Register      Login
Health Promotion Journal of Australia Health Promotion Journal of Australia Society
Journal of the Australian Health Promotion Association
RESEARCH ARTICLE

Building workforce capacity for ethical reflection in health promotion: a practitioner’s experience

Annabel Axford A and Drew Carter B C
+ Author Affiliations
- Author Affiliations

A School of Education, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.

B School of Public Health, Mail Drop DX 650 550, University of Adelaide, SA 5005, Australia.

C Corresponding author. Email: drew.carter@adelaide.edu.au

Health Promotion Journal of Australia 26(3) 222-230 https://doi.org/10.1071/HE15031
Submitted: 30 April 2015  Accepted: 29 October 2015   Published: 23 December 2015

Abstract

Health promotion does not have a code of ethics, although attempts have been made to assist practitioners in their understanding and application of ethical concepts. This article describes and analyses one such attempt, sustained from 2006 to 2014 in rural South Australia. The attempt comprised capacity-building activities that were informed by principles of organisational change management, especially the principle of creating champions. The article also presents a framework (largely comprising ethical questions) that may help practitioners as a prompt and guide to ethical reflection. The framework was developed to be as accessible as possible in light of the diverse educational backgrounds found in rural settings. Finally, the article highlights some philosophical dimensions to the framework and defends its role, proposing that ethical reflection is integral to good practice and never simply the province of theorists. The article does all this with a view to stimulating discussion on how to increase the frequency and quality of ethical reflection undertaken by health promotion practitioners.

Key words: codes of ethics, community health planning, ethical analysis, South Australia.


References

[1]  Mittelmark MB (2008) Setting an ethical agenda for health promotion. Health Promot Int 23, 78–85.
Setting an ethical agenda for health promotion.Crossref | GoogleScholarGoogle Scholar | 18006563PubMed |

[2]  Australian Health Promotion Association. Core competencies for health promotion practitioners. Maroochydore: University of the Sunshine Coast; 2009.

[3]  Bolger J. Capacity development: why, what, and how. Gatineau, Quebec: Canadian International Development Agency; 2000.

[4]  Chapman S (2004) Advocacy for public health: a primer. J Epidemiol Community Health 58, 361–5.
Advocacy for public health: a primer.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2c7os1egtw%3D%3D&md5=7d5cf351acd5bd59faf689d37991f688CAS | 15082730PubMed |

[5]  Johnson A, Paton K. Health promotion and health services: management for change. Melbourne: Oxford University Press; 2007.

[6]  McLean S, Feather J, Butler-Jones D. Building health promotion capacity: action for learning, learning from action. Vancouver: UBC Press; 2005.

[7]  Skinner H. Promoting health through organizational change. San Francisco: Benjamin Cummings; 2002.

[8]  Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O (2004) Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 82, 581–629.
Diffusion of innovations in service organizations: systematic review and recommendations.Crossref | GoogleScholarGoogle Scholar | 15595944PubMed |

[9]  Prairie Region Health Promotion Research Centre. Health promotion capacity checklists: a workbook for individual, organizational, and environmental assessment. Saskatoon: University of Saskatchewan; 2004.

[10]  Regional World Health Organization (WHO) Office for the Western Pacific. Social mobilization for health promotion. Manila: WHO; 2003.

[11]  Standing Council on Health. National strategic framework for rural and remote health. Canberra: Commonwealth of Australia; 2012.

[12]  Chisholm M, Russell D, Humphreys J (2011) Measuring rural allied health workforce turnover and retention: what are the patterns, determinants and costs? Aust J Rural Health 19, 81–8.
Measuring rural allied health workforce turnover and retention: what are the patterns, determinants and costs?Crossref | GoogleScholarGoogle Scholar | 21438950PubMed |

[13]  Lenthall S, Wakerman J, Opie T, Dunn S, Macleod M, Dollard M, Rickard G, Knight S (2011) Nursing workforce in very remote Australia, characteristics and key issues. Aust J Rural Health 19, 32–7.
Nursing workforce in very remote Australia, characteristics and key issues.Crossref | GoogleScholarGoogle Scholar | 21265923PubMed |

[14]  Keane S, Smith T, Lincoln M, Fisher K (2011) Survey of the rural allied health workforce in New South Wales to inform recruitment and retention. Aust J Rural Health 19, 38–44.
Survey of the rural allied health workforce in New South Wales to inform recruitment and retention.Crossref | GoogleScholarGoogle Scholar | 21265924PubMed |

[15]  National Rural Health Alliance. Shining a light on rural and remote health: 2013 election charter. Canberra: National Rural Health Alliance; 2013.

[16]  Department of Health and Ageing. Report on the audit of health workforce in rural and regional Australia. Canberra: Commonwealth of Australia; 2008.

[17]  Carter SM, Rychetnik L, Lloyd B, Kerridge IH, Baur L, Bauman A, Hooker C, Zask A (2011) Evidence, ethics, and values: a framework for health promotion. Am J Public Health 101, 465–72.
Evidence, ethics, and values: a framework for health promotion.Crossref | GoogleScholarGoogle Scholar | 21233436PubMed |

[18]  Holland S. Public health ethics. Cambridge: Polity Press; 2007.

[19]  Tannahill A (2008) Beyond evidence–to ethics: a decision-making framework for health promotion, public health and health improvement. Health Promot Int 23, 380–90.
Beyond evidence–to ethics: a decision-making framework for health promotion, public health and health improvement.Crossref | GoogleScholarGoogle Scholar | 18971394PubMed |

[20]  Have MT, van der Heide A, Mackenbach JP, de Beaufort ID (2013) An ethical framework for the prevention of overweight and obesity: a tool for thinking through a programme’s ethical aspects. Eur J Public Health 23, 299–305.
An ethical framework for the prevention of overweight and obesity: a tool for thinking through a programme’s ethical aspects.Crossref | GoogleScholarGoogle Scholar | 23132871PubMed |

[21]  Brown SL, Whiting D (2014) The ethics of distress: toward a framework for determining the ethical acceptability of distressing health promotion advertising. Int J Psychol 49, 89–97.
The ethics of distress: toward a framework for determining the ethical acceptability of distressing health promotion advertising.Crossref | GoogleScholarGoogle Scholar | 24811879PubMed |

[22]  Shickle D (2009) The ethics of public health practice: balancing private and public interest within tobacco policy. Br Med Bull 91, 7–22.
The ethics of public health practice: balancing private and public interest within tobacco policy.Crossref | GoogleScholarGoogle Scholar | 19549633PubMed |

[23]  Guttman N, Ressler WH (2001) On being responsible: ethical issues in appeals to personal responsibility in health campaigns. J Health Commun 6, 117–36.
On being responsible: ethical issues in appeals to personal responsibility in health campaigns.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mzkt1Wrtg%3D%3D&md5=0ea5355eef2468f4af80ce7226bcf5f5CAS | 11405077PubMed |

[24]  Nordenfelt L (1993) On the nature and ethics of health promotion. An attempt at a systematic analysis. Health Care Anal 1, 121–30.
On the nature and ethics of health promotion. An attempt at a systematic analysis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2czjt1ersw%3D%3D&md5=3842b06ee9eaa2800a25a3c0329a6751CAS | 10135590PubMed |

[25]  Courtwright A (2013) Stigmatization and public health ethics. Bioethics 27, 74–80.
Stigmatization and public health ethics.Crossref | GoogleScholarGoogle Scholar | 21797912PubMed |

[26]  Trickett EJ (1998) Toward a framework for defining and resolving ethical issues in the protection of communities involved in primary prevention projects. Ethics Behav 8, 321–37.
Toward a framework for defining and resolving ethical issues in the protection of communities involved in primary prevention projects.Crossref | GoogleScholarGoogle Scholar | 11660541PubMed |

[27]  Australian Health Practitioner Regulation Agency. Registration standards. 2015. Available from: http://www.ahpra.gov.au/Registration/Registration-Standards.aspx [Verified 20 April 2015].

[28]  Infoxchange Australia. Quality improvement program planning system. 2013. Available from: http://www.qipps.infoxchange.net.au [Verified 20 April 2015].

[29]  YouthLink Scotland. CLD code of ethics: a youth work commentary. Glasgow: The Standards Council for Community Learning and Development for Scotland; 2011.

[30]  Australian Commission on Safety and Quality in Health Care. National safety and quality health service standards. 2012. Available from: http://www.safetyandquality.gov.au [Verified 6 October 2015].

[31]  The National Health and Medical Research Council, the Australian Research Council, and the Australian Vice-Chancellors’ Committee. National Statement on Ethical Conduct in Human Research (updated May 2015). Canberra: Commonwealth of Australia; 2007.

[32]  Government of South Australia. Preparing an Aboriginal health impact statement: a process for involving Aboriginal people in new initiatives. Adelaide: SA Health; 2007.

[33]  Government of South Australia. Research governance policy directive. Adelaide: SA Health; 2013.

[34]  Government of South Australia. Research ethics operational policy directive. Adelaide: SA Health; 2013.

[35]  Patton MQ. Qualitative research & evaluation methods. 3rd edn. Thousand Oaks: Sage Publications; 2002.

[36]  Community Services and Health Industry Skills Council. HLT42307 – Certificate IV in population health. Canberra: Commonwealth of Australia; 2012. Available from: http://training.gov.au/training/details/HLT42307 [Verified 20 November 2015].

[37]  Carter SM, Klinner C, Kerridge I, Rychetnik L, Li V, Fry D (2012) The ethical commitments of health promotion practitioners: an empirical study from New South Wales, Australia. Public Health Ethics 5, 128–39.
The ethical commitments of health promotion practitioners: an empirical study from New South Wales, Australia.Crossref | GoogleScholarGoogle Scholar |

[38]  Carter SM (2014) Health promotion: an ethical analysis. Health Promot J Austr 25, 19–24.
Health promotion: an ethical analysis.Crossref | GoogleScholarGoogle Scholar | 24739775PubMed |

[39]  World Health Organization. The Ottawa charter for health promotion. 1986. Available from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ [Verified 4 November 2015].

[40]  Beauchamp TL, Childress JF. Principles of biomedical ethics. 6th edn. Oxford: Oxford University Press; 2009.

[41]  Hofmann B (2005) Toward a procedure for integrating moral issues in health technology assessment. Int J Technol Assess Health Care 21, 312–18.
Toward a procedure for integrating moral issues in health technology assessment.Crossref | GoogleScholarGoogle Scholar | 16110710PubMed |

[42]  Gaita R (2006) Torture: The lesser evil? Tijdschrift voor Filosofie 68, 251–78.

[43]  Gaita R. Good and evil: an absolute conception. 2nd edn. London: Routledge; 2004.

[44]  Watson D. Death sentence: the decay of public language. 2004. Available from: http://www.randomhouse.com.au/books/don-watson/death-sentence-the-decay-of-public-language-9781740512787.aspx [Verified 22 April 2015].

[45]  Cordner C. Ethical encounter: the depth of moral meaning. Houndmills, Basingstoke, UK: Palgrave; 2002.

[46]  Regenberg AC, Mathews DJ (2005) Resisting the tide of professionalization: valuing diversity in bioethics. Am J Bioeth 5, 44–5.
Resisting the tide of professionalization: valuing diversity in bioethics.Crossref | GoogleScholarGoogle Scholar | 16179308PubMed |

[47]  Klugman CM (2008) Is bioethics a profession? Online J Health Ethics 5, article 6

[48]  Sokol DK (2012) Is bioethics a bully? BMJ 345, e5802
Is bioethics a bully?Crossref | GoogleScholarGoogle Scholar | 22945953PubMed |

[49]  Wittgenstein L. Philosophical investigations. (Transl. G. E. M. Anscombe.) Oxford: Blackwell; 2001.