Health Promotion Code of Ethics

[Torill.Bull]

The IUHPE Student and Early Career Network (ISECN, see http://www.isecn.org/ for information) invites all with interest in health promotion to join a dialogue about a code of ethics for health promotion. The dialogue has up to this point been internal to the ISECN and you may read it at http://www.hpethics.blogspot.com/.

Now, ISECN wish to open the dialogue to the widest possible participation, using the newly established IUHPE Views of Health Promotion Online (VHPO), a managed online forum for dialogue on a wide range of health promotion subjects.

Amongst the questions that may be addressed in the dialogue are these:

• Do we need an ethical code?
• What would distinguish a health promotion code from codes for other professions?
• What should the content be? Should it be short, long, specific, general? What format? What level of detail?
• How do we ensure that the code is globally applicable?
• What are the challenges of creating a global code? How can we handle those challenges?

SUMMARY

[j.hope.corbin]

I do believe health promotion would benefit from a code of ethics.

At the IUHPE European Conference in Turin, Torill and I had the pleasure of talking with Diane Levin about ethics in Health Promotion. One idea we discussed was that it might be interesting to compile a store of examples of ethical dilemmas that we have been challenged with in the course of our research and practice in health promotion. We could then use these examples to help draft a code that would be relevant for the kinds of ethical challenges we actually face. Then the code could act as a touch stone we could use to help solve similar dilemmas in the future.

I think it would be quite interesting if VHPO users participating in or viewing this stream could spend a moment to reflect on their own experiences and share an example of a time they have been confronted with an ethical dilemma. Nothing too elaborate (unless you feel inspired) -- just a summary.

In my own research, I am doing a case study of a community based organisation in Tanzania. One ethical dilemma that a participant shared with me is the conflict between bottom-up and top-down approaches. Ideally, you want all the ideas for programmes to come from the community but if funding can not be found for the programmes they want-- then you have raised their hopes and then dashed them.

[Torill.Bull]

As Global Secretary of ISECN, I have an ethical dilemma when people cannot join ISECN because they cannot afford IUHPE membership. To people in poor regions - and even to students in more well-off regions - such financial limitations are real, even if IUHPE has a graded membership fee. I see that we could have helped build the capacity of these people, connecting them with others in empowering networks, supporting them in participating and publishing - all the good health promotion ideals. Still we end up excluding people when a major aim of IUHPE is 'to promote equity within and between nations'.

[Pius.Attandoh]

With over three year’s active professional experience in ‘health promotion/development’ in Ghana (Africa), I have been confronted with real dilemmas, which affected effective practice. This very first dilemma may be related to the ‘bottom-up/top-bottom’ point raised by Hope. The point must be made that most of the health development programmes that take place in Africa are donor driven, and often these donors are interested in programmes that produce tangible results (outputs, and to some extent outcomes). Of course these donors are also accountable to their tax payers so would want to ‘invest’ in result-driven initiatives. Regrettably, many of such initiatives are not priorities of the target communities and therefore end up not benefitting the intended recipient groups. The difficulty is as an implementing body, do you accept such a package (just to keep your organization active/running) or decline such donations from donor agencies, who may not change their approach anyway.

The second dilemma relates to health education as an important strategy not having the critical infrastructure to support it. Let me not confound issues: take for instance advocacy on the need for communities to drink clean water but cannot easily access it.

In the coming days, I intend to contribute much more on successes, and also real complexities in relation to effective health promotion practice in Africa.

[gabrielle]

I think that the newly established IUHPE Views of Health Promotion Online (VHPO) provides a wonderful opportunity for people from all parts of the globe to express their thoughts and ideas, and to share their experiences concerning the promotion of health and well-being. And in starting VHPO, it seems most appropriate that the topic of the first stream is a code of ethics for health promotion. What we do and how we do it will always have consequences for others, either good or bad, and from a health promotion perspective, it is so important that the "what" and the "how" will contribute to the promotion of health for everyone and not cause harm. And for this, a code of ethics for health promotion will hopefully serve as a valuable guideline for all practice and research.

I want to congratulate everyone who has contributed to the establishment of VHPO, and I look forward to following, and participating in, the stimulating dialogues that I know will follow.

Very best wishes
Gabrielle

[Maurice Mittelmark]

Early next week, the entire IUHPE membership will be contacted and informed about the topics in process. However, we want all interested parties to participate, so, IUHPE members: please tell others in your network about this new communications tool!

[Oguda]

Thanking everyone for this timely venture to continue building the ever changing face of Health Promotion. I am Gabriel Owiti Oguda, from the African Institute for Health and Development (AIHD) Kenya. Dr. Mary Amuyunzu-Nyamongo had introduced me to Prof. Maurice and Pius. I had been working with Pius and Prof. Maurice on the HP SOURCE.NET Kenyan Chapter. Although I have a Bachelors degree in Anthropology, I have already asked Prof. about the possibilities of me joining the University of Bergen in 2010.

It is with this in mind that I request that I be allowed to join this forum.

[Torill.Bull]

Thanking everyone for this timely venture to continue building the ever changing face of Health Promotion. I am Gabriel Owiti Oguda, from the African Institute for Health and Development (AIHD) Kenya. Dr. Mary Amuyunzu-Nyamongo had introduced me to Prof. Maurice and Pius. I had been working with Pius and Prof. Maurice on the HP SOURCE.NET Kenyan Chapter. Although I have a Bachelors degree in Anthropology, I have already asked Prof. about the possibilities of me joining the University of Bergen in 2010.

It is with this in mind that I request that I be allowed to join this forum.

Hi Gabriel,

We are happy to have you take part in the discussion on ethics! From your Kenyan perspective, how would you respond to the questions asked in the introduction to this discussion? What are the ethical challenges of health promotion? Can a health promotion code of ethics become a helpful tool to help us make practical decisions in everyday life? Could you describe a situation from your work or research which you experienced as an ethical dilemma? Looking forwards to hearing your view on this!

Best wishes,
Torill

[Torill.Bull]

In ethical dilemmas, the choice is most often not between the obviously 'good' and 'bad', 'right' or 'wrong'. I think what makes choices difficult at times, is that we have to choose between different degrees of good, or different degrees of bad.

Are there any principles of priority within health promotion? Are there any 'goods' that should be valued more than others? Any 'bads' that should be avoided more than others?

[Oguda]

Thanks Torill,

As field workers always in touch with the grassroots, there is need to understand the intertwining linkages in the communities where we arrive to impart life changing health messages. Take a look at this case study.

Makueni District in Eastern Province of Kenya is found in the Arid and Semi-Arid Lands. Most of the time the residents of this district rely on relief food (especially cereals) from the government and external development partners. In a bid to ensure food security, the residents often store these cereals without observing basic preservation criteria and after a while the foods go bad. Three years ago, 157 people died in Makueni as a result of high Aflatoxin in the maize they consumed. The irony is that when the Ministry of Health stepped in to incinerate the intoxicated cereals that were still in their custody, the residents hoarded the cereals. The reasoning being that after the destruction of the maize, they shall be left with nothing to survive on hence starvation and eventual death. They gamble with filling their stomachs with poison than observing life and die.

In view of the above, Health Promotion practitioners arriving in situations like Makueni to sensitize them on how well to preserve food would not be taken seriously. This is because most of them lack basic household infrastructure and so there would be no store. HP experts, in developing countries, therefore should develop some understanding with like-minded organizations aimed at boosting a people's health status because the message alone would never be adequate to ensure change of attitude.

It is imperative, therefore, that an understanding be arrived at with the relevant Health sector stakeholders to assist HP experts realise their mission. This understanding should have terms of refference attached to it hence the code of ethics in Health promotion.