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Politics and Public Health Ethics in Practice: Right and Left Meet Right and Wrong

Gollust, Sarah E. BA; Baum, Nancy M. MHS; Jacobson, Peter D. JD, MPH

Journal of Public Health Management & Practice: July/August 2008 - Volume 14 - Issue 4 - p 340–347
doi: 10.1097/01.PHH.0000324561.42039.47
Commentary

As public health practitioners are no doubt aware, public health practice and politics are closely linked. Although theoretical discussion of the emerging field of public health ethics has been rich, scholars have paid little attention to the relationship between ethical issues and politics in public health practice. We conducted semistructured interviews with 45 public health practitioners across a range of occupations (eg, health officers, medical directors, sanitarians, nurses, educators, and commissioners) working at 12 local health departments across Michigan and the state health department. Practitioners were asked to describe the ethical issues they faced in their daily practice. Ethical issues that resulted from the political environment emerged as one major category of ethical issues our interviewees described. This article illustrates how political issues engender ethical challenges in 4 main areas: public health agenda-setting, political pressures, political conflicts with best practices, and the scope of public health practice. The findings suggest that politics and public health ethics intrinsically intersect, because political pressures and priorities often impose ethical challenges that practitioners negotiate in their daily work.

This article illustrates the relationship between ethical issues and politics in public health practice.

Sarah E. Gollust, BA, is a PhD candidate, Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor.

Nancy M. Baum, MHS, is a PhD candidate, Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor.

Peter D. Jacobson, JD, MPH, is a professor of Health Law and Policy, and director, Center for Law, Ethics, and Health, Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor.

Corresponding Author: Sarah E. Gollust, BA, Department of Health Management and Policy, University of Michigan School of Public Health, 109 Observatory, Ann Arbor, Dearborn, MI 48109.

This work was supported from a grant from the Greenwall Foundation. We thank Robert M. Pestronk for his advice during development of the study and for his comments on the manuscript, and Susan D. Goold for her advice on the study design and analysis. We also thank the public health professionals who participated in this study and offered us their considerable insights.

© 2008 Lippincott Williams & Wilkins, Inc.