Stimulating addition to public health resources
Stephen Peckam, Alison Hann, editors. Public health ethics and practice. The Policy Press, Bristol, UK, 2010.
The past two decades have seen a heightened awareness of and discussions about ethical aspects of the practice of public health. This book is an interesting addition to the repertoire of resource materials on public health ethics. The essays included in this edited version are proceedings of a conference on public health ethics in Birmingham, UK, in 2007.
The book has been divided into three parts. The first part contains two chapters one by Cribb and the other by Holland, each addressing the broad aspects of public health ethics with a unique perspective. While the first chapter covers the technical, philosophical and social sciences approaches to public health ethics, the second chapter puts into perspective the central issues in public health ethics and the various principles and frameworks.
The second part of the book gives a detailed picture of ethics of various public health practice situations. Upshur handles the issue of drug resistant tuberculosis and the practical situations such as restriction on individuals with resistant tuberculosis to prevent harm to the community in the context of the principles of harm, least restriction, reciprocity and transparency. Allmark, Tod and Abbott introduce a discourse on the ethical considerations in public health education initiatives on smoking and lung cancer. They state that public health education cannot be evaluated based on behavior change alone, and that a complete benefit and harm analysis has to be done. They highlight some of the potential negative effects of public health education. Solari and Escobar-Koch pen an interesting description of bioethics committees in a primary care practice in Santiago, Chile, with examples of cases discussed in these committees. Unlinked anonymous blood testing, especially in the context of HIV surveillance and its ethical implications have been elucidated in the chapter by Datta and Kessell. They emphasise the importance of informed consent in the public health context.
The chapter on the obesity epidemic, highlighting the weakness of evidence, misplacement of values, and several important ethical debates, presents a thorough analysis of the importance of ethical appraisal of public health practice. In the next chapter on vaccine policy, the editors of the book focus on the utilitarian and liberalist concepts against the background of evidence-based vaccine policy. In the chapter on the HPV vaccine they further highlight the issue of cervical cancer, HPV infection, cervical cancer screening and the HPV vaccine. Sutton and Upshur in their chapter on vaccination ethics, highlight the ethical implications of compulsory or mandatory vaccination policy and the role of exemptions to this policy. They also introduce a human rights aspect to the vaccine debate.
The third and last part of the book is a summary integrating ethics into the practice of public health. Angus Dawson presents a majestic exposition of ethical theories, frameworks and models in public health. He takes up important points from various authors and analyses them thoroughly to present his ideas on ethical practice of public health. Dawson argues that most public health ethics literature gives individual liberty a very high value, whereas it has to be viewed from a collective community perspective. His arguments in this section have a communitarian leaning and guide the readers to adopt a different perspective compared to the rest of the book.
This well-edited book, compiling the writings of different authors from varied backgrounds, some theorists, some practitioners, has a consciously laid fine undercurrent of public health ethics. The editors have also given an excellent summary of the entire book in the introductory chapter which helps the readers understand the natural flow between the chapters, and the way the themes remain connected. On the down side, it is disappointing to see the limited range of topics covered by the book. This is probably because it is a summary of proceedings of a meeting with time restrictions and limitations. Certain highly contentious areas of public health ethics such as equity, universal access, targeted interventions, incentives, research ethics, etc. have not been addressed. One of the greatest strengths of the book is its practical nature with relevant examples from public health practice situations. Theoretical discussions are kept minimal, as teasers to stimulate the interested into exploring further. The smooth flow and brevity ensure that the book could easily be read in one go.