Ethical Issues of Public Health Practitioners in Promoting Health Equity

Bernie Pauly1, Wanda Martin2, Marjorie MacDonald1, Lenora Marcellus1, Tina Revai1

University of Victoria1, University of Saskatchewan2

Pathways to Equity Winnipeg, MB May 31,2016

Partners

Fraser Health

BACKGROUND

• Public health ethics is an emerging field within health care ethics distinct from biomedical ethics.

• Focus is on health of the whole community and normative obligation of social justice and health equity.

• There is relatively little known about ethical issues related to health equity work and little ethical guidance for public health practitioners

Intersectoral collaboration

Health equity priorities and

strategies Power and

ethics in public health

Health equity tools

EQUITY LENS IN PUBLIC HEALTH (ELPH)

STUDY OBJECTIVE

What are the ethical issues of public health practitioners involved in work related to promoting health equity and reducing of health inequities? How do public health practitioners navigate these issues?

SAMPLE

• Direct care public health staff with responsibilities for promoting mental health and preventing the harms of substance use

• Semi-structured interviews with 32 participants 28 Female and 4 male 27 had post-secondary 19 RN’s 6.05 Average yrs in position 10.26 years in Public Health

METHODS

• Data collected via phone and in person one on one interviews

• Interviews audiotaped and transcribed verbatim • Thematic Qualitative Analysis using Constant

Comparison • Team Coding • NVIVO 10

Selected Ethical Issues • Barriers to Accessing Services • Balancing Relationships with Clients, Others • Balancing Bureaucracy vs Client Needs • Balancing Professional Responsibilities Safety Confidentiality Issues Consent Issues

• Systemic Silos Lack of Access to the SDOH Lack of Collaboration b/t Agencies and Sectors

• Targeted Programs • Societal Judgements and Stigma of MH/SU

THEMES

1. Feeling the Weight of Witnessing Caring for people who experience health inequities put public health practitioners in a position of moral distress. Yeah, I don’t know the best words. But it just, it just weighs sort of heavy on you when you hear that.

2. Being Held Back Screening tools determine who gets care versus clinical judgement and resources are felt to be scarce, not well allocated, or fragmented. But sometimes people need help that doesn’t fit into an assessment.

THEMES (cont’d)

3. Watching Over Critical engagement with complicated issues of safety, requiring attention to the unfolding particulars of a situation. And at what point can we or should we intervene or push harder or try and get a Mental Health Act involved?

4. Navigating Obligation to Equity Different understandings of their work as it relates to equity and issues of practitioner agency towards equity v.s. structural constraints. I try to reframe it for them so that they can look through a different lens.

IMPLICATIONS

• PH ethical issues are largely a result of systemic problems that privilege biomedicine and individualistic approaches to care.

• Where practitioners are situated in their development of a critical PH consciousness impacts how they define the ethical issues and how they navigate those issues.

NEXT STEPS . . .

• Developing a grounded theory that will explicate the concept of critical PH consciousness.

• Basis of a proposed Canadian ethical framework for public/population health programs focused on reducing health inequities.

Funders

Thank you

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