Description

The Centers for Disease Control and Prevention (CDC) defines health equity as the state in which everyone has a fair and just opportunity to attain their highest level of health. In CDC’s definition, achieving this requires focused and ongoing societal efforts to address historical and contemporary injustices; overcoming economic, social, and other obstacles to health and healthcare; and eliminating preventable health disparities. [1] Public Health Ethics (PHE), a systematic process to clarify, prioritize, and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information, complements health equity.[2] Both, Health Equity Science and PHE pursue social and health justice. Achieving health equity involves removing barriers to ensure everyone has a fair chance to attain their highest level of health. Public health ethics concerns populations, policy structures rather than individuals, and places equity and non-health care partners such as underserved communities at the forefront [3] [4].There is a legacy of historical trauma in our nation linked to health inequity and public health. Part of that legacy is the infamous United States Public Health Service Study of Untreated Syphilis in the Negro Male at Tuskegee and Macon County, Alabama, 1932 -1972 that led to negative health care outcomes among a group of African American men, including death, with sequela such as medical mistrust among historically marginalized and minoritized populations and reforms leading to fundamental changes in research ethics. [5]Lessons learned from this, and other unethical research are reminders of how to prevent history from repeating itself. Therefore, this program aims to support health equity by training public health students and other professionals on PHE, including how to make decisions with situations where ethical tensions may arise (e.g., avoiding stigmatizing groups/populations when messaging about diseases, fairly distributing among groups the burdens and benefits of public health actions). The approach outlined in this notice of funding opportunity (NOFO) includes six strategies that will be used to increase public health ethics capacity and other outcomes specified in the logic model:Curriculum development: a well-established practice in the field of education and applied in health professions for knowledge and skill building [6] [7];Intensive (short-term) public health ethics training: successfully implemented among health care professionals in continued education on topics such as COVID-19 [8];Mentorship: successful technique used to build clinical ethics capacity among health professionals and students [9] [10];Partnership building: applied in the field of public health several decades ago to increase community buy-in and participation as partners in the identification and solution of factors affecting community health [11] [12] [13];The USPHS-Study of Untreated Syphilis Commemoration: opportunity to discuss lessons learned and move from trust to trustworthiness [14] [15]; andDissemination: best practice for building trust, transparency, and accountability in public health programs. [16] [17]References[1] Centers for Disease Control and Prevention (CDC). 2022. What is Health Equity? (cdc.gov)[2] Centers for Disease Control and Prevention (CDC). 2011. Advancing excellence & integrity of CDC science. Public health ethics. http://www.cdc.gov/od/science/integrity/phethics/ [3] Ortmann, L.W. (2022). Defining Public Health Ethics for Practitioners. In: Barrett, D.H., Ortmann, L.W., Larson, S.A. (eds) Narrative Ethics in Public Health: The Value of Stories. Public Health Ethics Analysis, vol 7. Springer, Cham. https://doi.org/10.1007/978-3-030-92080-7_1[4] Pauly, B., Revai, T., Marcellus, L., Martin, W., Easton, K., & MacDonald, M. (2021). "The health equity curse": ethical tensions in promoting health equity. BMC Public Health, 21(1), 1567.[5] Tobin M. J. (2022). Fiftieth Anniversary of Uncovering the Tuskegee Syphilis Study: The Story and Timeless Lessons. American Journal of Respiratory and Critical Care Medicine, 205(10), 1145–1158. https://doi.org/10.1164/rccm.202201-0136SO[6] Thomas, P.A., Kern, D.E., et al. (2022). Curriculum development for medical education: a six-step approach. Baltimore: Johns Hopkins University Press.[7] Schuitema, Jaap, Dam, Geert Ten and Veugelers, Wiel (2007) 'Teaching strategies for moral education: a review', Journal of Curriculum Studies, 1 - 21. DOI: 10.1080/00220270701294210 URL: http://dx.doi.org/10.1080/00220270701294210[8] Siddiqui, S.S., Saxena, S. et al. (2023). The impact of a “short-term” basic intensive care training program on the knowledge of nonintensivist doctors during the COVID-19 pandemic: An experience from a population-dense low- and middle-income country. Australian Critical Care, 36 (1), 138-144.[9] Burgess, A., van Diggele, C. & Mellis, C. (2018). Mentorship in the health professions: a review. The Clinical Teacher,15: 197–202. https://doi.org/10.1111/tct.12756[10] Bibler, T.M., Nelson, R.H., et al. (2022). Building Effective Mentoring Relationships During Clinical Ethics Fellowships: Pedagogy, Programs, and People. HEC Forum, 36, 1-29.[11] Rose, G.L. & Rukstalis, M.R. (2008). Imparting medical ethics: the role of mentorship in clinical training. Mentoring & Tutoring: Partnership in Learning. 16 (1), 77-89. https://doi.org/10.1080/13611260701801031[12] Hunter, D., & Perkins, N. (2012). Partnership Working in Public Health: The Implications for Governance of a Systems Approach. Journal of Health Services Research & Policy, 17 (2), 45-52. https://doi.org/10.1258/jhsrp.2012.011127[13] Israel, B.A., Schulz, A.J., Parker, E.A., & Becker, A.B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 30, 173-202.[14] Centers for Disease Control and Prevention (CDC). 2023. Tuskegee Remembrance | OS | CDC[15] Final Report of the Tuskegee Syphilis Study Ad Hoc Advisory Panel, Department of Health, Education, and Welfare (Washington, D.C.: GPO, 1973). [16] McDavitt, B., Bogart, L.M., et al., 2016. Dissemination as Dialogue: Building Trust and Sharing Research Findings Through Community Engagement. Preventing Chronic Disease, 13. URL: Dissemination as Dialogue: Building Trust and Sharing Research Findings Through Community Engagement (cdc.gov)[17] Murray, D.M. (1986). Dissemination of community health promotion programs: the Fargo-Moorhead Heart Health Program. Journal of School Health, 56 (9), 375-381. DOI: 10.1111/j.1746-1561.1986.tb05776.x