A Code of Ethics for Public Health

The mandate to ensure and protect the health of the public is an inherently moral one. It carries with it an obligation to care for the well-being of communities, and it implies the possession of an element of power to carry out that mandate. The need to exercise power to ensure the health of populations and, at the same time, to avoid abuses of such power are at the crux of public health ethics. Until recently, the ethical nature of public health has been implicitly assumed rather than explicitly stated. Increasingly, however, society is demanding explicit attention to ethics. This demand arises from technological advances that create new possibilities and, with them, new ethical dilemmas; new challenges to health, such as the advent of HIV; and abuses of power, such as the Tuskegee study of syphilis. Medical institutions have been more explicit about the ethical elements of their practice than have public health institutions. However, the concerns of public health are not fully consonant with those of medicine. Thus, we cannot simply translate the principles of medical ethics to public health. In contrast to medicine, public health is concerned more with populations than with individuals, and more with prevention than with cure. The need to articulate a distinct ethic for public health has been noted by a number of public health professionals and ethicists.1–5 A code of ethics for public health can clarify the distinctive elements of public health and the ethical principles that follow from or respond to those elements. It can make clear to populations and communities the ideals of the public health institutions that serve them, ideals for which the institutions can be held accountable.