Ethics refers to the practices that humans adapt in the provision of services in a way that shows humanity and social consideration of the person being attended. In the health sector, there are ethical issues that need to be adhered to so that the public is served in a way that is socially acceptable (Coleman, Bouesseaub, & Reisb, 2008). There have been cases of disparities in the provision of health services in many regions worldwide. In addition, infectious diseases have led to the deaths of many persons in different places around the world. There has been a need to foster international cooperation in the monitoring and surveillance of various health aspects. The promotion of health is a key factor in addressing non-communicable diseases, such as diabetes type 2. Transparency and accountability in the health sector have been said to be crucial in the development of the health department in many nations. The aim of this paper is to address these ethical health issues, while giving real life examples in regions where they have been practiced or neglected. However, a lot of emphasis will be on the United Arab Emirates (UAE). The application of ethical principles in public health will be discussed as well.
Disparities in Health Status, Access to Health Care and the Benefits of Medical Research
Differences in the health sector are seen in the inequalities that are experienced in the medical field. The World Health Organization (2014) indicates that many nations around the world have elements of disparities when it comes to the delivery of health services to the communities. Some of the reasons that the WHO gives as contributors to the inequalities in the provision of health services include the level of education, income status, gender, the status of employment, and ethnicity in some cases.
Inequalities in the medical field bring about social and ethical injustices. The development of any given country is hampered by practices such as disparities in the health sector. It is argued that the richer a person, the more access to health services that they get. On the other hand, the poorer a person gets a lesser attention and inadequate health care from the health personnel, as indicated by Kronfol (2012).
An example of a region that practices disparities in the health sector is the United Arab Emirates. According to Blair, Grivna, and Sharif (2014), the United Arab Emirates region is said to have inequalities in various health issues. These researchers go on to say that research has been carried out on the effectiveness, accuracy, and consistency in the tests that different health personnel carry out on the same diseases over a particular period. The researchers say that there were a lot of inconsistencies in the way tests were carried out. They attributed this scenario to income statuses of the respondents, where those who seemed to be richer were subjected to comprehensive forms of tests, whereas those who appeared to be poorer were given relatively poorer kinds of tests. Also, different tests were said to be performed by various insurance companies. The question that arose concerning these tests was: Which is the best health practice that is accepted in health tests?
Another example that shows the inequality in the provision of health services in the Arab Nations and the UAE, in particular, is the issue of rural-urban disparities. Kronfol (2012) says that people who reside in the rural areas are not given the same kind of health care as people living in the urban areas. He continues to add that rural dwellers do not have access to better health facilities, enough medicines, and the ratio of health practitioners to patients is always wanting.
Blair et al. (2014) give another inequality that is witnessed in the health sector. The authors say that the migrant workers in the UAE do not have access to better health care as the residents do. This is attributed to the fact that many of the employers of these migrant workers do not put in place health insurance programs that can assist in the financing of the health bills in case the workers get sick. In addition, the issue of ethnicity is attributed to this type of inequality, where the bosses of these workers feel that they are better than their migrant workers. Therefore, they do not get access to better health care than the locals.
One can address the issue of inequality from a neutral point of view. The governments of this region need to sensitize their health personnel on the need to be fair to all patients, regardless of their education status, employment status, ethnicity, or gender. In fact, this ethical issue can better be addressed if strict penalties are imposed on those found to violate the set standards of health equality. In addition, the people from the rural regions should be given the same health consideration as their counterparts in the urban areas. The ratio of health practitioners to patients should almost be the same across all regions. The rural people should have better access to health facilities and medicines like those in the urban areas do.
The Threat of Infectious Diseases
An infectious disease is a disease that can be transferred from one person to another (WHO 2014). It could be a hereditary disease or an acquired disease, where a healthy person gets the disease through close association with an infected person. The World Health Organization gives examples of infectious diseases, which include tuberculosis, influenza, and Ebola, among others. If not adequately controlled, an infectious disease can wipe out an entire community. A good example is the country of Liberia, where Ebola has in the past claimed the lives of many Liberians, including some of the health personnel who were attending to the infected people.
The United Arab Emirates has made efforts to address the issue of infectious diseases in the region. One such emirate is the Abu Dhabi emirate. This emirate has made commendable efforts in addressing the issue of diseases, such as influenza, tuberculosis, and malaria. According to the Health Authority-Abu Dhabi (2011), strict preventive measures have been put in place to prevent the spread of diseases like tuberculosis.
Among the preventive measures that the Abu Dhabi emirate has adopted include increased surveillance and reporting of infectious diseases. The Health Authority-Abu Dhabi (2011) indicates that there is increased surveillance of the infectious diseases throughout Abu Dhabi. It is said that those applying for visas to Abu Dhabi are taken through a thorough testing to ascertain that they are not carriers of any infectious disease. Those found with a disease like tuberculosis are isolated from the public and given the required medical attention so that they do not spread the disease to other unsuspecting people.
The Health Authority-Abu Dhabi (2011) offers another effective method that the emirate of Abu Dhabi uses to address the issue of infectious disease. According to this resource, the couples who intend to marry are first passed through a series of medical tests, where they are screened for various diseases as HIV/AIDS and infectious diseases. In case there is evidence of any of them being a carrier of an infectious disease, then the couple is taken through an intensive counseling program where they are advised of the consequences of getting married under such a circumstance. Although, the couple is not compelled to get married or not, at least they are made aware of their health status and the effects should they go ahead with the marriage.
Training of medical staffs on infectious diseases has been an exercise that the Emirate of Abu Dhabi has been practicing in the last few years, as reported by the Health Authority-Abu Dhabi (2011). This training process is aimed at equipping the medical personnel with the necessary skills that are used in the screening and reporting of infectious diseases. There are cases where medical staffs have been reported to become culprits of infectious diseases where they did not adhere fully to the required screening procedures. Therefore, the training given to various medical personnel is essential as the medical staffs will handle themselves in a professional manner as possible.
It is easy to conclude that the United Arab Emirates and specifically the emirate of Abu Dhabi have made excellent efforts to address the issue of infectious diseases in this Arab region. The amount and extensiveness of the screening process are commendable as the occurrence of an infectious disease is identified in the early stages. Proper counseling is given to those proven to be carriers of any infectious disease. One can, therefore, conclude that the ethical health standards are being adhered to when addressing infectious diseases in the UAE.
International Cooperation in Health Monitoring and Surveillance
The World Health Organization (2014) has given the areas that different countries should focus on and cooperate with other countries in the health sector to foster international surveillance of disease. According to the WHO (2014), there was an agreement that was reached at in 2005 on International Health Regulation. Among the issues that were discussed included the participating countries agreeing to partner in areas pertaining to legislation, coordination, surveillance, preparedness, and risk communication. In addition, countries were supposed to show readiness regarding zoonotic conditions, as well as radiation events.
Countries that cooperate with the international community in the field of health benefit a lot as a result of the exchange programs that they have with other nations. Research is enhanced between the partnering countries. There is also the possibility of getting financial and human resource support from the partner countries in case of a health crisis. It is, therefore, vital for countries to collaborate with the international community, as this can improve the health status of citizens of the collaborating countries.
According to the World Health Organization (2014), the UAE is a developed federal government; therefore, it does not receive much funding to support its surveillance and monitoring of various health aspects of the region. However, the WHO reports that the UAE has been very cooperative with agencies such as the United Nations Development Program, the United Nations Environmental Program, and the United Nations AIDS, among others. This cooperation has gone well, given that support from these agencies has been of great help to the development of the health sector in the UAE.
The Emirates News Agency (2011) admits that the UAE has cooperated with several nations in order to boost its health sector. This agency gives an example of a memorandum of understanding that the UAE signed with South Korea, where the two countries would have exchange programs in the health sector. Among the agreements that this agency mentions as having been arrived at is the issue of monitoring, surveillance, and reporting of communicable diseases. This was said to be a sign of commitment, where the authorities in the UAE committed themselves to join hands with the international community in addressing conditions such as communicable ailments.
According to the Emirates News Agency (2011), the UAE has also committed itself to collaborating with the international community when it comes to health research. The agency claims that the UAE has for long been working with the United States of America, Canada, Australia, and Europe in health research. Universities across these countries conduct joint research related to health and many other programs, such as staff training.
It is evident from the examples given here that the UAE has collaborated enough with the international community in the surveillance and motoring of diseases. However, the WHO admits that the UAE and the partnering countries have been challenged in coordinating the findings across the different countries into one. Therefore, the kind of progress that would have been expected to emanate from this cooperation is slow.
Exploitation of Individuals in Low-income Countries
Exploitation can be defined as the act of misusing the human rights of a less privileged individual. According to the World Health Organization, exploitation means anything that shows the lack of empathy and concern for the other person due to their income status, health status, or level of education. There are several cases where exploitation of individuals from the lower-income countries has been carried out (WHO, 2014).
The exploitation of low-income persons is an act that does not portray any element of human character in individuals practicing exploitation. It is sad to note that some of the individuals who have been reported to exploit individuals from the lower-income countries are health professionals who have signed performance contracts.
In Cambodia, for example, there have been cases of exploitation of people from the low-income regions when it comes to the treatment and care of mental ailments. According to Aberdein and Zimmerman (2015), the exploitation has been attributed mainly to the trafficking of persons that are said to be from low-income countries. The prevalence of trafficking in Cambodia is at an alarming rate. A few residents fear to visit health facilities in case of a mental problem because there have been reports that trafficking has been going on even in the health facilities. Another reason that is noted by Aberdein and Zimmerman (2015) regarding exploitation of individuals with low income is the shortage of health personnel. In Cambodia, there is a high shortage of medical staffs. As a result, patients from low-income regions are not given preference. The availability of human resource to attend to patients in Cambodia is a challenge. This has negatively impacted the delivery of health services to the residents of Cambodia. Aberdein and Zimmerman (2015) add to the reasons for the exploitation of the low-income people by saying that there are limited financial resources that have been generated towards the delivery of better health services. Most people earning low incomes are typically concentrated in the less developed areas or the rural areas. This has not been different in the case of Cambodia, where low-income earners are concentrated in areas that have not been developed well in terms of health delivery. There has been a poor collaboration between the health personnel and the authorities over the challenges that are facing the delivery of health services to the low-income people. As a result, there continues to be the exploitation of the low-income people in Cambodia (Aberdein & Zimmerman, 2015).
The exploitation of persons, especially the low-income people is an inhuman act that should be condemned using the strongest terms possible. There is no justification for the exploitation of such individuals, as this is against health ethics. The governments of countries where the exploitation is so rampant that even the targeted people fear going to health facilities should have strict measures that can result in the prosecution of whoever is involved in such acts. Human trafficking ought to be stopped, which calls for the collaboration between the countries that are affected by the problem. The number of health workers needs to be increased so that there will be enough medics to attend to patients, regardless of their location. Medical personnel need to be trained on the need to adhere to social and health ethics while on duty. In addition, strict measures should be taken against those who are found practicing exploitation of people from the low-income regions.
Health Promotion
Health promotion entails the support that the government offers to the public in connection with health provision. However, this is applied mainly when addressing diabetes and other diseases that cannot be transmitted. According to the World Health Organization (2014), the non-transmissible health conditions account for 60% of all deaths across the globe. In the UAE, these conditions are among the leading causes of deaths. The main reason for this prevalence is a sedentary lifestyle, where a majority of the population prefers sitting behind a computer or other non-physical activities as opposed to exercising.
The prevalence of non-communicable diseases has not gone without international consideration. In 2011, there was a United Nations Summit that deliberated on how to address the diseases that are not infectious in a professional and efficient manner (WHO 2014). Several nations have adopted the resolutions that emanated from the summit. Consequently, there has been a slight reduction in the number of cases of diseases that are not transmissible in the countries that adopted the recommendations.
In the UAE, the cases of diabetes, especially diabetes type 2, have been so rampant that in 2010, various countries within the Middle East came together to sign what was called the “Dubai Declaration of 2010.” In the declaration, the various causes that lead to these types of diseases were listed. Among the listed causes were poor maternal nutrition, poor dietary lifestyle, and a lack of regular exercises, and stress and depression, among others.
According to the Government of Dubai (2014), the UAE is devoted to promoting health so that the rate at which the noninfectious illnesses are being contracted can reduce. Moreover, the government admits that a reduction in the rate of contracting non-communicable conditions will lead to a reduction in the number of deaths in the region. One of the measures taken by this government is to support the weight loss program, which is being done by raising awareness of the importance of having a moderate weight. The Government of Dubai (2014) says that it does awareness through channels like the television, newspapers, and radio. In so doing, many people get the information contained in the campaigns and adopt weight loss programs in case they are overweight or obese. In addition, the Government of Dubai (2014) admits that it has to come up with adequate training facilities that will be available to those who wish to have weight loss. Such facilities will be well equipped and have qualified instructors on how to lose weight. It is worth noting that the Government of Dubai (2014) has recognized the need to discourage discrimination on the people who are seen as obese. There have been claims that obese people find it difficult to associate with the rest of the public because they are discriminated, including being sidelined when it comes to marriage and relationships.
Other measures that the Government of Dubai (2014) has put in place to address the issue of lifestyle diseases include monitoring and surveillance. Several groups of people are monitored, such as individuals who have a weight loss program, in a move to ensure that the program is effective. Monitoring is also done at the health facilities, where visiting patients are taken through a series of tests and measurements to ascertain that they are not at the risk of becoming overweight or obese. If any of the patients is reported to be obese or overweight, then they are given counseling on how to go about the medication process and behavioral change. The Government of Dubai (2014) also admits that it has gone an extra mile in the fight against noninfectious illnesses by making the issue a center for political agendas. There need to be policies that will guide the approach to non-communicable diseases, as doing so will reduce the costs involved in the treatment process of any non-communicable conditions, such as diabetes type 2. Effective national targets ought to be laid down on how the issue of lifestyle health conditions ought to be addressed.
Participation, Transparency, and Accountability
As ethical matters, participation, transparency, and accountability have been essential in ensuring that the health sector makes progressive advancements for the betterment of the health of the public. Participation refers to the willingness and actual involvement in healthy activities that are carried out in the region. Transparency, as defined by the WHO (2014) is a bold move of recognizing and publicly accepting the true state of a matter. On the other hand, accountability is taking full responsibility for the outcome of a given course or activity.
Transparency is an ethical issue that has many advantages. According to Henke, Kelsey, and Whately (2011), transparency in the field of health has led to inventions that have steered the health sector in a good direction. These writers claim that the economic status of any given nation is bound to arise when there are transparency and accountability among the persons that have been given the power to lead a given country. The authors say that there will be increased research in the health sector when there is transparency, as well as accountability. In case a problem arises in the health sector, then the concerned personnel will be free to communicate the problem and research on how well to address it.
Europe is a perfect example that has exercised participation, transparency, and accountability in the field of medicine and health. Henke et al. (2011) give examples of Europe showing commitment to transparency and liability in the fields of health and medicine. In their first example, the authors revisited the experience that the United Kingdom had in the period between 1997 and 2000. During this period, many elderly people were reported to die as a result of dehydration. It could be argued that the first measure that the authorities concerned with the health issues would do was to hide this information from the relevant authorities and the general public at large. On the contrary, the concerned persons were transparent enough to give this information to the relevant health bodies. As a result, the issue was addressed as quickly as possible, and the number of deaths resulting from dehydration in elderly people reduced significantly (Henke et al., 2011). Moreover, there were cases of “superbugs” attacking people during the same period. The issue was reported in time and deaths resulting from the attack were prevented.
In 2009, the mortality rates in a particular hospital in Stafford were exceptionally high (Henke et al., 2011). The doctor in charge of the facility decided to be as transparent as possible and reported the matter to the relevant authorities. The result was that research was conducted on the cause of the increased mortality rates in the hospital. Henke et al. (2011) confirmed that eventually, the increased rate of mortality started to reduce and patients could no longer fear seeking medical assistance from the health facility.
The examples show that transparency and accountability are ethical issues that should be taken seriously by medical practitioners in support of a healthier world. As Henke et al. (2011) have clearly shown, the people that are tasked with the responsibility of heading health facilities and departments should be transparent and accountable in order to contribute to the development of the health departments in the countries that they serve. Doing so would lead to a reduction in mortality rates and an increase in the public trust.
Applications of Ethical Principles in Public Health
Utilitarianism, communitarianism, social justice, and personalism are examples of public health principles that can be used to address to various challenges that this sector face from time to time. According to Henke, Kelsey and Whatley (2001), these principles cut across various departments, including the government and the public as well. It means that the involvement of the government, the public, and the health personnel are crucial in ensuring that the ethical principles of public health are observed.
Personalism
This principle involves the respect for human life. It advocates for the equality of human beings, as it is only humans who can appreciate the value of life and its meaning (Petrini & Gainotti, 2008). It is opposed to exclusivity in the health sector, where the minority and less-privileged are discriminated on the basis of their color, race, or social class. On the contrary, personalism calls for special attention to the most sick and less disadvantaged in the society (Petrini & Gainotti, 2008). Personalism is one public health principle that can eliminate disparities in the health status. According to Henke, Kelsey and Whatley (2001), personalism requires that all human beings be treated equally and have equal access to health care. No health personnel should give special attention to certain groups of people just because of their economic status, race, or color. Personalism requires that governments put measures that will ensure all persons enjoy the benefits that arise from medical research (Henke et al., 2001). It means that the government needs to implement the recommendations from research conducted in the medical field without prejudice (Henke et al., 2001).
The respect for human life has many other advantages. According to Petrini and Gainotti (2008), where personalism is practiced, the threat of an infectious disease is normally addressed with the urgency it deserves. It means that the public is taken into consideration in the event of an outbreak of an infectious disease. The people are educated on the best possible means of preventing such infections. In addition, the infected are isolated in a humane way in a move to safeguard the community from getting such an infection.
According to Petrini and Gainotti (2008), personalism is applied during the promotion of health personnel. Caution is exercised so as to give promotions only to deserving individuals who will not put the lives of the public at risk. It means that smokers and individuals who were reported to have practiced violence and child abuse are not being given a promotion, until such a time when they have proven to be of good morals. The respect for human life will compel leaders in organizations that deal with public health to promote transparency and accountability in their departments so that the public may feel appreciated and their rights respected (Petrini & Gainotti, 2008).
Social Justice
The principle of social justice is used in the field of public health to make people realize their potential in the society. It is meant to advocate equality and justice to all regarding public health. According to Gostin and Powers (2006), the principle of social justice calls for fair treatment for all in the community. This means that even the less disadvantaged ought to be treated in the same way that other groups are treated. There needs to be a fair distribution of such resources in the allocation of public health resources. The public health facilities in marginalized areas should have enough resources that will cater for the needs of the members of the society to satisfaction (Gostin & Powers, 2006). In so doing, then the communities will feel that their health rights are addressed and provided fairly.
Social justice as a public health principle requires that there is an improvement in the health of individuals (Gostin & Powers, 2006). In effect, it calls for the establishment of trust funds for the public health. Such a move will assist in ensuring that the health of human beings in the society is catered for and improved. In addition, the trust fund can be used to finance research in new and emerging public health issues, such as bioterrorism and avian flu (Petrini & Gainotti, 2008). According to Gostin and Powers (2006), health improvement leads to the examination of the leading causes of both poor and good health. This is done in an effort to bring social justice in public health to all members of the society.
According to Petrini and Gainotti (2008), there are several ways through which social justice can be exercised in the public health. One such method is by creating equal environments for all people, irrespective of their location and gender. Environment in this case includes economic environment, informational environment, as well as the national environment (Petrini & Gainotti, 2008). In the economic environment, all persons should be empowered economically through the provision of the same facilities, such as the health centers. The informational environment requires all citizens be given the same piece of information regarding public health. For example, in case of an outbreak of an infectious disease, all members of the community should be given the same piece of information that will direct them to the next course of action that is to be taken by the authorities (Petrini & Gainotti, 2008). For instance, transportation should be available to all in the same magnitude, so that there is easier access to facilities like health centers.
Communitarism
Communitarism is a public health principle that encourages the production of excellent individuals through the creation of a good society (Gostin & Powers, 2006). Every society has its own values, norms and beliefs. The practices that are considered to be good should be passed on from one generation to the other. This will ensure that good individuals are produced from time and time, leading to advancements in the health sector (Henke et al., 2011). The question that arises is; “who is to decide on good virtues within the society?” This question is addressed by upholding the values and beliefs that generations inherited from the preceding generations (Henkel et al., 2011).
According to Gostin and Powers (2006) some values are specific to specific communities. However, a community may have values and other virtues that are good to all human beings all over the world. These virtues should be universally adopted in a move to create a better society. Some of the universally accepted virtues include “no smoking in the public”. This virtue may have originated from one community, but its benefits are to all the communities in the world. Gostin and Powers (2006), therefore, admit that communities that have good virtues should serve as reference points, where the world can borrow virtues that can be used for the good relations of the community members. In addition to ‘not smoking’, there are health care policies that aid in addressing various challenges that the public health faces from time to time. For example, an infectious disease can be prevented from occurring through the application of health care policies, such as “no careless spitting and ‘no smoking in public” (Henkel et al., 2011). Other health care policies that are vital in promoting public health include the idea of washing hands after visiting the toilet, before eating, and after performing a certain task (Gostin & Powers, 2006).
Communitarism advocates care in the society, among other things. Human life is so precious that it needs to be cared for by the society (Gostin & Powers, 2006). However, the feminine groups of people are viewed by a majority of communities as being more caring than the masculine groups (Henkel et al., 2011). This observation should be applied in addressing some of the challenges that are facing public health. For example, in health promotion, women health professionals should be prioritized in areas where more care will be needed. This could include promotions in facilities that care for the aged, as well as correctional institutions (Gostin & Powers, 2006).
Utilitarianism
Utilitarianism is mainly applied in public health to develop policies. In other words, it is used in policymaking in the public health sector. According to Henke et al. (2011), the consequences are the basis for judging particular decisions. It implies that a decision is neither good nor bad, unless its consequences are evaluated and critically analyzed. In utilitarianism, more emphasis is made for the happiness of the public (Gostin & Powers, 2006). It is argued that decisions in the public health should be directed towards producing the greatest happiness in the greatest numbers of people, as more people rely on such public health decisions for their happiness. These beliefs and expectations can be used to effectively address the challenges that the public health sector faces. For example, the decisions that are made should ensure that there are no disparities in the provision of health care. This can add to the happiness of the public on the realization that they have been provided with the same facilities and given the same services (Gostin & Powers, 2006).
A good example in which the officials in the public health sector can demonstrate that they are contributing to the happiness of the public is through the successful reduction in the burden of a disease. This can be shown by ensuring that infectious diseases are prevented from spreading from one individual to another. Also, the cost of accessing health care should be reduced to amounts that would be affordable to almost all citizens. In addition, individuals from the low income areas should be considered in the programs intended for the public health. Henkel et al. (2011) add that it is through public participation that there will be fair and just allocation of resources to all members of the society. In addition, transparency and accountability contribute to the satisfaction of the public with the services provided. Utilitarianism has, however, been opposed by some schools of thought, who argue that some people will be sacrificed for the sake of others. In other words, it has been argued that utilitarianism does not promote equity like other principles do, such as communitarianism and social justice (Gostin & Powers, 2006). All the same, ethical principles in the public health are vital in addressing the challenges facing the public health sector.
Conclusion
There are ethical standards that ought to be applied in the health sector for the betterment of healthcare provision. There have been disparities in the provision of health services in various countries. In the UAE, for example, the migrant workers do not get access to better health care due to the effects of ethnicity and ill treatment by their employers. Infectious diseases have continued to pose a threat to the health department of every nation. In the Emirate of Abu Dhabi, this issue has been addressed in a manner that has resulted in maximum screenings of people, especially those applying for visas and those intending to be married. There has been a need for nations to cooperate with the international community in monitoring and surveillance of diseases. The UAE has succeeded in this area, where Dubai signed an MOU with South Korea on how to implement the monitoring and the surveillance programs. The UAE has been so considerate in promoting health that it has signed an agreement with other Middle East nations on how to address the issue of non-communicable diseases in an effective way. There have been improvements in the health sectors of countries, such as Europe, where transparency and accountability have been practiced. Various principles in the public health sector can be used to address the challenges that are facing this sector. Such principles include utilitarianism, communitarianism, social justice and personalism.
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