Better Health For All

By John Coggon Hon MFPH, Professor of Law, Centre for Health, Law, and Society, University of Bristol Law School

Public health is proudly an evidence-based field. But evidence without values cannot tell us what we should do.

We need public health ethics if we are to understand and explain, by reference to the classic definition of public health advanced by Winslow, what we, as a society, ought to do to assure the conditions in which people can enjoy good health and equitable prospects for health. Using the ‘organised efforts of society’ to protect and promote health and wellbeing is an ethical goal – indeed, as many of us would argue, it is an ethical imperative. And to be achieved, it requires law and policy. To evaluate when threats to health warrant a public health response, scientific analyses must be complemented by matters such as the balancing of values, an assessment of the relative merits of different possible interventions, an appreciation of the likely risks and impacts of intervening, and a sensitivity to political and cultural contexts and realities.

At a workshop convened in London, at the Royal College of Physicians on 18 January 2018, public health practitioners, trainees, leaders, researchers and policy-makers joined with scholars in public health ethics to discuss how public health ethics and law (PHEL) might be established as a professional competency, and how we might ensure that it is robust and rigorous through education and training. This is part of a project I am involved in with AM Viens at the University of Southampton, and Farhang Tahzib, Chair of the Faculty of Public Health (FPH)’s ethics committee and a champion for bringing academic public health ethics into practice.

We argue that the public health workforce needs a clearly defined PHEL competency, secured within public health education and ongoing professional training. This builds on further work that we have done regarding PHEL expertise to support the Public Health Skills and Knowledge Framework. As contributions throughout the day affirmed, such a competency requires to be explained in a way that is academically robust: is it based on sound and coherent principles? It must be practically realisable: is it clear how to apply the PHEL competency in the vast, complex, and challenging range of practical situations covered by public health? And it must be treated properly as an essential part of public health capacity: how, for example, can we ensure it is taken seriously as part of continuing professional development requirements? The feedback and engaged discussion from all participants were complemented and further stimulated by contributions from Bruce Jennings – described by Farhang as one of the fathers of public health ethics – as well as an expert panel on which Bruce was joined by Angus Dawson, Vikki Entwistle, Kevin Fenton and Fiona Sim.

Just as areas such as statistical analysis and detection of disease require skills and expertise, so do legal and ethical understanding and practice. As FPH President John Middleton suggested at the start of the day, we need to consider how questions of justice impact public health practice, and how our overall political agendas should be shaped if we are to achieve a sustainably fairer society. For good practice, and good frameworks for practice, PHEL experts need to work with the public health community to ensure that ethical challenges, big and small, can be addressed with proper knowledge, understanding, and skills in ethical, legal, and political reasoning.

We look forward to publishing a full report on our findings, detailing how the PHEL competency should be defined, and a range of model materials for PHEL education and training through FPH’s website, as well as wider academic papers. It is an exciting time to be engaging with FPH and other partners to advance these agendas, strengthening capacity for ethics and law in public health.

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