This document outlines a module on ethical codes and frameworks for public health. It lists the module's objectives of describing current public health codes and frameworks, utilizing ethical analysis frameworks to identify issues, and applying tools to systematically analyze ethical issues. The module outline discusses what codes and frameworks are, the differences between them, examples of applying them to analyze public health ethics issues, and having participants assess programs using frameworks. It also lists several codes and frameworks, including the American Public Health Code, Kass' ethics framework, and Nuffield Council on Bioethics' stewardship model.

1. Ethical codes and frameworks
EMPHNET
Ghaiath M. A. Hussein
MBBS, MHSc. (Bioethics), PhD Researcher
Email: ghaiathme@gmail.com
[Insert Venue]
[Insert Dates]
2013

2. Module’s objectives
2
• List and critically describe the current PHE
codes and frameworks
• Utilize ethical analysis frameworks in
identifying potential ethical issues and to
conduct ethical analysis of public health
interventions,
• Apply the appropriate tools and frameworks
to systematically analyse the ethical issues
and dilemmas that arise during the practice
of public health interventions

3. Module’s Outline
• What the ethical codes and frameworks? And
why are they needed?
• The difference between codes, frameworks, and
legislative approaches to Public Health
• Examples of the application Public Health Ethics
codes and frameworks in analysing PH ethical
issues (in practice and research)

4. Code & Frameworks?
• What is/are the difference(s) between codes and
frameworks?
• Why do you think we need them?
• Have you developed or used one of them in your
practice?

5. The American Public Health Code
• respects the rights of individuals in the community
• ensure an opportunity for input from community
• ensuring that the basic resources are accessible to all
people in the community
• should obtain the community's consent
• anticipate and respect diverse values, beliefs, and
cultures
• should protect the confidentiality of information
• should engage in collaborations and affiliations in ways
that build the public's trust
The code is available at: http://www.apha.org/codeofethics

6. An Ethics Framework for
Public Health
Nancy E. Kass, ScD, Am J Public Health. 2001 November; 91(11): 1776–1782.
1. What are the public health goals of the proposed
program?
2. How effective is the program in achieving its stated
goals?
3. What are the known or potential burdens of the
program?
4. Can burdens be minimized? Are there alternative
approaches?
5. Is the program implemented fairly?
6. How can the benefits and burdens of a program be
fairly balanced?

7. Nuffield’s Stewardship mode
Acceptable public health goals include (examples?):
• reducing the risks of ill health that result from other people's actions;
• reducing causes of ill-health relating to environmental conditions;
• protecting and promoting the health of children and other vulnerable
people;
• ensuring that it is easy for people to lead a healthy life;
• appropriate access to medical services; and
• reducing unfair health inequalities.
At the same time, public health programs should:
• not attempt to coerce adults to lead healthy lives;
• minimise the use of measures that are implemented without
consulting people (either individually or using democratic
procedures); and
• minimize measures that are very intrusive or conflict with
important aspects of personal life, such as privacy
Lord Krebs K, Unwin J, et al.: Public health: ethical issues. London: Nuffield Council on Bioethics; 2007.

8. Now… your turn
• Which model of codes/frameworks you would
endorse? Why?
• Exercise: in groups, choose one of the
programs/departments you work(ed) with then
assess it using one of the above
frameworks/codes?

9. References & Readings
• THOMAS, J. C., SAGE, M., DILLENBERG, J. & GUILLORY, V. J. 2002. A code of ethics for public health.
Journal Information, 92.
• Childress JF, Faden RR, Gaare RD, Gostin LO, Kahn J, Bonnie RJ, Kass NE, Mastroianni AC, Moreno JD,
Nieburg P: Public health ethics: mapping the terrain.
• Lord Krebs K, Unwin J, et al.: Public health: ethical issues. London: Nuffield Council on Bioethics; 2007.
Required Readings:
• Childress JF, Faden RR, Gaare RD, Gostin LO, Kahn J, Bonnie RJ, Kass NE, Mastroianni AC, Moreno JD,
Nieburg P: Public health ethics: mapping the terrain. J Law Med Ethics 2002, 30(2):170-178.
• American Public Health Association (APHA)
http://www.apha.org/programs/education/progeduethicalguidelines.htm
• Kass N. An Ethics Framework for Public Health. AJPH. 91(11): 1776-1782. November 2001.
Optional/additional readings:
• American Medical Association Code of Ethics: http://www.amaassn.org/ama/pub/physician-resources/
medical-ethics.shtml
• Lord Krebs K, Unwin J, et al.: Public health: ethical issues. London: Nuffield Council on Bioethics; 2007.
• Roberts MJ, Reich MR. Ethical analysis in Public Health. Lancet (2002) 359:1055-1059
• Field RI, Caplan AL. A proposed ethical framework for vaccine mandates: competing values and the case
of HPV. Kennedy Inst Ethics J 2008;18(2):111-124.