Abstract
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.
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Alliance for Health Systems and Policy Research. (2007). What is Health Policy and Systems Research and why does it matter? Geneva: World Health Organization. http://www.who.int/alliance-hpsr/resources/Alliance HPSR-Briefing Note 1. Accessed on August 17, 2017.
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.
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.
Anand, S., Peter, F., & Sen, A. (Eds.). (2004). Public health, ethics and equity, introduction. Delhi: Oxford University Press.
Babu, G., et al. (2014). An appraisal of the tuberculosis programme in India using an ethics framework. Indian Journal of Medical Ethics, XI(1).
Balrajana, Y., Selvaraja, S., & Subramanian, S. C. (2011). Health care and equity in India. The Lancet, 377(9764), 505–515.
Banks, S., et al. (2013). Everyday ethics in community based participatory research. Contemporary Social Science, 8(3), 266–277.
Barik, D., & Thorat, A. (2015). Issues of unequal access to public health in India. Frontiers in Public Health, 3, 245.
Barret, D. H., et al. (2016). Public health ethics: Cases spanning the globe. Cham: Springer.
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.
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).
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.
Beacuchamp, T., & Childress, J. (2001). Principles of biomedical ethics. Oxford: Oxford University Press.
Beauchamp, D. E. (1983). What is public about public health? Health Affairs, 2(4), 76–87.
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.
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.
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.
Cribb, A. (2005). Health and the good society. Oxford: Oxford University Press.
Cribb, A. (2007). Health promotion, society and health care ethics. In Ashroff et al. (Eds.), Principles of health care ethics. Chichester: Wiley.
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.
Dawson, A. (Ed.). (2011). Public health ethics: Key concepts and issues in policy and practice. London: Cambridge University Press.
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.
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.
Dewan, P. K., et al. (2006). Improving tuberculosis control through public-private collaboration in India: Literature review. British Medical Journal, 332(7541), 574–578.
Drez, J., & Sen, A. (2015). Uncertain glory: India and its contradictions. Delhi: Oxford University Press.
Farmer, P., et al. (2006). Structural violence and clinical medicine. PLoS Medicine, 3(10), 1–6.
Gadre, A., & Shukla, A. (2016). Dissenting diagnosis. Gurugram: Penguin Random House Publishers.
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.
Ghosh, S. (2011). Catastrophic payments and impoverishment due to out of pocket health spending. Economic and Political Weekly, XLVI(47), 63–70.
Gilson, L. (Ed.). (2012). Health policy and systems research: A methodology reader. Geneva: Alliance for Health Policy and Systems Research, World Health Organization.
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.
Gopichandran, V., Luyckx, V. A., Biller-Andorno, N., et al. (2016). Developing the ethics of implementation research in health. Implement Science, 11, 161.
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.
Harper, I. (2007). Translating ethics: Researching public health and medical practices in Nepal. Social Science & Medicine, 65(11), 2235–2247.
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.
Holland, S. (2015). Public health ethics. Cambridge: Polity Press.
Institute of Medicine. (1988). The future of public health. Washington DC: The National Academic Press.
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.
Kass, N. E. (2001). An ethics framework for public health. American Journal of Public Health, 91(11), 1776–1782.
Kass, N. (2004). Public health ethics: From foundations and frameworks to justice and global health. Journal of Law Medicine and Ethics, 32, 232–242.
Khanna, R. (2012). A feminist, gender, rights perspective for evaluation of women’s health programs. Indian Journal of Gender Studies, 19(2), 259–278.
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 http://www.commonhealth.in/Dead%20Women%20Talking%20full%20report%20final.pdf
Khanna, R. (2015). Ethical issues in community based monitoring: Reflections from India, COPASH, issue paper 3. Delhi: CHSJ.
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).
Kleinman, A. (1999). Moral experience and ethical reflection: Can ethnography reconcile them? A quandary for the new bioethics. Daedalus, 128(4), 69–97.
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.
Madiwala, N. (2009). What constitutes a community. In R. Cash (Ed.), Case book on ethical issues in international research. Geneva: WHO.
Mann, J. (1997). Medicine and public health, ethics and human rights. Hastings Center Report, 27, 6–13.
Mazumdar, S. (2015). Murky waters of medical practice in India: Ethics, economics and politics of health care. Economic and Political Weekly, 29, 40–45.
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.
Mishra, A. (2013). Introduction: Special issue on anthropology and public health. Indian Anthropoologist, 43(1), 1–15.
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.
Nagral, S. (2014, July 19). Corruption in Indian Medicine – or “Overenthusiasm of the Marketing Department”. Economic & Political Weekly, XLIX(29), 13–15.
Nambiar, D., & Muralidharan, A. (Eds.). (2018). Social determinants of health in India: Concepts, processes and indicators. Singapore: Springer.
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.
Navarro, V. (2009). What we mean by social determinants of health. International Journal of Health Services, 39(3), 423–441.
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.
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.
Peckham, S., & Hann, A. (Eds.). (2010). Public health ethics and practice. Bristol: Policy Press.
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.
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.
Posel, D., & Ross, F. (Eds.). (2014). Ethical quandaries in social research. Cape Town: HSRC Press.
Pradhan, A. (2011). Sustaining ppm-dots: The case of Pimpri Chinchwad, Maharashtra, India. The Indian Journal of Tuberculosis, 58, 18–28.
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.
Ramanathan, M., Krishnan, S., & Bhan, A. (2006). Reporting on the first national bioethics conference. The Indian Journal of Medical Ethics, III(1).
Rao, S. (2017). Do we care? Indian’s health system. Delhi: Oxford University Press.
Rawlinson, M. C. (2001). The concept of a feminist bioethics. The Journal of Medicine and Philosophy, 26(4), 405–416. https://doi.org/10.1076/jmep.26.4.405.3010.
Reismann, C. K. (2005). Exporting ethics: A narrative about narrative research in South India. Health, 9(4), 473–490.
Roberts, M., & Reich, M. R. (2002). Ethical analysis in public health. The Lancet, 359(9311), 1055.
Rogers, W. (2006). A (2006) feminism in public health. Journal of Medical Ethics, 32, 351–354.
Rothstein, M. A. (2012). The future of public health. American Journal of Public Health, 202(1), 09.
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.
Sarojini, N., & Bhagianadh, D. (2017). “The invisible”: Participant’s experiences in clinical trials. Perspectives in Clinical Research, 8, 5–10.
Sarojini, N., et al. (2015). Bilaspur sterilisation deaths: Evidence of oppressive population control policy. Indian Journal of Medical Ethics, XII(1).
Schicktanz, S., Wiesemann, C., & Wöhlke, S. (Eds.) (2010) Teaching ethics in organ transplantation and tissue donation: Cases and movies. Universitätsverlag Göttingen.
Sen, G., Iyer, A., & George, A. (2007). Systematic hierarchies and systematic failures. Economic and Political Weekly, XLII(8).
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.
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. https://doi.org/10.1371/journal.pmed.1001073.Sin.
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.
Sundari, R., & Gaitonde, R. (Eds.). (2018). Health inequities in India: A synthesis of recent evidence. Singapore: Springers.
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.
Uplekar, M., Pathania, V., & Raviglione, M. (2001). Private practitioners and public health: Weak links in tuberculosis control. Lancet, 358, 912–916.
Upshur, R. (2002). Principles for the justification of public health intervention. Canadian Journal of Public Health, 93(2), 101–103.
Verweij, M., & Dawson, A. (2018). Public health ethics: 10 years on. Public Health Ethics, 11(1), 1–5.
World Health Organization. (2010). Closing the gap in the generation: Report of the commission on social determinants of health. Switzerland: WHO.
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.
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Mishra, A., Subbiah, K. (2018). Locating Public Health Ethics. 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_1
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