Equity in public health ethics: a community-engaged, empirical study of values, principles, and practices

Public health ethics provides a framework for navigating ethical dilemmas, distinguished from clinical bioethics by its focus on population health, prevention, and explicit acknowledgement of political context. While public health ethical frameworks have been developed, concerns are raised about lack of utility or integration of equity and Indigenous perspectives (First Nations, Inuit, Métis). This study aimed to engage groups impacted by public health decisions to identify ethical values and develop recommendations for public health ethics practice in British Columbia.

A two-phase, community-engaged qualitative study was conducted from March 2024 to January 2025. 40 public health professionals and members of equity-deserving groups (people with disabilities, Indigenous Peoples, newcomer, seniors), were recruited for interviews or focus groups in phase one. Phase two involved follow-up surveys or interviews with 18 participants. Directed content analysis was utilized to identify themes.

Participants emphasized the importance of equity, humanization, Indigenous Cultural Safety, and wholistic wellbeing, as well as relational values of trust and transparency. Recommendations included increasing equity through addressing social determinants of health and developing accessible practice tools.

Engaging equity-deserving groups generated insights and actionable recommendations to improve equity, strengthen public health ethics practice and build trust in public health.