Fostering Ethical Public Health Through Community Engagement

Effective public health policies make communities and families safer and healthier. Ethical decision-making in public health promotes policies that are just, fair and respectful of individual rights, while aiming for the greatest good for the most people.¹

One of the most important ethical guidelines for public health policymakers is to engage communities and stakeholders in public health issues. Community involvement increases transparency, builds trust and improves the effectiveness of interventions for the common good, ranging from research to health care programs and sanitation initiatives. Public health officials who work with community members can develop tailored strategies that are more likely to be accepted and successful because they are founded on a deeper understanding of local values and priorities.²

This article will explore the importance of community engagement in making ethical public health decisions.

People have a right to understand and participate in healthcare decisions that affect them personally and as community members. Whether conducting clinical research, public health research or interventions, policymakers and practitioners have a moral obligation to encourage public participation in planning, designing, implementing and evaluating health initiatives. This approach empowers communities by making sure they have a say in the decisions that affect them.³

Community engagement supports ethical principles such as mutuality, respect and shared decision-making. When public health officials seek diverse perspectives and encourage public participation in their policy-making, they demonstrate respect for the knowledge, perspectives and needs of community members, especially those often marginalized in decision-making processes.

Practicing inclusivity and building relationships helps create programs that effectively address the social determinants of health that may contribute to health inequities. Inclusive practices also help ensure equitable resource allocation and lower barriers to access.¹

Participatory approaches help public health practitioners make ethical choices by including the different perspectives of community members and other stakeholders in project development steps. Allowing the community to participate also increases the relevance and effectiveness of interventions, as it helps ensure the policy addresses the community’s needs and upholds the dignity and autonomy of individuals within the community. This ethical engagement increases the legitimacy of public health actions by building community and ownership that empowers communities. It also gives public health officials insights into local health issues and cultural practices so they can meet the needs of the local population.⁴

Ethical decision-making in public health policymaking is a structured process for resolving the moral dilemmas surrounding public health research and programs. Public health officials examine the relevant facts and ethical considerations of a given decision and then analyze how different options affect the rights and well-being of specific groups, individuals and communities.⁵ This process is guided by frameworks such as the American Public Health Association’s Code of Ethics and the Clinical and Translational Science Awards’ Principles of Community Engagement.^{1, 3}

The goal of ethical decision-making is to produce public health initiatives that are effective, just and equitable. Ethical guidelines help policymakers consider outcomes and issues such as fairness, how resources are distributed, respect for individual rights and cultural differences.¹ The guidelines compel decision-makers to balance competing interests and values, ensuring that officials conduct health efforts responsibly and promoting trust and cooperation from the public. All of this is necessary for the success of public health interventions.¹

Community engagement is a cornerstone of ethical decision-making in public health. Engaging a broad range of stakeholders–including community members, policymakers, healthcare professionals and representatives from vulnerable populations–helps public health efforts better address the diverse needs and values of the communities they serve.⁶

The first step in effective and inclusive community engagement is to identify and involve a comprehensive list of stakeholders early in the process to ensure all relevant perspectives are included. This includes those directly affected by the health issues at hand and those who influence public health outcomes.⁶ Once the policymakers have identified and begun collaboration with those stakeholders, they should maintain open and ongoing communication through regular meetings, workshops and forums that facilitate dialogue and information exchange. These interactions should be structured to encourage active participation, to provide community members with adequate information for informed participation, and to ensure that every voice is heard and valued.⁶

Building community engagement requires public health officials and practitioners to be transparent in their decision-making. Responsiveness to the concerns and feedback of stakeholders is foundational to effective health promotion initiatives. When community members understand the policy-making goals or the processes and outcomes of public health initiatives, they will be more likely to buy into the initiatives.⁷

A project to combat the Guinea worm disease, a debilitating waterborne disease, is a historical example of a health promotion program that effectively involved community members. Organizations, including The Carter Center, employed strategies that relied heavily on the participation of the general public in affected regions of Africa. Villagers in these regions were trained to use cloth filters and chemical treatments in water sources. Other local volunteers conducted surveillance and provided education on disease prevention. This community-driven approach eradicated the disease.⁸

Another example of an effective public health program that succeeded because of community engagement is the Female Community Health Volunteer (FCHV) program in Nepal. This program empowered women in local communities to provide maternal and child health services. The FCHV program reduced child mortality and increased vaccination rates, among other positive outcomes.⁹

These examples illustrate the effectiveness of participatory approaches in harnessing local knowledge and promoting community ownership of public health challenges. Encouraging public participation in designing and implementing health initiatives can lead to more effective and sustainable public health projects.⁸

One of the most frequent conflicts public health officials deal with is balancing individual rights with community well-being. This issue often comes up in debates over issues like vaccination mandates, quarantine during pandemics and public smoking bans.¹⁰

Frameworks such as that proposed in the article “Public Health Ethics: Mapping the Terrain” help public health practitioners and policy-makers navigate these dilemmas. The first step in this framework is to determine how likely a public health initiative is to achieve its goal. Next, evaluate the initiative’s proportionality by weighing its community benefits against the infringement on individual rights. Other considerations in the framework include necessity—whether a specific action is required to address the issue at hand, the principle of least infringement and public justification. The principle of least infringement requires health policies that minimize their impact on individual autonomy, privacy, and confidentiality.¹¹ Officials should also publicly justify their reasons for any restrictive policies in order to build trust with the community.¹²

If you’re interested in advancing your career and improving public health, the online Master of Public Health from Kent State University can equip you with the necessary skills and knowledge. You can study from anywhere on your own schedule.

Kent State offers specializations in Health Policy and Management, Social and Behavioral Sciences, and Epidemiology. Expert faculty will help you gain the skills and experience you need to positively impact public health. Connect with an admissions outreach advisor today to learn more.