Issues in Medicare and Public Health Ethics

What is Public Health Ethics?

Public Health Ethics refers to a system of moral principles that apply values to the practice of public health and scientific research in public health including community medicine. In practice, ethics allow for people, regardless of their race, gender, or religion to be guaranteed quality and principled care. Medical ethics is based on a set of values that public health professionals and other health practitioners can refer to in the case of any confusion or conflict. These values include the principles of non – maleficence, beneficence, respect for autonomy, and justice.

The Nuffield Bioethics Council 2007 and several other seasoned scholars have identified a number of general moral considerations that includes:

  1. Building and maintaining trust.
  2. Distributing health benefits fairly, or distributive justice (fair distribution of social goods).
  3. Producing benefits, often but not exclusively health benefits.
  4. Protecting non-dominant subgroups from marginalization and stigmatization.
  5. Preventing harms, often health harms, such as preventable morbidity and premature death.
  6. Procedural justice (fair process), participation, and transparency.
  7. Respecting individual autonomy and liberty of action.
  8. Respecting and fulfilling universal human rights.
  9. Respecting privacy and confidentiality.

Public health activities and programs routinely brings some of these moral considerations into conflict. One important area concerns the power of public health as an agent of the state to restrict individual choice in efforts to promote health and prevent diseases. While many public health activities try to influence individual actions, in a less restrictive way the impact of certain public health policies may completely eliminate choice altogether, a typical example is the compulsory quarantine of patients with infectious diseases such as Ebola or Lassa fever, another example of restriction of choice is the banning of smoking in some public places.

 Paternalism in Healthcare

The major objectives of Public health action is to influence human behavior that arguably does no harm to self and to others. In developed countries of the world chronic diseases account for the majority of deaths, and personal behaviors account for a significant cause of their onset and progression. Current research and action in public health seeks to change behaviors whose consequential effects are felt primarily by those who engage in them.

What is Paternalism?

Paternalism occurs when the state or a situation or an individual interferes with the preferences of a person for his/her own benefit with the sole aim of promoting health. Paternalism also involves limiting a person or group’s freedom or autonomy with sole aim of promoting their own good.


What are the Types of Paternalism Healthcare?

Hard and soft Paternalism

Soft Paternalism: Under this form of paternalism, action can only be justified when an action to be committed is involuntary.

Soft Paternalism Example: An example of soft paternalism is preventing a person from crossing a bridge when we know the bridge is damaged and we are unable to tell the fellow that the bridge is damaged as he doesn’t speak our language. If he knows and intends to jump off the bridge and commit suicide and we allow him this is soft paternalism.

Hard paternalism: Under this form of paternalism, action can only be justified when an action to be committed is voluntary.

Hard Paternalism Example: An example of hard paternalism is forcefully preventing a man who knows a bridge is damaged from crossing the bridge and committing suicide.


Pure and impure Paternalism

Pure paternalism: Under this form of paternalism a person or group of persons have their freedom or autonomy restricted due to their being protected.

Impure paternalism: Under this form of paternalism a person or group of persons have their freedom or autonomy violated and are not just the persons being protected.


Moral and welfare

Moral paternalism: Under this system paternalism is justified to promote the moral well-being of a person or group of persons even if their welfare wouldn’t improve.

Moral paternalism Examples: An example of moral paternalism is preventing a man or woman from prostitution even if they make a decent living from the action and they practice safe sex.


What constitutes a fair distribution of health?

The most important question in the allocation of scarce resource for health is often how to balance the objective of achieving maximum health benefits against genuine concerns relating fairness of the distribution of health. Systematic analysis of social justice and health equity have thrown up a number of basic but important questions, which includes the following:

  1. Are social inequalities in health unjust?
  2. Which inequalities are most urgent?
  3. What constitutes a fair distribution of health?

It is vital to note that, while the utilitarian goal aims to maximize aggregate health, the distributive goals principal objective is to produce a fair distribution of health even though health policies and public health activities tend to produce more health improvement and reduce health inequalities, health initiatives can often reproduce or exacerbate health disparities because individuals who are better  off people tend to benefit sooner and disproportionately from most health promotion interventions. The systematic distribution of health in a fair and equitable manner involves two major approaches.


  1. Constructing Measures Of The Inequality In Health (The Inequality Adjustment Approach)

This involves constructing measures of the inequality in health, in addition to proposing ways of constructing measure of aggregate goodness which can be achieved by combining measures of health inequality and measures of aggregate health.


  1. Cost-Effectiveness Approach

Distributional objectives are not included into standard cost effectiveness analysis, such goals can easily be accommodated within this approach by attaching distributional weights to health outcomes. This method just as the inequality adjustment approach, will produce an overall measure of goodness that represents both the concern for a fair distribution of health (equity) and the concern for aggregate health (efficiency).

What is participation in health?

Participation in health is defined as a collaborative process that equitably engages members of the community, organizational representatives, researchers, among others in knowledge creation and social change.  In practice, such processes produce more equitable and effective outcomes and may also protect non-dominant communities, cultures and tribes from health interventions that will marginalize, stigmatize or place them in a further disadvantaged position.


Parents Right To Refuse Vaccination

As a health personnel there are times you will have to deal with issues related to preventative health measures or interventions that provide little or no benefit to the individual, yet provide substantial or valuable collective benefit to the public’s health.

A typical example being immunization. When most of the people in a community are vaccinated, those who did not receive the vaccines are also protected from the contagious disease due to the lower risk of an outbreak. This is referred to as herd or community immunity. If a patient refuses a legally required immunization in locations where it is mandatory to be immunized either due to personal, religious or cultural beliefs the best and most effective response is to maintain a therapeutic alliance with a child’s parent and gently move in a direction to douse their fears and address their concerns about vaccination by promoting the importance and safety of vaccination.

However, If not legally required, a duly filled informed refusal form, expressing compelling personal, cultural or religious beliefs, may be respected. Vaccination refusal is very common in northern Nigeria, this has exacerbated the polio epidemic and resulted in the eventual return of the wild polio virus after 2 year absence.

How Should Communicable Diseases Be Reported To Public Health Authorities?

Each country or state has specific protocols and or guidelines that identify specific diseases with public health implications, such as communicable diseases, which require mandatory reporting. If you are uncertain whether reporting is required or not it is often advised that you contact the local public health authority for clarifications and further guidance. Beyond this statutory or legal requirement lies the ethical question of when it is justified to potentially break the code of confidentiality to protect the public’s interest or health.

It is ethically justified and morally correct to disclose a diagnosis to public health authorities if the potential risk to the general public has the following characteristics:

  • The magnitude of risk is serious.
  • The probability of risk is high.
  • The risk relates to an identifiable individual or group

What Diseases are Included in the Mandatory CDC Reportable Diseases?

CDC Notifiable Diseases in USA

Complete List of CDC National Notifiable Conditions

  1. Anthrax
  2. Arboviral diseases, neuroinvasive and non-neuroinvasive
  3. California serogroup virus diseases
  4. Chikungunya virus disease
  5. Eastern equine encephalitis virus disease
  6. Powassan virus disease
  7. St. Louis encephalitis virus disease
  8. West Nile virus disease
  9. Western equine encephalitis virus disease
  10. Babesiosis
  11. Botulism
  12. Botulism, foodborne
  13. Botulism, infant
  14. Botulism, wound
  15. Botulism, other
  16. Brucellosis
  17. Campylobacteriosis
  18. Cancer
  19. Carbon monoxide poisoning
  20. Chancroid
  21. Chlamydia trachomatis infection
  22. Cholera
  23. Coccidioidomycosis
  24. Congenital syphilis
  25. Syphilitic stillbirth
  26. Cryptosporidiosis
  27. Cyclosporiasis
  28. Dengue virus infections
  29. Dengue
  30. Dengue-like illness
  31. Severe dengue
  32. Diphtheria
  33. Ehrlichiosis and anaplasmosis
  34. Anaplasma phagocytophilum infection
  35. Ehrlichia chaffeensis infection
  36. Ehrlichia ewingii infection
  37. Undetermined human ehrlichiosis/anaplasmosis
  38. Foodborne Disease Outbreak
  39. Giardiasis
  40. Gonorrhea
  41. Haemophilus influenzae, invasive disease
  42. Hansen’s disease
  43. Hantavirus infection, non-Hantavirus pulmonary syndrome
  44. Hantavirus pulmonary syndrome
  45. Hemolytic uremic syndrome, post-diarrheal
  46. Hepatitis A, acute
  47. Hepatitis B, acute
  48. Hepatitis B, chronic
  49. Hepatitis B, perinatal infection
  50. Hepatitis C, acute
  51. Hepatitis C, chronic
  52. HIV infection (AIDS has been reclassified as HIV Stage III)
  53. Influenza-associated pediatric mortality
  54. Invasive pneumococcal disease
  55. Lead, elevated blood levels
  56. Lead, elevated blood levels, children (<16 Years)
  57. Lead, elevated blood levels, adult (≥16 Years)
  58. Legionellosis
  59. Leptospirosis
  60. Listeriosis
  61. Lyme disease
  62. Malaria
  63. Measles
  64. Meningococcal disease
  65. Mumps
  66. Novel influenza A virus infections
  67. Pertussis
  68. Pesticide-related illness and injury, acute
  69. Plague
  70. Poliomyelitis, paralytic
  71. Poliovirus infection, nonparalytic
  72. Psittacosis
  73. Q fever
  74. Q fever, acute
  75. Q fever, chronic
  76. Rabies, animal
  77. Rabies, human
  78. Rubella
  79. Rubella, congenital syndrome
  80. Salmonellosis
  81. Severe acute respiratory syndrome-associated coronavirus disease
  82. Shiga toxin-producing Escherichia coli
  83. Shigellosis
  84. Silicosis
  85. Smallpox
  86. Spotted fever rickettsiosis
  87. Streptococcal toxic shock syndrome
  88. Syphilis
  89. Syphilis, primary
  90. Syphilis, secondary
  91. Syphilis, early latent
  92. Syphilis, late latent
  93. Syphilis, late with clinical manifestations (including late benign syphilis and cardiovascular syphilis)
  94. Tetanus
  95. Toxic shock syndrome (other than streptococcal)
  96. Trichinellosis
  97. Tuberculosis
  98. Tularemia
  99. Typhoid fever
  100. Vancomycin-intermediate Staphylococcus aureus and Vancomycin-resistant Staphylococcus aureus
  101. Varicella
  102. Varicella deaths
  103. Vibriosis
  104. Viral hemorrhagic fever
  105. Crimean-Congo hemorrhagic fever virus
  106. Ebola virus
  107. Lassa virus
  108. Lujo virus
  109. Marburg virus
  110. New World arenavirus – Guanarito virus
  111. New World arenavirus – Junin virus
  112. New World arenavirus – Machupo virus
  113. New World arenavirus – Sabia virus
  114. Waterborne Disease Outbreak
  115. Yellow fever
  116. Zika virus disease and Zika virus infection
  117. Zika virus disease, congenital
  118. Zika virus disease, non-congenital
  119. Zika virus infection, congenital
  120. Zika virus infection, non-congenital

Complete List Of Notifiable Diseases in Canada

Complete List Of Notifiable Diseases in Canada

IDS 1986 – present
Anthrax 1930 – 1982, 2002 – present
Botulism 1933 – present
Brucellosis 1928 – present Originally called ‘undulant fever’
Campylobacteriosis 1986 – present
Chickenpox (Varicella) 1924 – 1958, 1986 – present
Chlamydia 1991 – present See ‘sexually transmitted infections’ in the listing of links
Cholera 1930 – present Asiatic’ cholera specified between 1930 and 1958
Clostridium difficile Associated Diarrhea (CDI) 2009 – pr
Congenital Rubella Syndrome (CRS) 1979 – present
Congenital Syphilis 1993 – present See ‘sexually transmitted infections’ in the listing of links
Creutzfeldt-Jakob Disease (CJD) 2000 – present Not presented on the application
Cryptosporidiosis 2000 – present
Cyclosporiasis 2000 – present
Diphtheria 1924 – present
Giardiasis 1983 – present
Gonorrhea 1924 – present See ‘sexually transmitted infections’ in the listing of links
Group B Streptococcal Disease of the Newborn (GBS) 2000 – present
Hantavirus Pulmonary Syndrome 2000 – present
Hepatitis A 1927 – 1958, 1969 – present Originally named ‘infectious jaundice’. Between 1959 and 1968, hepatitis was reported as a combined category, and since the type of hepatitis cannot be determined, these data are not reported.
Hepatitis B 1969 – present Originally named ‘serum hepatitis’. Reporting does not differentiate between acute and chronic cases
Hepatitis C 1991 – present Hepatitis C cases would have been captured in the earlier categories of Hepatitis non-A, non-B, and Hepatitis, unspecified by type
HIV Infection 2000 – present
Influenza, Epidemic 1924 – 1958
Influenza, Laboratory Confirmed 2000 – present
Invasive Group A Streptococcal Disease 2000 – present
Invasive Haemophilus influenzae, non-b Disease 2007 – present
Invasive Haemophilus influenzae, type b Disease 1986 – present Invasive Haemophilus influenzae disease was collected from 1979 onward, but with no type specified
Invasive Meningococcal Disease 1924 – present
Invasive Pneumococcal Disease 2000 – present Replaced pneumococcal meningitis. Invasive pneumococcal disease is a more general category that would include pneumococcal meningitis, but would also include other invasive pneumococcal infections.
Legionellosis 1986 – present
Leprosy 1925 – present
Listeriosis 1990 – 1999, 2007 – present All forms of listeriosis were notifiable from1999-2000. Starting in 2007, only invasive forms required notification
Lyme Disease 2009 – present
Malaria 1929 – 1978, 1983 – present
Measles 1924 – 1958, 1969 – present
Mumps 1924 – 1958, 1986 – present
Norovirus Infection 2007 – present Only outbreaks are to be notified
Paralytic Shellfish Poisoning 2007 – present
Paratyphoid 1924 – present Paratyphoid was reported in a separate category between 1924 and 1952 then from 1953 to 1968 combined with typhoid, once again reported separately from 1969 to 1999, then combined with salmonellosis in 2000.
Pertussis 1924 – present Also known as whooping cough
Plague 1930 – present
Poliomyelitis 1924 – present Non-paralytic poliomyelitis was presented in the viral meningitis category starting in 1962
Rabies 1927 – present
Rubella 1924 – 1958, 1969 – present Also referred to as German measles
Salmonellosis 1959 – present Paratyphoid was included with salmonellosis beginning  in 2000
SARS 2004 – present Though SARS was added to the list in 2004
Shigellosis 1924 – present Originally named ‘bacillary dysentery’
Smallpox 1924 – 1981, 2002 – present Although Smallpox was eradicated globally in 1980. It was returned to the list of notifiable diseases in 2000 as a potential bioterrorism agent
Syphilis 1924 – present
Tetanus 1957 – present
Tuberculosis 1924 – present
Tularemia 1930 – 1982, 2002 – present
Typhoid 1924 – 1952, 1969 – present Between 1953 and 1968, was presented as a combined category of ‘typhoid and paratyphoid’
Verotoxigenic Escherichia coli Infection 1991 – present
Viral Hemorrhagic Fever 1979 – 1982, 2002 – present
West Nile Virus Infection (WNV) 2003 – present
Yellow Fever 1930 – present


Issues in Medicare and Public Health Ethics

Complete List Of Notifiable Diseases in Nigeria

Complete List Of Notifiable Diseases in Nigeria

Public Health Ng
Public Health Nigeria an Interdisciplinary public health movement focused on health education, advancing fair public health policies, promoting fitness, healthy diets, responsible behavior, community health and general well-being.


  1. Public health is the key to success in a nigerian community where ignorance, social stigma, full acceptance and participation of local and untrained medical practitioner’s is at high benefits among local communities.
    But challenge is public health practice are not handed by public health professionals. Attention is needed.

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