Hyder Adnan A, Merritt Maria, Ali Joseph, Tran Nhan T, Subramaniam Kulanthayan, Akhtar Tasleem
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America.
Bull World Health Organ. 2008 Aug;86(8):606-11. doi: 10.2471/blt.08.051110.
Scientific progress is a significant basis for change in public-health policy and practice, but the field also invests in value-laden concepts and responds daily to sociopolitical, cultural and evaluative concerns. The concepts that drive much of public-health practice are shaped by the collective and individual mores that define social systems. This paper seeks to describe the ethics processes in play when public-health mechanisms are established in low- and middle-income countries, by focusing on two cases where ethics played a crucial role in producing positive institutional change in public-health policy. First, we introduce an overview of the relationship between ethics and public health; second, we provide a conceptual framework for the ethical analysis of health system events, noting how this approach might enhance the power of existing frameworks; and third, we demonstrate the interplay of these frameworks through the analysis of a programme to enhance road safety in Malaysia and an initiative to establish a national ethics committee in Pakistan. We conclude that, while ethics are gradually being integrated into public-health policy decisions in many developing health systems, ethical analysis is often implicit and undervalued. This paper highlights the need to analyse public-health decision-making from an ethical perspective.
科学进步是公共卫生政策与实践变革的重要基础，但该领域也关注充满价值观念的概念，并每日应对社会政治、文化及评估方面的问题。推动诸多公共卫生实践的概念是由界定社会系统的集体和个人道德规范塑造而成的。本文旨在通过聚焦两个案例来描述在低收入和中等收入国家建立公共卫生机制时所涉及的伦理过程，这两个案例中伦理在推动公共卫生政策产生积极的制度变革方面发挥了关键作用。首先，我们概述伦理与公共卫生之间的关系；其次，我们为卫生系统事件的伦理分析提供一个概念框架，指出这种方法如何可能增强现有框架的效力；第三，我们通过分析马来西亚一项加强道路安全的计划以及巴基斯坦一项设立国家伦理委员会的倡议来展示这些框架的相互作用。我们得出结论，虽然在许多发展中的卫生系统中伦理正逐渐被纳入公共卫生政策决策，但伦理分析往往是隐含的且未得到重视。本文强调了从伦理角度分析公共卫生决策的必要性。
