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Principled Leadership in Public Health: Integrating Ethics Into Practice and Management

Bernheim, Ruth Gaare JD, MPH; Melnick, Alan MD, MPH

Journal of Public Health Management and Practice: July-August 2008 - Volume 14 - Issue 4 - p 358–366
doi: 10.1097/01.PHH.0000324564.64910.f5

Public health officials frequently face ethical tensions and conflicting obligations when making decisions and managing health departments. Leadership requires an ongoing approach to ethics that focuses on two dimensions of practice: the professional relationships of officials developed over time with their communities and the ethical aspects of day-to-day public health activities. Education and competencies in ethics may be helpful in practice, by providing, at a minimum, frameworks and ethical principles to help structure analysis, discussion, and decision making in health departments and with community stakeholders. Such a “practical ethics” approach in public health practice begins with a focus on public health values and an agency mission statement and integrates ethics throughout the organization by, for example, setting performance measures based on them. Using a case in emergency preparedness, this article describes ways in which ethical frameworks and the Code of Ethics can be used as tools for education and to integrate ethics into agency activities and programs.

This article focuses on the ethical tensions and conflicting obligations faced by public health officials when making decisions and managing health departments.

Ruth Gaare Bernheim, JD, MPH, is Director of the Division of Public Health Policy and Practice and master of Public Health Program, as well as Associate Director of the Institute for Practical Ethics and Public Life, at the University of Virginia. Ms Gaare Bernheim previously was on the faculty of Johns Hopkins School of Public Health and Johns Hopkins Bioethics Institute. She also served on Johns Hopkins Hospital Ethics Committee and the Johns Hopkins Health Care Scientific and Benefits Assessment Committee.

Alan Melnick, MD, MPH, is Health Officer, Clark and Skamania Counties in Washington and Associate Professor for the Department of Family Medicine at Oregon Health and Science University. Dr Melnick is also an Associate Professor in the Department of Public Health and Preventive Medicine and Department of Medical Informatics and Clinical Epidemiology at Oregon Health and Science University. Currently, he is a member of the National Board of Public Health Examiners, a member of the Community Level Health Promotion Study of the National Tri-Country Health Care Safety Net Enterprise.

Corresponding Author: Ruth Gaare Bernheim, JD, MPH, Division of Public Health Policy and Practice, University of Virginia, School of Medicine (

© 2008 Lippincott Williams & Wilkins, Inc.