The context of practitioner-client relationships was one of mistrust due to systemic stigma and previous negative experiences in health care. As a result, participants indicated that building and maintaining trust and autonomy were priorities that sometimes conflicted with organizational or legal requirements that required surveillance and sometimes social control. Currently, there is little literature on the relationship between ethics, evidence and values in health promotion. Hamilton, Bhatti86 and Raphael29 both argued that the evidence is supported by values and that these values should be explicit. That supports our point; We build on their work by suggesting how values can be made explicit. Tannahill points out that health promotion can only be informed by theory and evidence (not on the basis of).22 He cites « ethical principles »—including equality, respect, empowerment, participation, and openness—as taking precedence over evidence or theory. We believe that it is more useful to examine evidence in an iterative relationship with ethics, and that most of the principles listed by Tannahill are actually ethically relevant concepts that require further specification, as described in our framework. The Nuffield Council`s Stewardship Framework for Public Health Ethics57 is perhaps the most significant contribution to date. Like our work, this framework addresses concrete cases, recognizes the centrality of evidence, explicitly defines health as something valued, and seeks to « develop an ethical framework that identifies key values to guide public policy in this area. » 57 (p. 13) He uses political philosophy to propose a « stewardship model » for governments.52 The detailed examination of several case studies in the Nuffield report is an excellent example of the kind of specificity we advocated; However, the report seeks to achieve greater universality than we believe. We believe our framework would encourage a more conscious exposition of implicit concepts such as vulnerability, equality, and non-intrusion, and perhaps a more formal movement between ethics and evidence in reasoning. Health promotion interventions are often carried out in collaboration with public and private sector organizations, including labour organizations, businesses and commercial media companies. This is a growing phenomenon because companies want to engage in activities that demonstrate their social responsibility (also for economic reasons).
While these collaborations may be seen as useful and even necessary to reach different populations, receive funding, or make health-promoting changes within these organizations, they inevitably raise ethical concerns. Food marketing organizations collaborate on health promotion efforts to promote healthier diets. A striking example is the collaboration between a heart disease prevention organization and a large company that produces breakfast cereals (Glanz et al., 1995). Another striking and controversial example is the partnerships between road safety organisations and alcohol companies to promote road safety. These companies support road safety initiatives such as promoting the use of designated drivers or providing rides to drivers who have consumed alcoholic beverages. These initiatives not only give them legitimacy, but can also continue to promote their product and increase sales (Hastings, 2007). There are also collaborations with organizations that could be considered in the « opposite camp » or « competition » – for example, working on health promotion interventions with religious groups that oppose sex education (Truss & White, 2010). Some organizations or individuals may object to providing information and education to young people on the prevention of sexually transmitted diseases, even though these young people may be at risk of contracting these diseases.
Any form of cooperation raises ethical issues that must be identified and taken into account. Selgelid MJ. Disease prevention and control. Public Health Ethics: Cases Around the Globe: Springer Open; 2016. pp. 95-136. Pauly B, MacDonald M, Hancock T, Martin W, Perkin K. Reducing Health Inequalities: The Contribution of Key Public Health Services in British Columbia.
BMC Public Health. 2013;13(1):550. doi.org/10.1186/1471-2458-13-550. The discipline of ethics contains several competing and well-articulated systems of reasoning; These include deontology, utilitarianism, virtue theory, social contract theory, competency-based approach, and narrative ethics.1 These systems contain significant differences in values. They could, for example, value reason, dignity, moral obligations, obtain the best possible result for as many people, virtues, individual freedoms or common goods as possible. These valued concepts are often elaborated in detail in the ethics literature. They must sometimes be weighed against each other (individual freedom versus utilitarian maximization of utility, for example). To date, these formal systems have not made significant progress in public health practice or health promotion. Recently, the first model curriculum for public health ethics was published in the United States.51 It adopted a casuistic approach that encouraged students to examine practical problems, but offered limited opportunities to acquire the detailed conceptual tools available in the discipline of ethics.
To fully understand either of these approaches, further study is needed.1 It has been shown that not only stigma, but also labelling influence the identity of individuals or groups.