Public health institutions increasingly realize the importance of creating a culture in their organizations that values ethics. When developing strategies to strengthen ethics, institutions will have to take into account that while public health research projects typically undergo thorough ethics review, activities considered public health practice may not be subjected to similar oversight. This approach, based on a research-practice dichotomy, is increasingly being criticized as it does not adequately identify and manage ethically relevant risks to those affected by nonresearch activities. As a reaction, 3 major public health institutions (the World Health Organization, US Centers for Disease Control and Prevention, and Public Health Ontario) have implemented mechanisms for ethics review of public health practice activities. In this article, we describe and critically discuss the different modalities of the 3 approaches. We argue that although further evaluation is necessary to determine the effectiveness of the different approaches, public health institutions should strive to implement procedures to ensure that public health practice adheres to the highest ethical standards.
Institute of Ethics, History & Theory of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany (Ms Klingler); Public Health Ethics Unit, Office of Scientific Integrity, Office of the Associate Director for Science, Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia, USA (Dr Barrett); Science Office, Public Health Ontario, Toronto, Ontario, Canada (Dr Ondrusek); Department of Reproductive Health and Research & UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland (Dr Johnson); and Global Health Ethics Unit, Health Systems and Innovation Cluster, World Health Organization, Geneva, Switzerland (Drs Saxena and Reis).
Correspondence: Corinna Klingler, MSc, Institute of Ethics, History & Theory of Medicine, Ludwig-Maximilians-Universität München, Lessingstr. 2, 80336 Munich, Germany (email@example.com).
All authors contributed to conceptualizing the paper and developing the argumentation; C.K., D.H.B., and N.O. wrote the first draft of the manuscript; all authors critically revised and approved the final manuscript.
C.K. has received funding for a Carlo Schmid Fellowship from the German Academic Exchange Service (DAAD) in 2014-2015 in support of an internship with the WHO Global Health Ethics Unit during which parts of this paper were developed. Funding bodies had no influence on this paper.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
The views and opinions expressed in this article are those of the authors and do not necessarily represent those of, or reflect, the official position of Public Health Ontario.
B.R.J., A.S., and A.A.R. are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of the World Health Organization.
The authors declare no conflicts of interest. All authors, however, were involved in developing and implementing the services presented in this paper.