Class 10 - Public Health Ethics

Question 1

Midwifery to Inuit, Metis and First Nations Communities

Answer 1

Women in community and indigenous midwives were the first caring for public health/community health

Question 2

Mary Seacole 1850s (Link to Crimean War)

Answer 2

Contemporary from florence nightingale
Context of conflict and war
Opened british coffee shop during crimean war
She did less training and righting than F.N

Question 3

Mary Mohoney 1879

Answer 3

First African nurse 1879

A lot of nursing were done by those that did not hold a degree

1920s: black cross nursing → many did not have nursing degrees because not allowed; but many black woman came together at the time to take care of their own (started in the States then progressed to Canada)
Engaging in healthcare

Question 4

Jean Goodwill (1928-1997)

Answer 4

One of the first indigenous nurses in Canada
Jean got TB when she was young
Link to video screencast (she went to Sanatorium and lived there for 3 years) → made her want to be a nurse
Canadian indigenous nursing association founder (CINA)
Advocated for TRC

Question 5

Midwifery Now - Tia Felix

Answer 5

Contemporary of ours

Sustainable community health goals
- We have overmedicalized maternal healthcare
- Indigenous communities were flown away for delivery → advocacy to bring back midwifery to bring back to indigenous healthcare lens

Indigenous midwife

Question 6

A Community Health Nurse

Answer 6

“works with people where they live, work, learn, worship, and play to promote health”

Question 7

Public Health

Answer 7

The organized efforts of society to keep people healthy and prevent injury, illness, and premature death. It is a combination of programs, services, and policies that protect and promote the health of all Canadians.

Question 8

“What we, as a society, do collectively to assure the conditions in which people can be healthy”

Answer 8

Public Health

Question 9

why was SARS important for public health

Answer 9

SARS was important for public health because it created the PHAC (public health agency of Canada)

Question 10

does the healthcare system help in public health?

Answer 10

Most of the improvements of public health DO NOT come from the healthcare system

Question 11

This is Public Health: 12 Great Achievements
(Canada)

Answer 11

• Safe and healthier foods
• Control of Infectious Diseases
• Healthier Environments
• Recognition of Tobacco Use as a Health Hazard
• Decline in Deaths from - Coronary Heart Disease and Stroke
• Universal Policies
• Family Planning
• Safer Workplaces
• Acting on the Social Determinants of Health
• Healthier Mothers and Babies
• Motor Vehicle Safety
• Vaccination

Question 12

why is it important to make the public aware of ROI

Answer 12

ROI is important because the public may falsely believe that public health puts a drain on our budget (when actually its the opposite)

Question 13

public health purpose

Answer 13

achieve optimal health and well being for all people living in canada

Question 14

aims of public health (3)

Answer 14

enhance the health status of populations

protect against health emergencies and mitigate the impacts

achieve equitable health outcomes

Question 15

essential public health functions (6)

Answer 15

• health promotion
• health surveillance
• health protection
• population health assessment
• disease and injury prevention
• emergency preparedness and response

Question 16

why is PH inherently political

Answer 16

Need to convince them it is financially worth it (or else governments and politics wont on invest)

Question 17

1.Health Protection

Answer 17

Actions to ensure water, air, and food are safe
A regulatory framework to control infectious diseases
Protection from environmental threats (ex: air quality)
Expert advice to food and drug safety regulators (high safety legislations for drugs and any type of product for health care)

Question 18

what is the nemesis of Public Health

Answer 18

Success is sometimes the nemesis of Public Health
If we are successful = nothing happens → people say, why are we investing

Question 19

2.Health Surveillance

Answer 19

The ongoing, systematic use of routinely collected health data for the purpose of tracking and forecasting health events or health determinants

Question 20

Health Surveillance
(4 ethical questions)

Answer 20

privacy and confidentiality
stigma and discrimination
ownership
informed consent

Question 21

3.Population Health Assessment

Answer 21

Produce better policies and services based on an understanding of:
The health of communities or specific populations
Factors that underlie good health or pose potential risks
Looks broader, looks at determinants across dimensions
Wants to look at health disparities in a population
Want to better align the health needs
Same ethical issues of health surveillance, but looking as smaller groups (ex: montreal)
Ownership, privacy, health needs.

Question 22

4.Disease and Injury Prevention

Answer 22

Reduce risk of infectious disease emergence, outbreaks and, preventable illness and injury through:

Investigation, contact tracing, preventive measures

Activities to promote safe, healthy lifestyles (ex: masks, helmets)

Question 23

Disease and Injury Prevention
(4 ethical issues)

Answer 23

victim blaming
social control
harm principle
paternalism

Question 24

5. Health Promotion

Answer 24

• Preventing disease and encouraging safe behaviors
• Looking much broader, various domains, healthy public policies, healthy environments, not just health domains
• Improving health through public policy, community-based interventions, active public participation
• Advocacy or action on environmental and socio-economic determinants of health

Question 25

Health Promotion (5 ethical issues)

Answer 25

Infringing on the freedom of citizens What goods and benefits are valued? Victim blaming Stigmatization Distribution of benefits

Question 26

6.Emergency Preparedness & Response

Answer 26

Planning for both natural disasters and man-made disasters to minimize serious illness, overall deaths, and social disruption Mtl: floods, snow storms, verglas (ice storm), epidemics and infectious disease, metro and car crashes, fires in hospital, mass shootings Requires planning and preparedness

Question 27

Emergency Preparedness & Response (4 ethical issues)

Answer 27

resource allocation vulnerability distributive justice tragic decisions

Question 28

Public Health Interventions to Control Obesity (ethical issues)

Answer 28

- Effectiveness of programs (benefits) - Potential harms - Widening inequity - Paternalism - Weight stigma in healthcare

Question 29

2 important public health values

Answer 29

social justice and health equity

Question 30

Social Justice

Answer 30

- Fair distribution of society’s benefits and responsibilities, and focuses on eliminating the root causes of inequities (CNA, 2010) - Leads to degree of equality of opportunity for health that a society provides for the population Not equal care but opportunity for health - Involves the political, social, and economic structures of a society

Question 31

Health Equity

Answer 31

Fair distribution of resources for health Absence of systematic disparities in health between groups with different levels of wealth, power or prestige Ethical principle, closely related to human rights Comes back to ethics… - Is it avoidable? - Is it unfair? - Is it unjust?

Question 32

Broad Approaches for Health Equity (3)

Answer 32

- Improvement of daily living conditions = very important - Tackling inequitable distribution of resources - Increasing public’s awareness of, and health professionals’ training in, the SDoH as foundational to good health and the structural action necessary to address them

Question 33

"How we, collectively as a society, use the law to ensure that conditions exist for people to be healthy"

Answer 33

Public Health Law

Question 34

examples of public health law

Answer 34

- signs about pedestrian crossing - making workers wear protective equipment to work - keeping alcohol and cigarettes in different sections in the store

Question 35

Public Health Act (Quebec- Provincial) (examples)

Answer 35

- National Programming & Surveillance - Health Promotion & Prevention - Vaccination -Compulsory Treatment or prophylaxis - Reporting - Powers in situation of threat --> Public health can take over and exert power in certain situations (ex: pandemic) Etc...

Question 36

MADO

Answer 36

maladie à déclaration obligatoire rabies, chlamydia, syphillis, lyme disease, amiantosis, HIV (only if gave or received blood, organ or tissue), Hep B and C, gonorrhoea, giardia, measles, TB (not all), carbon monoxide poisoning, accidental poisoning

Question 37

clinal and public health ethics is part of what sphere of ethics

Answer 37

both are part of bioethics, which is part of the normative

Question 38

difference between public health ethics and clinical ethics

Answer 38

- community setting (vs not clinical setting) - can be hard to opt out of (vs the pt can reject advice in clinical ethics) - may not be in the best interest of some individuals (vs should be in the best interest of the patient) - focus on populations (vs focus on individuals)

Question 39

4 perspectives on public health ethics

Answer 39

professional ethics applied ethics advocacy ethics critical public health ethics (please refer to image in our notes)

Question 40

mission of public health to protect and promote health and focuses on the virtues or professional character

Answer 40

professional ethics (a PH ethics perspective)

Question 41

applied ethics (a PH ethics perspective)

Answer 41

seeks to develop general principles that can be applied to practical situations to guide ethical practice

Question 42

advocacy ethics (a PH ethics perspective)

Answer 42

involves taking a stand for the goals, interventions, and reforms that are most likely to achieve the moral aims of public health

Question 43

critical public health ethics (a PH ethics perspective)

Answer 43

- historically informed, practically oriented - considers social values and trends in analyzing and understanding both the public health situation at hand and the moral problems it raises - it asks us 'to question the taken for granted and think about how power relations are represented' in a particular public health concerns

Question 44

PH ethics framework (4) from MacDonald name and describe them

Answer 44

harm principle least restrictive or coercive means reciprocity principle transparency principle **refer to image in notes and reading for description

Question 45

what is an alternative way to look at how individuals make decisions?

Answer 45

Some theorists advocate that we should try and advocate more from a relationship theory Refers to feminist ethics lens, looks at relational personhood, and relational solidarity Many of the decisions we make (ex: deciding to become a nurse, take a new job, etc) are not decisions you make only considering yourself, you consider other people and relationships

Question 46

Describe relational personhood using its 3 components

Answer 46

relational autonomy (Embraces the fact that we are socially, political and economically dependent on others; not entirely independent) social justice (move away from distributive justice, and look at access to rights, dignity, access to power; broadening the lens) relational solidarity (comes up in global health; instead of us and them we want to think of solidarity of all; ex infectious disease)

Question 47

what has contributed to vaccination hesitancy

Answer 47

Media, AI = ability to shift the message and create misinformation at a large scale

Question 48

what is the nurse's responsibility with vaccination hesitancy

Answer 48

Nurses have moral and ethical responsibility to build critical knowledge

Question 49

what is the ethical principles at play for the ethical question "Should primary schools require mandatory vaccinations?"

Answer 49

Parents autonomy vs benefits to public health

Question 50

The Case of Environment + Health 4 features

Answer 50

Risks to health Differential need for evidence - For public health, actions are taken even if the evidence is uncertain but in the case of climate change evidence is clear Precautionary principle - When an activity raises a threat to human health or the environment, precautions should be put into place EVEN with little/direct links. Facing pushback - The youth that are going to court are able to showcase a clear link between health and climate health due to risk of harm yet they are still facing pushback

Question 51

Critical Role of Health Professionals

Answer 51

- Be informed - Recognize exposure and related health conditions Ex: implications of climate changes (heat waves and elderly) - Research, publish, and disseminate knowledge - Prescribe solutions, and educate families and communities Social prescription: join a group (ex: for loneliness) - Educate colleagues and students - Advocate solutions to other sectors, policy and decision makers

Question 52

Achieving planetary health will require what?

Answer 52

Achieving planetary health will require a Great Transition where we all learn to do nearly everything differently, such as: - How we produce and consume food, manufactured products, and energy - How we construct and live in our cities - How we manage our natural landscapes and resources - And the stories we tell ourselves about our place in the world, our relationship to Nature, and what it means to live a good life (ex: think back to the inidegnous populations)