Reducing health inequalities: Ethical issues in a Scottish child health home visiting program

Abstract

Childhood inequalities have far-reaching consequences throughout the life cycle. Reducing health inequalities for children is an important goal for health policy, grounded in justice and the desire to prevent avoidable ill health. The purpose of this article is to report and discuss the results of a qualitative study into the ethical issues identified by staff involved in a paediatric home visiting program in Scotland. One of the major aims of the visiting program was to reduce health inequalities. The results presented here relate to two issues identified by study participants: conflicting responsibilities, and ethical tensions inherent in the very task of reducing inequalities. The requirement for evaluation, meeting targets and working with partners led to conflicting responsibilities for some participants. Working to reduce health inequalities led to some paradoxical effects, and a fear that root causes of inequality were not being addressed. These results suggest that programs aimed at reducing inequalities may lead to unexpected ethical tensions. Policy-makers and those implementing such programs need to be aware of possible unintended effects and tensions experienced by staff.