Code of Public Health Ethics

OUR SHARED RESPONSIBILITIES
CODE OF ORGANIZATIONAL ETHICS
MAHONING COUNTY DISTRICT BOARD OF PUBLIC HEALTH

Introduction

This Code of Organizational Ethics was developed in consultation with members of the District Board of Health and staff. Meetings were held with management and staff to gather information on shared values, professional practices, and organizational structures. Several interviews were also conducted that helped refine that information. Hence this Code reflects a consensus on the values, commitments, and standards of conduct within the Board of Health.

The purpose of this Code is threefold:

This Code expresses our shared responsibilities. It shall be disseminated to all members of the District Board of Health and staff and made available to the community.

  • to provide guidance to officers, members, and staff of the Board of Health
  • to encourage and support an institutional culture of ethical awareness and high ethical standards in all aspects of the Board of Health's functions
  • to provide a process of open and transparent decision making.

Mission

The mission of the District Board of Health is to promote and protect the health of individuals and our communities, to create a safer, healthier environment and to improve quality of life.

Basic Values of Public Health

Three values are fundamental to public health professionals and the profession.

Population-based Values
The basic value of public health is to protect and promote the health and physical well-being of, as well as to prevent injury and disease in, whole populations. It   is, therefore, concerned with the fundamental conditions that affect entire communities. It aims to avoid, prevent, and remove harms; produce maximal benefits for the community; and distribute burdens and benefits fairly. Public health works primarily through government agencies and has access to the state's police and coercive powers. The exercise of those powers, however, must be balanced with respect for the rights of individuals in the community.

Advocacy Values
The population health focus of public health makes the distribution of health and health inequalities across individuals and groups a central concern of the field. An important value of public health is therefore to advocate for disenfranchised, underserved, and vulnerable populations. Accordingly, programs and priorities should ensure an opportunity for all individuals in a community to have a voice, articulate the implications of policies for vulnerable populations, respect the diverse values, beliefs and cultures in a community, and provide a fair distribution of public health resources.

Professional Values
Another important value of public health is respect for the rights of individuals in the community, including the rights to privacy, confidentiality, and autonomy. The rights of individuals can sometimes conflict with the basic values of public health. Reaching a reasonable balance of values is often difficult and frequently case-specific. In each case, however, we should strive to identify the intervention that is least restrictive while consistent with the public's health.

Organizational Values & Standards

Public health professionals are expected to adhere to standards of individual professional performance and to the rules and regulations imposed on them by their agencies, public policies, and laws. In order to meet the mission of the Board of Health and to secure and promote an ethical workplace, members of the Board of Health and staff shall uphold the following organizational values that serve as standards of conduct:

Competence
The maintenance of high standards of competence is a responsibility shared by all Board and staff members. They will perform only those services for which they are qualified by training or experience, follow and promote standards of conduct in accord with the best current practices, gather, tabulate, interpret and report data honestly and conscientiously, and maintain knowledge of current scientific and professional information related to the mission of the Board of Health.

Trust and Honesty
To protect the integrity of this agency, we must uphold the public's trust in all of our professional interactions. The Board of Health and staff are therefore committed to honest, accurate, and timely professional and organizational communication and to avoid misleading or deceptive information.

Fairness
As a public agency, the Board of Health is accountable to the public. Members of the Board of Health and staff must be impartial in the quality of service delivered, implementation of rules and regulations, and in the exercise of public health authority and police powers.

Respect
Members of the Board of Health and staff shall treat those with whom they have a professional relationship in a respectful, dignified, honest, and fair manner, accept other's right to hold values and beliefs that differ from one's own, accurately represent other's qualifications and professional opinions, treat respectfully all persons regardless of race, religion, sex, sexual orientation, age, or national origin, and recognize the prerogatives and obligations of the Board of Health.

Professional Integrity
Professionals play the very important role of delivering services that are essential for protecting and promoting vital social values. It is therefore imperative that the management and staff of the Board of Health conduct themselves in accordance with the highest levels of professional standards in the discharge of their official duties, in relations among each other, and particularly with the public. They should recognize and avoid undue influence of any interest on their professional obligations.

Collegiality
Members of the Board of Health and staff recognize that an ethical workplace requires us to act with proper consideration to the competencies and obligations of our professional colleagues and in relations between staff and management, and that we accurately and fairly represent the qualifications, views, and findings of colleagues.

Teamwork
The Board of Health and staff are committed to continuous organizational improvement focused on satisfying stakeholder and client expectations, problem-solving, and improving business processes through management-staff teamwork and collaboration with other community organizations.

Conflict of Interest
A conflict of interest occurs whenever a professional has a private or personal interest sufficient to influence, or that can potentially influence or appear to influence, her or his professional objectivity in the exercise of official duties. Members of the Board of Health and staff will avoid such conflicts and disclose them to their immediate supervisors. Whenever there is doubt that such a conflict exists, members of the Board of Health and staff should request the opinion of the Ethics Advisory Committee.

Ethics Advisory Committee (EAC)

Purposes of EAC.
The EAC is an advisory – not enforcement – committee. Its main purpose is to assist the Board of Health and staff in making ethical decisions by applying the organization's basic values.

Other important purposes served by the EAC are:

Management has a particular obligation to create a working environment conducive to ethical conduct and to ensure that individuals may freely express their ethical and professional concerns.

Members of the Board of Health and staff who have good reason to believe that a violation of this Code has occurred should bring the matter to the attention of the colleague in an informal manner. If the matter cannot be resolved informally, it should be referred to the Ethics Advisory Committee.

EAC Methodology
Subsequent to a written request by any member of the Board of Health or staff, the EAC will meet to consider the ethical issues as reflected in this Code. The EAC will conduct an initial fact-finding of the issue(s), identify the relevant rights and interests of the stakeholders, apply the relevant values and standards, and, whenever consensus exists, recommend a course of action.

Three important principles of procedure are:

Composition of the EAC
The EAC seeks to have wide representation. The constituencies to be represented include members of the Board of Health and staff, other public health practitioners, community members, and representatives of relevant professions. Membership is by appointment of the Board of Health or election by staff, with equal representation. Ideally, it will have between ten and twelve members. A chair will be elected by simple majority of the members of the EAC.

Meetings of the EAC
Meetings shall be convened for case consultation subsequent to a written request, for the purpose of educating its members, and on a scheduled basis determined by the chair and members of the EAC.

Minutes of the EAC Meetings

APPENDIX

Principles of the Ethical Practice of Public Health
In 2002, the American Public Health Association, under the guidance of the Public Health Leadership Society, adopted twelve ethical principles. Those principles are based on values that are inherent to the professional practice of public health and are intended to guide decisions and deliberations of public health professionals

  • to develop the ability to identify an ethical issue in the practice of public health and in the Board of Health
  • to provide members of the Board of Health and staff a decision-making process aimed at resolving disagreements on actions by the Board of Health and issuing recommendations on potential actions
  • to serve as a consultative body for discussion and recommendations; and to educate the Board of Health and staff on the ethical practice of public health.
  • Principle of Democratic Deliberation: The Board of Health exists for the benefit of the community. The rights of the relevant groups, particularly those affected by Board of Health decisions, should be ensured, and further, they may participate, in some sense and whenever possible, in decisions that substantially affect their interests and welfare.
  • Principle of Fiduciary Relationship: The Board of Health and staff bear a fiduciary relationship to stakeholder groups and the organization. It must, therefore, act in the interest of the stakeholders, namely, the community and the Board of Health.
  • Principle of Organizational Ethics: The deliberations and recommendations of the EAC are to be guided, first and foremost, by the Values and Standards of this Code.
  • Public health should address principally the fundamental causes of disease and requirements for health, aiming to prevent adverse health outcomes.
  • Public health should achieve community health in a way that respects the rights of individuals in the community.
  • Public health policies, programs, and priorities should be developed and evaluated through processes that ensure an opportunity for input from community members.
  • Public health should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all.
  • Public health should seek the information needed to implement effective policies and programs that protect and promote health.
  • Public health institutions should provide communities with the information they have that is needed for decisions on policies or programs and should obtain the community's consent for their implementation.
  • Public health institutions should act in a timely manner on the information they have within the resources and the mandate given to them by the public.
  • Public health programs and policies should incorporate a variety of approaches that anticipate and respect diverse values, beliefs, and cultures in the community.
  • Public health programs and policies should be implemented in a manner that most enhances the physical and social environment.
  • Public health institutions should protect the confidentiality of information that can bring harm to an individual or community if made public. Exceptions must be justified on the basis of the high likelihood of significant harm to the individual or others.
  • Public health institutions should ensure the professional competence of their employees.
  • Public health institutions and their employees should engage in collaborations and affiliations in ways that build the public's trust and the institution's effectiveness.