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Yale University

Publication Date

Spring 2009

Program Name

Switzerland: Development Studies and Public Health


Discussions on public health ethics often appeal to the same codes of conduct established in the field of bioethics. Principles of bioethics contribute to the morality of the study of public health—proposing an optimal code of conduct in the medical care and human research aspects of the field. For example, public health researchers are aware of their obligations to consider informed consent, confidentiality, and the equal distribution of risks and benefits in the implementation of their studies and interventions. However, public health practice extends far beyond medical care and human research. Thus, it is inappropriate to assume that codes established by bioethics adequately address all of the issues associated with public health. Several authors have identified the incongruity in applying bioethics principles to the practice of public health without establishing a separate public health ethics; but, few have attempted to define public health ethics as a subject independent of bioethics. My paper is an original piece of scholarship, as it aims to address this gap in public health literature.

Public health ethics is unique because, unlike bioethics, there is no “Hippocratic Oath” or universal code for properly executing an intervention. Aside from evidence-based knowledge, public health interventions rely upon ingenuity and flexibility. Interventions, and the circumstances and environments under which they are implemented, are often multivariable. In this paper, I argue that public health ethics should focus on the responsibilities that international, national, and sub-national communities have in improving health outcomes. I assert that health policies should rely on diagonal approaches—combining the disease-specific tactics of vertical interventions with horizontal approaches to improve health systems based on applied knowledge and awareness of the broader social determinants of health within a country. Thus, public health ethics resides in the goals of an intervention, the roles of the parties involved, and how those policies are implemented. I explore this public health ethic in the context of the Global Polio Eradication Initiative’s (GPEI) efforts in Nigeria.

Nigeria is a nation with complex political, social, economical, and epidemiological contexts. The Nigerian President struggles for unity as State governors amend the Nigerian Constitution, threatening rights to freedom of religion. Tensions between Nigeria’s two dominant religions, Christianity and Islam, result in social exclusion, educational, and health disparities among the groups. The Nigerian health system is fragile and inadequate, as evidenced by its near-last-place status in the WHO ranking of national health systems. With poor infrastructure and low retention rates among human health resources, the country is poorly positioned to sustain, or build upon the benefits of vertical interventions like the GPEI. Under its current circumstances, the Nigerian health system is ill-equipped to address its weak health system through vertical interventions alone. Thus, a diagonal approach must be taken in which both vertical and horizontal approaches to health are taken, and social aspects of communities are considered as well. A “culture of cohesiveness” is necessary and must be nurtured in an effort to build accountability and reliability throughout all aspects of the health system. In addition, the Nigerian government must emphasize, and firmly advocate for the separation between religion and state, and the importance of freedom of religion. Ultimately, through my research, I find that political commitment is not an empty suggestion mentioned in WHO policy recommendations, but it is an absolutely imperative component. Political commitment and accountability begins at international and national levels, but it must resonate on community and grass-root levels as well.


Bioethics and Medical Ethics | International Public Health


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