American Journal of Epidemiology Advance Access originally published online on November 6, 2007
American Journal of Epidemiology 2008 167(1):121-122; doi:10.1093/aje/kwm296
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BOOK REVIEW |
Public Health Ethics: Theory, Policy, and Practice
Edited by Ronald Bayer, Lawrence O. Gostin, Bruce Jennings, and Bonnie Steinbock
From the Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341
(e-mail: sic9{at}cdc.gov)
ISBN 0 19 518085 2, Oxford University Press, New York, New York (Telephone: 800-445-9714, Fax: 919-677-1303, E-mail: custserv.us{at}oup.com, World Wide Web: http://www.oup.com/), 2006, 418 pp., $49.95 Paperback
Public health ethics is the identification, analysis, and resolution of ethical problems arising in public health practice and research (1, 2). Ethical concerns in public health often relate to the dual obligations of public health professionals: to acquire and apply scientific knowledge aimed at improving and protecting the public's health while respecting individual autonomy. Ethics in public health involves an interplay between protecting the welfare of the individual, as in medicine, and protecting the public welfare, as in public health. Ethical concerns in public health also relate to the need to ensure a just distribution of public health resources. Public health ethics has a broad scope that includes ethical and social issues arising in health promotion and disease prevention, epidemiologic research, and public health practice (2–4).
Public Health Ethics: Theory, Policy, and Practice (5) is edited and composed by scholars who are internationally recognized for their work in public health policy, ethics, and health law. This anthology provides an engaging overview of the emerging field of public health ethics. It includes selected articles that were previously published over the period 1985–2004, including articles written by one or more of the editors.
An introductory chapter provides an overview of public health ethics and describes the rise of interest in this field in recent decades. As the editors explain, "Today there is rapidly growing interest within the field and profession of public health in those ethical issues and perspectives that may be said to be distinctive to public health and to set it apart from the perspective of clinical medicine" (5, p. 4). Key concepts such as ethical relativism and ethical theories (for example, utilitarianism and Kantian ethics) are also briefly described.
The remainder of the book is divided into six parts: 1) the public health perspective, 2) autonomy and paternalism, 3) justice and health, 4) infectious disease: coercion and the protection of society, 5) regulation and environmental and occupational health, and 6) genetics and public health. Part 1, on the public health perspective, includes articles that do not directly relate to public health ethics—for example, Geoffrey Rose's classic article "Sick individuals and sick populations" (6)—but were included by the editors in order to explain the broader context to persons who may not be intimately familiar with public health concepts and perspectives. The articles included in part 2 deal more directly with important issues in public health ethics, such as the need to avoid blaming individuals for illnesses that are probably due to a variety of causes, including societal influences.
The most valuable section of the book is likely to be part 3, which includes several excellent articles on justice and health written by British and American authors. As the editors note, "Ethical questions of justice are central to the design and workings of various institutions and programs (whether involving service delivery, education, or access to resources), and these are often the key objectives of policy analysis and implementation in public health" (5, p. 167). Articles by Angus Deaton (7), Richard Wilkinson (8), and Norman Daniels and colleagues (9), which provide insights for classroom discussion and debate, highlight the social determinants of health disparities, including the linkages between income, education, social class, and health identified in epidemiologic studies. The article by Daniels et al. (9) draws upon the theory of justice proposed by John Rawls (10) in examining ethical considerations in health inequalities and inequities, as well as policy questions about how best to address socioeconomic inequalities. These important articles (7–9) do not have the benefit of more recent scholarly works on public health, justice, and health equity (11, 12), which highlights the potential disadvantages of an anthology of articles published during an earlier time period.
With respect to other limitations, the book largely ignores the sizeable body of literature on professional ethics in epidemiology and other public health disciplines, which arguably constitutes an important part of the literature on public health ethics. The literature on the ethics of human subjects research in epidemiology and public health is also neglected.
Despite these oversights, this book is likely to interest a broad range of readers, including many practicing epidemiologists and other public health professionals and students in graduate training programs. The book is likely to be a useful adjunct to courses on public health theory and practice, health policy, public health ethics, and health equity.
ACKNOWLEDGMENTS
The findings and conclusions in this review are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Conflict of interest: none declared.
References
- Lappe M. Ethics and public health. In: Maxcy-Rosenau's public health and preventive medicine—Last JM, ed. (1986) 12th ed. Norwalk, CT: Appleton-Century-Crofts. 1867–77.
- Coughlin SS. Ethics in epidemiology and public health practice. In: Ethics in epidemiology and public health practice: collected works. (1997) Columbus, GA: Quill Publications. 9–26.
- Coughlin SS, Soskolne CL, Goodman KW. Case studies in public health ethics. (1997) Washington, DC: American Public Health Association.
- Childress JF, Faden RR, Gaare RD, et al. Public health ethics: mapping the terrain. J Law Med Ethics (2002) 30:170–8.
[Free Full Text] - Bayer R, Gostin LO, Jennings B, et al. Public health ethics: theory, policy, and practice. (2006) New York, NY: Oxford University Press.
- Rose G. Sick individuals and sick populations. Int J Epidemiol (1985) 14:32–8.
[Abstract/Free Full Text] - Deaton A. Policy implications of the gradient of health and wealth. Health Aff (2002) 21:13–30.
[Abstract/Free Full Text] - Wilkinson RG. Putting the picture together: prosperity, redistribution, health, and welfare. In: Social determinants of health—Marmot M, Wilkinson RG, eds. (1999) New York, NY: Oxford University Press. 256–74.
- Daniels N, Kennedy BP, Kawachi I. Why justice is good for our health: the social determinants of health inequalities. Daedalus (1999) 128:215–51.[Medline]
- Rawls J. A theory of justice. (1999) 2nd ed. New York, NY: Oxford University Press.
- Powers M, Faden R. Social justice: the moral foundations of public health and health policy. (2006) New York, NY: Oxford University Press.
- Anand S, Peter F, Sen A. Public health, ethics, and equity. (2004) New York, NY: Oxford University Press.
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