The study further contributes to the discussion of what contribution a Christian-informed public health ethic can make towards such a framework. This claim is based on a Google Scholar search of the topic along with a close analysis of public health ethics. Once this issue is addressed, the focus will be on what indicators can be defined by a Christian-informed public health ethical framework.
Public health is “the science and art of promoting health, preventing disease and prolonging life through the organized efforts of society” (WHO, 1998: 3). This can be complemented by a statement of purpose, namely the definition of a public health ethics framework for South Africa. A deeper understanding of the scope and practice of public health is needed to substantiate these claims.
The 1988 document 'The Future of Public Health' emphasizes what healthcare providers can do. Hence the following definition: “The field of public health is concerned with health promotion and disease prevention throughout society. As a result, public health can even be transformed into improving health and well-being (Berridge In the narrower sense, public health refers to a) the health of a population, b) the longevity of individual members, and c) freedom from disease. (Berridge, 2016: 2).
The Johns Hopkins Bloomberg School of Public Health takes a very pragmatic approach to defining public health.
The context and practice of public health
Based on these semantic claims, we conclude that public health refers to strategies and prevention to promote, secure and maintain the quality of health and well-being based on the public health value chain. The public health value chain is based on access to health care, quality habitat (consisting of social, environmental, work and living spaces conducive to good health), leisure as self-care, effective service delivery and health improvement as equity. Based on the summative semantic propositions promoted from the literature review, the public health context and practice will now be reviewed.
At the end of her term as Director General, she published a report on public health. These developments relate to the shift (a) to primary health care to build capacity through existing health care systems (or any system), policy and budget, (b) to primary health care as a tool to prevent waste and improve efficiency ; and (c) the role that social determinants can play to improve public health. In tackling these diseases, she calls for a change in mentality regarding public health.
Although her report does not relate to the state and/or purpose of a public health ethic, the importance of ethics cannot be ignored. From her study, three observations can be drawn that will be useful in guiding the understanding of public health. The combination of economic and moral determinism has long been a feature of public health – we can trace this combination in public health responses to the present day, where the good health of a population is seen as a component of economic development (Berridge, 2016 : 49).
Berridge's historical overview is clear: there was a shift from belief in technical solutions, for example to healthcare systems, to research and evidence, to the development of health promotion or 'new public health'. The focus extended from the treatment of the disease to service delivery (Berridge). Public health focuses mainly on lifestyle issues, for example drinking, smoking, sexual health and obesity. The role of ethics in public health programs is (a) to reduce the risks of ill health that people can impose on others, (b) to create an environment that sustains good health, (c) to care for vulnerable groups, d) presenting education/information; e) reducing unfair health inequalities;
These challenges included public health challenges and challenges related to policies, socio-economic needs, financing and the public health system. From these comments it is evident that public health in the South African context has very specific objectives, namely (a) developing a public health system challenged by equity, quality, access and affordability; (b) providing health services that are affordable and part of a global health system; (c) addressing health challenges such as life expectancy, reducing maternal and child mortality, HIV and tuberculosis; and (d) improving the effectiveness of the health system. In paragraph 3.2, the view was formulated that public health refers to strategies and prevention to promote, ensure and support the quality of health and lifestyle based on a public health value chain.
Linked to the MDGs, affordability (as cost), capacity and education will be important drivers for sustaining public health strategies and interventions. As the scope of what public health is has now been outlined, the role of ethics in public health can be discussed.
Ethics in public health
These observations communicate a unique role for public health ethics, namely population (groups) rather than disease prevention and health promotion rather than cure. Bioethics stems from medical care and human research, and focuses on a diverse set of concerns that arise in public health ethics. Although public health is different from global health, global health can help define the role of ethics in public health.
Third, the reality is that although public health is primarily concerned with a population and/or group, the role of the individual in the implementation of public health cannot be overlooked. It is a fair conclusion that a specific indicator that must be covered by a public health ethics framework is vulnerability. The scope of ethics in public health therefore goes beyond the potential conflict between individual and group interests.
This highlights the question of whether the community is well represented in public health ethics. In defining the role of ethics in public health, Kass (2001) helps provide a guideline that can be informed by six questions: . a) What are the public health objectives of the proposed programme. With this view, Kass essentially argues for the ethical management of public health programs.
This plea becomes even more relevant when the focus on financing and public health is considered. Because the public health agenda must be implemented and managed, professional ethics can never be removed from the scope of public health ethics. Public health ethics will protect the vulnerable, as a group and as individuals, in identifying, promoting, implementing and managing the public health agenda.
Based on this scope, public health ethics can be defined as the values that inform the public health value chain to ensure the quality of health and well-being. Public health ethics as applied ethics – public health ethics must identify values to address moral problems related to public health. Public health ethics should advocate values that can inform and guide the public health value chain.
Public health ethics should train skilled workers who will have the knowledge and skills to deal with dilemmas in the public health agenda. Public health ethics cannot be removed from professional conduct - professionals must act in a virtuous manner.
What contribution from a Christian informed paradigm towards a public health ethics framework?
Public health ethics should promote safety and security, individual interest and responsibility, and economic freedom through the integration of ethical values with the public health agenda. At the same time, this right is extremely vulnerable due to the influence of limiting or negative social determinants. Second, public health is about an activity and program organized to ensure access to quality (basic) health care, to improve and protect human dignity, and to create a sustainable environment.
Third, public health ethics is informed by a utilitarian perspective: it is not about a single person's interests, but those of a community. Fourth, public health ethics emphasizes not only the improvement of health and well-being, but especially the behaviors necessary to make this improvement a reality. Anthropology: Human health and well-being cannot be limited to the protection of human life.
Creation: The development of a livable environment is not only limited to the physical space, but also about sanitation, recreation, food, security and safety.
Conclusions
South Africa's healthcare and health system: historical roots of today's public health challenges.
