Locating Public Health Ethics

  • Arima MishraEmail author
  • Kalyani Subbiah


Several global health challenges including emergencies like Ebola, environmental disasters, rising epidemic of noncommunicable diseases, and persisting health inequities, among others, have raised serious concerns about public health goals and practices and necessitate an ethical lens to the “lessons learned” from such challenges. The last two decades or so have witnessed an increasingly explicit engagement with public health ethics in academic and professional forums trying to carve out a distinct field of inquiry – distinct from clinical and bioethics though sharing a historical legacy with these two fields. This chapter joins this conversation to map this emerging field of inquiry in the context of public health goals and values, and examine its implications in the context of India. The chapter shows how ethics is at the heart of public health practice and the methodology of doing public health ethics demands a critical and reflective lens that discerns ethical dilemmas/challenges in everyday practice and resolved through individual and collective deliberations. Ethics in public health practice is hence not a one-off activity of seeking ethical approval for research. It involves application of an ethical reasoning in all components of practice including policy making, program design/implementation/monitoring/evaluation, different kinds of research, and communication and advocacy.


  1. Alliance for Health Systems and Policy Research. (2007). What is Health Policy and Systems Research and why does it matter? Geneva: World Health Organization. HPSR-Briefing Note 1. Accessed on August 17, 2017.Google Scholar
  2. Allmark, P., Tod, A., & Abbott, J. (2010). The evaluation of public health initiatives on smoking and lung cancer: An ethical critique. In S. Peckham & A. Hann (Eds.), Public health ethics and practice. Cambridge: Polity Press.Google Scholar
  3. Anand, S., & Hanson, H. (2004). Disability adjusted life year: a critical review. In S. Anand, F. Peter, & A. Sen (Eds.), Public health, ethics and equity (pp. 183–200). Delhi: Oxford University Press.Google Scholar
  4. Anand, S., Peter, F., & Sen, A. (Eds.). (2004). Public health, ethics and equity, introduction. Delhi: Oxford University Press.Google Scholar
  5. Babu, G., et al. (2014). An appraisal of the tuberculosis programme in India using an ethics framework. Indian Journal of Medical Ethics, XI(1).Google Scholar
  6. Balrajana, Y., Selvaraja, S., & Subramanian, S. C. (2011). Health care and equity in India. The Lancet, 377(9764), 505–515.CrossRefGoogle Scholar
  7. Banks, S., et al. (2013). Everyday ethics in community based participatory research. Contemporary Social Science, 8(3), 266–277.CrossRefGoogle Scholar
  8. Barik, D., & Thorat, A. (2015). Issues of unequal access to public health in India. Frontiers in Public Health, 3, 245.CrossRefGoogle Scholar
  9. Barret, D. H., et al. (2016). Public health ethics: Cases spanning the globe. Cham: Springer.CrossRefGoogle Scholar
  10. Baru, R., et al. (2012). Inequities in access to health services in India: Caste, class, and region. Economic and Political Weekly, XLV(38), 49–58.Google Scholar
  11. Barua, N., & Pandav, C. (2011). The allure of the private practitioner: Is this the only alternative for the urban poor in India? Indian Journal of Public Health., 55(2).Google Scholar
  12. Beauchamp, D. E. (1999). Public health as social justice. In D. E. Beacuchamp & B. Steinbock (Eds.), New ethics for the Public’s health. New York: Oxford University Press.Google Scholar
  13. Beacuchamp, T., & Childress, J. (2001). Principles of biomedical ethics. Oxford: Oxford University Press.Google Scholar
  14. Beauchamp, D. E. (1983). What is public about public health? Health Affairs, 2(4), 76–87.CrossRefGoogle Scholar
  15. Beauchamp, D. E., & Steinbock, B. (1999). Introduction: Ethical theory and public health. In D. E. Beauchamp & B. Steinbock (Eds.), New ethics for the public's health. London: Oxford University Press.Google Scholar
  16. Brock, D. W. (2004). Ethical issues in the cost effectiveness analysis for the prioritization of health resources. In S. Anand, F. Peter, & A. Sen (Eds.), Public health, ethics and equity (pp. 183–200). Delhi: Oxford University Press.Google Scholar
  17. 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.CrossRefGoogle Scholar
  18. Cribb, A. (2005). Health and the good society. Oxford: Oxford University Press.CrossRefGoogle Scholar
  19. Cribb, A. (2007). Health promotion, society and health care ethics. In Ashroff et al. (Eds.), Principles of health care ethics. Chichester: Wiley.Google Scholar
  20. Cribb, A. (2010). Why ethics and what kinds of ethics for public health? In S. Peckham & A. Hann (Eds.), Public health ethics and practice. Cambridge: Polity Press.Google Scholar
  21. Dawson, A. (Ed.). (2011). Public health ethics: Key concepts and issues in policy and practice. London: Cambridge University Press.Google Scholar
  22. De Varies, J., & Henley, L. C. (2014). Staying silent when we should speak up: Informed consent and the interface between ethics as regulation and ethics in practice. In D. Posel & F. Ross (Eds.), Ethical quandaries in social research. Cape Town: HSRC Press.Google Scholar
  23. Desclaux, A. (2008). Medical research-ethics applied to social sciences: Relevance, limits, issues and necessary adjustments. Bulletin de la Société de Pathologie Exotique, 101(2), 77–84.Google Scholar
  24. Dewan, P. K., et al. (2006). Improving tuberculosis control through public-private collaboration in India: Literature review. British Medical Journal, 332(7541), 574–578.CrossRefGoogle Scholar
  25. Drez, J., & Sen, A. (2015). Uncertain glory: India and its contradictions. Delhi: Oxford University Press.Google Scholar
  26. Farmer, P., et al. (2006). Structural violence and clinical medicine. PLoS Medicine, 3(10), 1–6.CrossRefGoogle Scholar
  27. Gadre, A., & Shukla, A. (2016). Dissenting diagnosis. Gurugram: Penguin Random House Publishers.Google Scholar
  28. Ghaffar, A., Tran, N., Kieny, M. P., et al. (2012). Putting health policy and systems research on the map. Bulletin of the World Health Organization, 90, 797–797A.CrossRefGoogle Scholar
  29. Ghosh, S. (2011). Catastrophic payments and impoverishment due to out of pocket health spending. Economic and Political Weekly, XLVI(47), 63–70.Google Scholar
  30. Gilson, L. (Ed.). (2012). Health policy and systems research: A methodology reader. Geneva: Alliance for Health Policy and Systems Research, World Health Organization.Google Scholar
  31. Gopichandran, V., & Chetlapali, S. (2012). Conditional cash transfer to promote institutional deliveries in India: Toward a sustainable ethical model to achieve MDG 5. Public health ethics, 5(2), 173–180.CrossRefGoogle Scholar
  32. Gopichandran, V., Luyckx, V. A., Biller-Andorno, N., et al. (2016). Developing the ethics of implementation research in health. Implement Science, 11, 161.CrossRefGoogle Scholar
  33. Gostin, L. O. (2001). Public health ethics, human rights and health: A tribute to the late Jonathan Mann. Journal of Law, Medicine and Ethics, 29(121), 130.Google Scholar
  34. Harper, I. (2007). Translating ethics: Researching public health and medical practices in Nepal. Social Science & Medicine, 65(11), 2235–2247.CrossRefGoogle Scholar
  35. Hess, R., et al. (2010). Working with private practitioners on a public health intervention. In K. Sheikh & A. George (Eds.), Health providers in India: On the frontline of change. Delhi: Routledge.Google Scholar
  36. Holland, S. (2015). Public health ethics. Cambridge: Polity Press.Google Scholar
  37. Institute of Medicine. (1988). The future of public health. Washington DC: The National Academic Press.Google Scholar
  38. Kamm, F. (2004). Deciding whom to help, health adjusted lifeyears and disabilities. In S. Anand, F. Peter, & A. Sen (Eds.), Public health, ethics and equity. Oxford/Delhi: Oxford University Press.Google Scholar
  39. Kass, N. E. (2001). An ethics framework for public health. American Journal of Public Health, 91(11), 1776–1782.CrossRefGoogle Scholar
  40. Kass, N. (2004). Public health ethics: From foundations and frameworks to justice and global health. Journal of Law Medicine and Ethics, 32, 232–242.CrossRefGoogle Scholar
  41. Khanna, R. (2012). A feminist, gender, rights perspective for evaluation of women’s health programs. Indian Journal of Gender Studies, 19(2), 259–278.CrossRefGoogle Scholar
  42. Khanna, R., & Subha Sri B. (2014). Dead women talking: A civil society report on maternal deaths in India. Commonhealth and Jan Swasthya Abhiyan. Available online at
  43. Khanna, R. (2015). Ethical issues in community based monitoring: Reflections from India, COPASH, issue paper 3. Delhi: CHSJ.Google Scholar
  44. Kielmann, K., et al. (2014). Balancing authority, deference and trust across the public–private divide in health care: Tuberculosis health visitors in western Maharashtra, India. Global Public Health, 9(8).CrossRefGoogle Scholar
  45. Kleinman, A. (1999). Moral experience and ethical reflection: Can ethnography reconcile them? A quandary for the new bioethics. Daedalus, 128(4), 69–97.Google Scholar
  46. Luyckx, V. N., Biller-Andorno, N., Saxena, A., et al. (2017). Health policy and systems research: Towards a better understanding and review of ethical issues. BMJ Global Health, 2, e000314 doi:10.1136.CrossRefGoogle Scholar
  47. Madiwala, N. (2009). What constitutes a community. In R. Cash (Ed.), Case book on ethical issues in international research. Geneva: WHO.Google Scholar
  48. Mann, J. (1997). Medicine and public health, ethics and human rights. Hastings Center Report, 27, 6–13.CrossRefGoogle Scholar
  49. Mazumdar, S. (2015). Murky waters of medical practice in India: Ethics, economics and politics of health care. Economic and Political Weekly, 29, 40–45.Google Scholar
  50. Minocha, A. (2013). The socio-cultural context of informed consent in medical practice in India. In B. S. Baviskar & T. Patle (Eds.), Understanding Indian society: Past and present. Delhi: Orient BlackSwan.Google Scholar
  51. Mishra, A. (2013). Introduction: Special issue on anthropology and public health. Indian Anthropoologist, 43(1), 1–15.Google Scholar
  52. Mishra, A. (2018). Bringing the ‘social’ back in: Social determinants of health as a methodological lens. In D. Nambiar & A. Muralidharan (Eds.), Social determinants of health in India: Concepts, processes and indicators. Singapore: Springer.Google Scholar
  53. Nagral, S. (2014, July 19). Corruption in Indian Medicine – or “Overenthusiasm of the Marketing Department”. Economic & Political Weekly, XLIX(29), 13–15.Google Scholar
  54. Nambiar, D., & Muralidharan, A. (Eds.). (2018). Social determinants of health in India: Concepts, processes and indicators. Singapore: Springer.Google Scholar
  55. Narayan, T. (1999). A violation of citizens’ rights: The health sector and tuberculosis: One’s understanding of the problem of tuberculosis affects the choice of intervention strategies. Issues in Medical Ethics, VII(3), 75–78.Google Scholar
  56. Navarro, V. (2009). What we mean by social determinants of health. International Journal of Health Services, 39(3), 423–441.CrossRefGoogle Scholar
  57. Ogden, J., et al. (1999). Shifting the paradigm in tuberculosis control: Illustrations from India. The International Journal of Tuberculosis and Lung Disease, 3(10), 855–861.Google Scholar
  58. Pati, S., Sharma, A., & Jodpey, S. (2014, July–September). Teaching of public health ethics in India: A mapping exercise. Indian Journal of Medical Ethics, 11(3), 185–190.Google Scholar
  59. Peckham, S., & Hann, A. (Eds.). (2010). Public health ethics and practice. Bristol: Policy Press.Google Scholar
  60. Porter, J., & Ogden, J. (1999). Public health, ethics, and tuberculosis: Is DOTs a breakthrough or inappropriate strategy in the Indian context? Issues in Medical Ethics, VII(3), 79–85.Google Scholar
  61. Porter, J., & Venkatapuram, S. (2012). Ethics and the right to health. In G. Backman (Ed.), The right to health: Theory and practice. Lund: Studentlitteratur AB.Google Scholar
  62. Posel, D., & Ross, F. (Eds.). (2014). Ethical quandaries in social research. Cape Town: HSRC Press.Google Scholar
  63. Pradhan, A. (2011). Sustaining ppm-dots: The case of Pimpri Chinchwad, Maharashtra, India. The Indian Journal of Tuberculosis, 58, 18–28.Google Scholar
  64. Pratt, B., Paul, A., Hyder, A. A., et al. (2017). Ethics of health policy and systems research: a scoping review of the literature. Health Policy Plan, 32, 890–910.CrossRefGoogle Scholar
  65. Ramanathan, M., Krishnan, S., & Bhan, A. (2006). Reporting on the first national bioethics conference. The Indian Journal of Medical Ethics, III(1).Google Scholar
  66. Rao, S. (2017). Do we care? Indian’s health system. Delhi: Oxford University Press.CrossRefGoogle Scholar
  67. Rawlinson, M. C. (2001). The concept of a feminist bioethics. The Journal of Medicine and Philosophy, 26(4), 405–416. Scholar
  68. Reismann, C. K. (2005). Exporting ethics: A narrative about narrative research in South India. Health, 9(4), 473–490.CrossRefGoogle Scholar
  69. Roberts, M., & Reich, M. R. (2002). Ethical analysis in public health. The Lancet, 359(9311), 1055.CrossRefGoogle Scholar
  70. Rogers, W. (2006). A (2006) feminism in public health. Journal of Medical Ethics, 32, 351–354.CrossRefGoogle Scholar
  71. Rothstein, M. A. (2012). The future of public health. American Journal of Public Health, 202(1), 09.CrossRefGoogle Scholar
  72. Samuelsen, H., et al. (2013). Do health systems delay in the treatment of poor children? A qualitative study of child deaths in rural Tanzania. BMC Health Services Research, 13(67), 1–10.Google Scholar
  73. Sarojini, N., & Bhagianadh, D. (2017). “The invisible”: Participant’s experiences in clinical trials. Perspectives in Clinical Research, 8, 5–10.CrossRefGoogle Scholar
  74. Sarojini, N., et al. (2015). Bilaspur sterilisation deaths: Evidence of oppressive population control policy. Indian Journal of Medical Ethics, XII(1).Google Scholar
  75. Schicktanz, S., Wiesemann, C., & Wöhlke, S. (Eds.) (2010) Teaching ethics in organ transplantation and tissue donation: Cases and movies. Universitätsverlag Göttingen.Google Scholar
  76. Sen, G., Iyer, A., & George, A. (2007). Systematic hierarchies and systematic failures. Economic and Political Weekly, XLII(8).Google Scholar
  77. Sengupta, A., & Nundy, S. (2005, November 19). The private health sector in India is burgeoning, but at the cost of public health care. BMJ, 331(7526), 1157–1158.CrossRefGoogle Scholar
  78. Sheikh, K., Gilson, L., Agyepong, I., et al. (2011). Building the field of health policy and systems research: Framing the questions. PLoS Medicine, 8(8), e100173. Scholar
  79. Smith, M. J., & Upshur, R. E. G. (2015). Ebola and learning lessons from moral failures: Who cares about ethics? Public Health Ethics, 8(3), 305–318.Google Scholar
  80. Sundari, R., & Gaitonde, R. (Eds.). (2018). Health inequities in India: A synthesis of recent evidence. Singapore: Springers.Google Scholar
  81. Udwadia, Z. F., Pinto, L. M., & Uplekar, M. W. (2010). Tuberculosis management by private practitioners in Mumbai, India: Has anything changed in two decades? PLoS ONE, 5(8), e12023.CrossRefGoogle Scholar
  82. Uplekar, M., Pathania, V., & Raviglione, M. (2001). Private practitioners and public health: Weak links in tuberculosis control. Lancet, 358, 912–916.CrossRefGoogle Scholar
  83. Upshur, R. (2002). Principles for the justification of public health intervention. Canadian Journal of Public Health, 93(2), 101–103.Google Scholar
  84. Verweij, M., & Dawson, A. (2018). Public health ethics: 10 years on. Public Health Ethics, 11(1), 1–5.CrossRefGoogle Scholar
  85. World Health Organization. (2010). Closing the gap in the generation: Report of the commission on social determinants of health. Switzerland: WHO.Google Scholar
  86. Zachariah, R., et al. (2012). Language in tuberculosis services: Can we change to patient-centred terminology and stop the paradigm of blaming the patients? The International Journal of Tuberculosis and Lung Disease, 16(6), 714–717.CrossRefGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.School of DevelopmentAzim Premji UniversityBangaloreIndia
  2. 2.International Health ProgramCurtin UniversityPerthAustralia

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