Te Ture Whakaruruhau Code of Ethical Principles for Public Health in Aoteroa in New Zealand August 2012

Structure of presentation Why are ethical principles for public health important? Examples of ethical issues in public health practice Public health ethics in New Zealand Te Ture Whakaruruhau: PHA Code of Ethical Principles for Public Health in Aoteroa New Zealand Starting conversations about public health ethics in New Zealand

Public health ethics Measures to protect and promote public health often raise questions about the complex relationship between the state and the lives of individuals and communities. There is a substantial body of work about the relationship between the state and the individual, e.g. libertarian or collective political philosophies. The field of bioethics has also become increasingly important, but much of this work discusses ethics at the individual level.

Public health ethics Public health measures are directed at the population level, and require special consideration. Public health practice must balance: Actions to improve public health such as education, surveillance, interventions and regulations; with Actions that might restrict the freedoms of individuals and communities.

Examples of ethical issues in public health Communicable disease Reconciling individual consent with community benefits, e.g. vaccination, surveillance and treatment Non-communicable disease Policies and interventions with long-term benefits are sometimes difficult to match with shorter-term government priorities Alcohol and tobacco Societal interventions can be introduced to address the substantial harm to the community caused by people who drink excessive amounts of alcool A range of interventions are available to reduce the harm from regular smoking to individuals and those around them

Examples of ethical issues in public health Community-water fluoridation Water fluoridation has been in place for over 50 years in many countries The benefits of fluoridation have been difficult to quantify because of residential movement and the use of other sources of fluoride Ethical issues associated with community-water fluoridation Balancing risks and benefits Are there other interventions (e.g. improved dental care) that achieve the same outcome The role of consent

PHA Code of Ethical Principles for Public Health The PHA has recently developed a ‘living’ Code of Ethical Principles for Public Health. The Code has been developed to help public health practitioners consider ethical issues relevant to public health in NZ. The Code includes ethical principles for public health practice in New Zealand. The Code also includes a list of questions to consider when developing a policy, programme or project.

Principles in the PHA Code Maori-specific principles Generic principles Manaakitanga (respect for others) Solidarity/social capital Rangatiratanga (self-determination for Māori) Acting for the benefit for others Social justice Whanaungatanga (obligations of being part of a collective) Honesty Kotahitanga (unity of purpose and direction)

Questions to ask in policy, programme and project planning What is the evidence that the policy, programme or project will improve public health and reduce ethnic and socioeconomic health inequalities? How does the policy, programme or project reflect the aspirations of Māori? What are the ethical principles (both Māori-specific and general) raised by the policy, programme and project planning? How can these ethical issues be addressed?

Four ways to start the conversation about public health ethics How do we weave together general and Māori-specific public health ethical principles? How do we collect the evidence on how we consider public health ethics in New Zealand? How can we think systematically about including public health ethical principles we make decisions about new policies, programmes or projects? How can we integrate public health ethics into organisational practices?

Contact keriata@pha.org.nz