Why is ethical practice important?
If health promotion practitioners actively reflect on ethical considerations, they may be better placed to make informed, evidence-based decisions about complex health and wellbeing priority issues and how these decisions and resultant impact the communities they work with (1-3).
Ethical health promotion practice emphasises relationship-based approaches, valuing the lived experience and priorities of communities as much as empirical evidence as the basis of decision-making (1).
Ensuring our practice is ethical means aligning it with the core values and principles of critical health promotion (4). Doing this can help achieve the best possible health and wellbeing outcomes for people, from individuals through to whole of population levels.
Ethical health promotion encompasses all of the actions of a health promotion professional (IUHPE Core Competencies and Professional Standards for Health Promotion).
Health Promotion Values & Principles
As outlined in the IUHPE Core Competencies and Professional Standards for Health Promotion (5), ethical values and principles for Health Promotion include a belief in equity and social justice, respect for the autonomy and choice of both individuals and groups, and collaborative and consultative ways of working.
Ethical health promotion practice is based on a commitment to:
- Health as a human right, which is central to human development
- Respect for the rights, dignity, confidentiality and worth of individuals and groups
- Respect for all aspects of diversity including gender, sexual orientation, age, religion, disability, ethnicity, race, and cultural beliefs
- Addressing health inequities, social injustice, and prioritising the needs of those experiencing poverty and social marginalisation
- Addressing the political, economic, social, cultural, environmental, behavioural and biological determinants of health and wellbeing
- Ensuring that Health Promotion action is beneficial and causes no harm
- Being honest about what Health Promotion is, and what it can and cannot achieve
- Seeking the best available information and evidence needed to implement effective policies and programmes that influence health
- Collaboration and partnership as the basis for Health Promotion action
- The empowerment of individuals and groups to build autonomy and self-respect as the basis for Health Promotion action
- Sustainable development and sustainable Health Promotion action
- Being accountable for the quality of one’s own practice and taking responsibility for maintaining and improving knowledge and skill.
Critical health promotion
A way to design and deliver ethical health promotion is to use a critical health promotion approach.
The Critical Health Promotion Approach is a social justice approach to health promotion that is underpinned by a system of values and related principles that supports the reflective process of explicitly identifying and challenging dominant social structures and discourses that privilege the interests of the powerful and contribute to health and wellbeing inequities (6). The approach focuses on addressing the socio-ecological determinants of health and wellbeing from an equity perspective rather than a more selective, behavioural/biomedical approach.
What are the barriers to ethical practice?
We know that thinking about and demonstrating ethical practice is often challenging because we’re not quite sure what is meant by ethical practice. The ethics approval process can also seem long, technical and scary, particularly if we have not applied for ethics approval before!
Australian research with health promotion practitioners found the main barriers to ethical practice include (1, 7):
- Lack of understanding of ethical practice
- Competing priorities, limiting ability to engage in an ethical process
- Competing priorities within partnerships
- Uncertainty working with priority population groups
- Lack of access to a formal ethics approval process
How can I build ethical practice into my work?
- Engage in professional development to build your ethical practice competence
- Access frameworks and resources to support your practice
- Encourage your team and partners to apply ethical practice in your work with communities
- Share your experiences in applying ethical practice
- Utilise AHPA's ethical oversight process to review the ethical foundations of projects
- Critically reflect on the extent to which your health promotion practice aligns with a critical health promotion approach using QATCHEPP: A quality assessment tool for critical health promotion practice (4).
Literature, resources & support
- Blackford, K., Leavy, J., Taylor, J., Connor, E., Crawford, G. (2022). Towards an ethics framework for Australian health promotion practitioners: An exploratory mixed methods study. Health Promotion Journal of Australia, 33: 71–82. doi 10.1002/hpja.466
- Tretheway R, Taylor J, O’Hara L, Percival N. (2015). A missing ethical competency?: A review of critical reflection in health promotion. Health Promotion Journal of Australia. 26(3):216-221. doi:10.1071/HE15047
- Tretheway R, Taylor J, O’ Hara L. (2017). Finding new ways to practise critically: applying a critical reflection model with Australian health promotion practitioners. Reflective Practice. 18(5):627-40. https://www.tandfonline.com/doi/abs/10.1080/14623943.2017.1307721?journalCode=crep20
- O’Hara L, Taylor J. (2023). QATCHEPP: A quality assessment tool for critical health promotion practice. Frontiers in Public Health. 11:1121932-1121932. doi:10.3389/fpubh.2023.1121932
- International Union for Health Promotion and Education (2016). Core Competencies and Professional Standards for Health Promotion. http://www.ukphr.org/wp-content/uploads/2017/02/Core_Competencies_Standards_linkE.pdf
- O’Hara, L., & Taylor, J. (2022). A critical health promotion research approach using the Red Lotus Critical Health Promotion Model. In Global Handbook of Health Promotion Research. https://link.springer.com/chapter/10.1007/978-3-030-97212-7_36
- Reilly T., Crawford G., Lobo R., Leavy J., Jancey J. (2016). Ethics and health promotion practice: exploring attitudes and practices in Western Australian health organisations. Health Promot J Austr., 27(1):54-60. doi: 10.1071/HE15059.