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November 2001, Vol 91, No. 11 | American Journal of Public Health 1776-1782
© 2001 American Public Health Association

PUBLIC HEALTH MATTERS

An Ethics Framework for Public Health

Nancy E. Kass, ScD

Nancy E. Kass is with the Department of Health Policy and Management, Johns Hopkins School of Public Health, and the Johns Hopkins University Bioethics Institute, Baltimore, Md.

Correspondence: Requests for reprints should be sent to Nancy E. Kass, ScD, Hampton House 344, 624 N Broadway, Baltimore, MD 21205 (e-mail: nkass{at}jhsph.edu).

More than 100 years ago, public health began as an organized discipline, its purpose being to improve the health of populations rather than of individuals. Given its population-based focus, however, public health perennially faces dilemmas concerning the appropriate extent of its reach and whether its activities infringe on individual liberties in ethically troublesome ways. In this article a framework for ethics analysis of public health programs is proposed.

To advance traditional public health goals while maximizing individual liberties and furthering social justice, public health interventions should reduce morbidity or mortality; data must substantiate that a program (or the series of programs of which a program is a part) will reduce morbidity or mortality; burdens of the program must be identified and minimized; the program must be implemented fairly and must, at times, minimize preexisting social injustices; and fair procedures must be used to determine which burdens are acceptable to a community.




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