine against cervical cancer. Indian Journal of Cancer, 43(3), 139.

    Article  Google Scholar 

  • Baum, N. M., Gollust, S. E., Goold, S. D., & Jacobson, P. D. (2007). Looking ahead: Addressing ethical challenges in public health practice. Los Angeles: Sage.

    Google Scholar 

  • Baum, N. M., Gollust, S. E., Goold, S. D., & Jacobson, P. D. (2009). Ethical issues in public health practice in Michigan. American Journal of Public Health, 99(2), 369–374.

    Article  Google Scholar 

  • Begum, V., Van Der Werf, M. J., Becx-Bleumink, M., & Borgdorff, M. W. (2007). Viewpoint: Do we have enough data to estimate the current burden of tuberculosis? The example of Bangladesh. Tropical Medicine & International Health, 12(3), 317–322.

    Article  Google Scholar 

  • Bernheim, R. G. (2003). Public health ethics: The voices of practitioners. The Journal of Law, Medicine & Ethics, 31(s4), 104–109.

    Article  Google Scholar 

  • Bernheim, R. G., Nieburg, P., & Bonnie, R. J. (2007). Ethics and the practice of public health. Law in Public Health Practice, 110–135.

    Google Scholar 

  • Bernheim et al. (2009) (January 2016). Adapted summary of a public health ethics framework Bernheim et al. (2009) Ethics and the practice of public health. Available at: http://www.ncchpp.ca/docs/2016_eth_frame_bernheim_En.pdf.

  • Bhatla, N., & Moda, N. (2009). The clinical utility of HPV DNA testing in cervical cancer screening strategies. The Indian Journal of Medical Research, 130(3), 261.

    Google Scholar 

  • Bhaumik, S., & Biswas, T. (2012). India makes tuberculosis a notifiable disease. Canadian Medical Association Journal, 184(10), E519–E520.

    Article  Google Scholar 

  • Biomedical NCft PoHSo & BR. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. Department of Health, Education, and Welfare.

    Google Scholar 

  • Caplan, A. L. (2009). Is disease eradication ethical? The Lancet, 373(9682), 2192–2193.

    Article  Google Scholar 

  • Chauhan, L., & Agarwal, S. (2005). Revised national tuberculosis control programme. Tuberculosis Control in India, p. 23.

    Google Scholar 

  • Childress, J. F., Faden, R. R., Gaare, R. D., Gostin, L. O., Kahn, J., Bonnie, R. J., et al. (2002). Public health ethics: Mapping the terrain. The Journal of Law, Medicine & Ethics, 30(2), 170–178.

    Article  Google Scholar 

  • Control Gt. (2011). W. report. pp. 25–26. Available at: http://whqlibdoc.who.int/publications/2011/9789241564380_eng.pdf. Accessed 26th October 2012.

  • Detels, R., McEwen, J., Beaglehole, R., & Tanaka, H. (1999). Epidemiology: The foundation of public health. Oxford textbook of public health.

    Google Scholar 

  • Dewan, P. K., Lal, S., Lonnroth, K., Wares, F., Uplekar, M., Sahu, S., et al. (2006). Improving tuberculosis control through public-private collaboration in India: Literature review. BMJ, 332(7541), 574–578.

    Article  Google Scholar 

  • Dhillon, P., Yeole, B., Dikshit, R., Kurkure, A., & Bray, F. (2011). Trends in breast, ovarian and cervical cancer incidence in Mumbai, India over a 30-year period, 1976–2005: An age–period–cohort analysis. British Journal of Cancer, 105(5), 723.

    Article  Google Scholar 

  • Dye, C., Maher, D., Weil, D., Espinal, M., & Raviglione, M. (2006). Targets for global tuberculosis control. International Journal of Tuberculosis and Lung Disease, 10(4), 460.

    Google Scholar 

  • Dye, C., Bassili, A., Bierrenbach, A., Broekmans, J., Chadha, V., Glaziou, P., et al. (2008). Measuring tuberculosis burden, trends, and the impact of control programmes. The Lancet Infectious Diseases, 8(4), 233–243.

    Article  Google Scholar 

  • Eradication ITF FD Control, CFD, & Prevention. (1993). Recommendations of the International task force for disease eradication. US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC).

    Google Scholar 

  • Forman, D., Bray, F., Brewster, D., Gombe Mbalawa, C., Kohler, B., & Piñeros, M. (2017) Cancer incidence in five continents (Vol. X, electronic version). Lyon: International Agency for Research on Cancer. 2013.

    Google Scholar 

  • Goodchild, M., Sahu, S., Wares, F., Dewan, P., Shukla, R. S., Chauhan, L. S., et al. (2011). A cost-benefit analysis of scaling up tuberculosis control in India. The International Journal of Tuberculosis and Lung Disease, 15(3), 358–362 http://www.ingentaconnect.com/content/iuatld/ijtld/2011/00000015/00000003/art00011.

    Google Scholar 

  • Gorman, S. (2013) ‘Is disease eradication always the best Path?’. March 20, 2013. Plos Medicine Pathogens Neglected Tropical Disease.

    Google Scholar 

  • Government of India. (2017). ‘‘Revised national TB control program annual status report.’’ New Delhi, Central TB Division, Directorate general of health services, ministry of health and family welfare.

    Google Scholar 

  • Haug, C. J. (2008a). Human papillomavirus vaccination – Reasons for caution. New England Journal of Medicine, 359(8), 861–862. https://doi.org/10.1056/NEJMe0804638.

    Article  Google Scholar 

  • Haug, C. J. (2008b) Human papillomavirus vaccination – Reasons for caution. Mass Medical Soc.

    Google Scholar 

  • Hussain, R. S., McGarvey, S. T., Shahab, T., & Fruzzetti, L. M. (2012). Fatigue and fear with shifting polio eradication strategies in India: A study of social resistance to vaccination. PLoS One, 7(9), e46274.

    Article  Google Scholar 

  • John, T. J. (1976). Antibody response of infants in tropics to five doses of oral polio vaccine. British Medical Journal, 1(6013), 812.

    Article  Google Scholar 

  • John, T. J., & Vashishtha, V. M. (2012). Path to polio eradication in India: A major milestone. Indian Pediatrics, 49(2), 95–98.

    Article  Google Scholar 

  • Kaarthigeyan, K. (2012). Cervical cancer in India and HPV vaccination. Indian Journal of Medical and Paediatric Oncology, 33(1), 7–12. https://doi.org/10.4103/0971-5851.96961.

    Article  Google Scholar 

  • Kass, N. E. (2001). An ethics framework for public health. American Journal of Public Health, 91(11), 1776–1782.

    Article  Google Scholar 

  • Kim, J. J., & Goldie, S. J. (2008). Health and economic implications of HPV vaccination in the United States. New England Journal of Medicine, 359(8), 821–832. https://doi.org/10.1056/NEJMsa0707052.

    Article  Google Scholar 

  • LaMontagne, D. S., & Sherris, J. D. (2013). Addressing questions about the HPV vaccine project in India. The Lancet Oncology, 14(12), e492.

    Article  Google Scholar 

  • Lippman, A., Melnychuk, R., Carolyn Shimmin, B., Boscoe, M., & DU, R. (2007a). Human papillomavirus, vaccines and women’s health: Questions and cautions. Canadian Medical Association Journal, 177(5), 484–487.

    Article  Google Scholar 

  • Lippman, A., Melnychuk, R., Shimmin, C., & Boscoe, M. (2007b). Human papillomavirus, vaccines and women's health: Questions and cautions. Canadian Medical Association Journal, 177(5), 484–487.

    Article  Google Scholar 

  • Madhavi, Y., Puliyel, J. M., Mathew, J. L., Raghuram, N., Phadke, A., Shiva, M., et al. (2010). Evidence-based National Vaccine Policy.

    Google Scholar 

  • Mattheij, I., Pollock, A., & Brhlikova, P. (2012a). Do cervical cancer data justify HPV vaccination in India? Epidemiological data sources and comprehensiveness. Journal of the Royal Society of Medicine, 105(6), 250–262.

    Article  Google Scholar 

  • Mattheij, I., Pollock, A., & Brhlikova, P. (2012b). Do cervical cancer data justify HPV vaccination in India? Epidemiological data sources and comprehensiveness. Journal of the Royal Society of Medicine, 105(6), 250–262.

    Article  Google Scholar 

  • Minor, P. (2009). Vaccine-derived poliovirus (VDPV): Impact on poliomyelitis eradication. Vaccine, 27(20), 2649–2652.

    Article  Google Scholar 

  • Monie, A., Hung, C.-F., Roden, R., & Wu, T. C. (2008). Cervarix(™): A vaccine for the prevention of HPV 16, 18-associated cervical cancer. Biologics: Targets & Therapy, 2(1), 107–113 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727782/.

    Google Scholar 

  • Nair, N., Wares, F., & Sahu, S. (2010). Tuberculosis in the WHO South-East Asia region. Bulletin of the World Health Organization, 88, 164–164 http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862010000300004&nrm=iso.

    Article  Google Scholar 

  • Nelson–Rees, W. A. (2001). Responsibility for truth in research. Philosophical Transactions of the Royal Society of London Series B: Biological Sciences, 356(1410), 849–851.

    Article  Google Scholar 

  • Paul, Y. (2004). Need for re-appraisal of acute flaccid paralysis (AFP) case classification. Vaccine, 22(29), 3829–3830.

    Article  Google Scholar 

  • Paul, Y. (2005a). Polio eradication programme: some ethical issues. Indian Journal of Medical Ethics, 2(4), 115–116.

    Google Scholar 

  • Paul, Y. (2005b). Polio eradication: Let us face the facts and accept the reality. Indian Pediatrics, 42(7), 728.

    Google Scholar 

  • Paul, Y., & Dawson, A. (2005). Some ethical issues arising from polio eradication programmes in India. Bioethics, 19(4), 393–406.

    Article  Google Scholar 

  • Porter, J., & Ogden, J. (1997). Ethics of directly observed therapy for the control of infectious diseases. Bulletin de l’Institut Pasteur, 95(3), 117–127.

    Article  Google Scholar 

  • Rajeswari, R., Balasubramanian, R., Muniyandi, M., Geetharamani, S., Thresa, X., & Venkatesan, P. (1999). Socio-economic impact of tuberculosis on patients and family in India. The International Journal of Tuberculosis and Lung Disease, 3(10), 869–877.

    Google Scholar 

  • Ramanathan, M., & Varghese, J. (2010). The HPV vaccine demonstration projects: We should wait, watch and learn.

    Google Scholar 

  • Rastogi, T., Devesa, S., Mangtani, P., Mathew, A., Cooper, N., Kao, R., et al. (2007). Cancer incidence rates among south Asians in four geographic regions: India, Singapore, UK and US. International Journal of Epidemiology, 37(1), 147–160.

    Article  Google Scholar 

  • Roberts, M. J., & Reich, M. R. (2002). Ethical analysis in public health. The Lancet, 359(9311), 1055–1059.

    Article  Google Scholar 

  • Rothman, K. J., Greenland, S., & Lash, T. L. (2008). Modern epidemiology. Philadelphia: Lippincott Williams & Wilkins.

    Google Scholar 

  • Sarojini, N., Srinivasan, S., Madhavi, Y., Srinivasan, S., & Shenoi, A. (2010). The HPV vaccine: Science, ethics and regulation. Economic and Political Weekly, 45(27), 27–34.

    Google Scholar 

  • Sciences CfIOoM. (2002). International ethical guidelines for biomedical research involving human subjects. Bulletin of Medical Ethics, 182.

    Google Scholar 

  • State, C. o., Epidemiologists, T., Gostin, L. O., & Hodge, J. G. (2004). Public health practice vs. Research: A report for public health practitioners including cases and guidance for making distinctions. Council of State and Territorial Epidemiologists.

    Google Scholar 

  • Sumner, A. (2012). Where do the poor live? World Development, 40(5), 865–877. https://doi.org/10.1016/j.worlddev.2011.09.007.

    Article  Google Scholar 

  • Swaminathan, R., Shanta, V., Ferlay, J., Balasubramanian, S., Bray, F., & Sankaranarayanan, R. (2011). Trends in cancer incidence in Chennai city (1982–2006) and statewide predictions of future burden in Tamil Nadu (2007–16).

    Google Scholar 

  • Van Der Werf, M. J., & Borgdorff, M. W. (2007). How to measure the prevalence of tuberculosis in a population. Tropical Medicine & International Health, 12(4), 475–484.

    Article  Google Scholar 

  • WHO. (1991). Forty-fourth World Health Assembly, Resolutions and decisions. Resolution WHA 44.8. Geneva: World Health Organization. Report No. WHA44/1991/REC/1.

    Google Scholar 

  • WHO. (2005). Vaccine introduction guidelines: Adding a vaccine to a national immunization programme: Decision and implementation.

    Google Scholar 

  • Yang, D. Y., & Bracken, K. (2016). Update on the new 9-valent vaccine for human papillomavirus prevention. Canadian Family Physician, 62(5), 399–402 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865336/.

    Google Scholar 

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Authors and Affiliations

  1. Public Health Foundation of India, Indian Institute of Public Health-Hyderabad, Bengaluru, India

    Giridhara R. Babu & A. Yamuna

  2. Wellcome Trust-DBT India Alliance, Hyderabad, India

    Giridhara R. Babu

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  1. Giridhara R. Babu
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  2. A. Yamuna
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Editors and Affiliations

  1. School of Development, Azim Premji University, Bangalore, India

    Arima Mishra

  2. International Health Program, Curtin University, Perth, Australia

    Kalyani Subbiah

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Babu, G.R., Yamuna, A. (2018). Ethical Analysis of Public Health Programmes: What Does It Entail?. In: Mishra, A., Subbiah, K. (eds) Ethics in Public Health Practice in India. Springer, Singapore. https://doi.org/10.1007/978-981-13-2450-5_4

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