A code of ethical conduct for the public health profession

Ulrich Laaser, Peter Schröder-Bäck, Eliudi Eliakimu, Katarzyna Czabanowska, The One Health Global Think-Tank for Sustainable Health & Well-being (GHW-2030)


Aim: Agreeing on a Code of Ethical Conduct is an essential step in the formation and definition of a public health profession in its own right. In this paper we attempt to identify a limited number of key ethical principles to be reflected as professional guidance.

Methods: We used a consensus building approach based on narrative review of pivotal literature and theoretical argumentation in search for corresponding terms and - in a second step - attempted to align them to a limited number of key values. The resulting draft code of ethical conduct was validated employing a framework of the Council of Europe and reviewed in two quasi Delphi rounds by members of a global think tank.

Results: The alignment exercise demonstrated the acceptability of five preselected key principles: solidarity, equity, efficiency, respect for autonomy, and justice whereas three additional principles were identified during the discussion rounds: common good, stewardship, and keeping promises.

Conclusions: In the context of emerging and re-emerging diseases as well as increase in lifestyle-related diseases, the proposed Code of Ethical Conduct may serve as a mirror which public health professionals will use to design and implement public health interventions. Future public health professional chambers or an analogous structure should become responsible for the acknowledgement and enforcement of the Code.



code of ethics, moral obligations, principle-based ethics, professional standards, public health profession, population ethics, societal responsibility, utilitarian ethics.

Full Text:


Cite this article


Meagher KM, Lee LM. Integrating Public Health and Deliberative Public Bioethics: Lessons from the Human Genome Project Ethical, Legal, and Social Implications Program. Public Health Rep 2016;131:44-51.

Kass NE. Public Health Ethics: From Foundations and Frameworks to Justice and Global Public Health. J Law Med Ethics 2004;32:232-42.

Coleman CH, Bouesseau MC, Reis A. The contribution of ethics to public health. Bull World Health Organ 2008;86:578-9. DOI: 10.2471/BLT.08.055954.

Krebs J. The importance of public-health ethics. Bull World Health Organ 2008;86:579. DOI: 10.2471/BLT.08.052431.

Slomka J, Quill B, DesVignes-Kendrick M, Lloyd LE. Professionalism and Ethics in the Public Health Curriculum. Public Health Rep 2008;123:27-35.

Benatar S. Explaining and responding to the Ebola epidemic. Philos Ethics Humanit Med 2015;10:5. DOI: 10.1186/s13010-015-0027-8.

Smith MJ, Upshur REG. Ebola and Learning Lessons from Moral Failures: Who cares about Ethics? Public Health Ethics 2015;8:305-18. DOI: 10.1093/phe/phv028.

World Health Organisation. Guidance for managing ethical issues in infectious disease outbreaks. Geneva, Switzerland: WHO, 2016.

Littman J, Viens AM. The ethical Significance of Antimicrobial Resistance. Public Health Ethics 2015;8:209-24. DOI: 10.1093/phe/phv025.

Klingler C, Silva DS, Schuermann C, Reis AA, Saxena A, Strech D. Ethical issues in public health surveillance: a systematic qualitative review. BMC Public Health 2017;17:295. DOI: 10.1186/s12889-017-4200-4.

Royo-Bordonada MA, Roman-Maestre B. Towards Public Health Ethics. Public Health Rev 2015;36:3. DOI: 10.1186/s40985-015-0005-0.

Marckmann G, Schmidt H, Sofaer N, Strech D. Putting public health ethics into practice: a systematic framework. Front Public Health 2015;3. DOI: 10.3389/fpubh.2015.00023.

Ortmann LW, Barrett DH, Saenz C, Gaare Bernheim R, Dawson A, Valentine JA, Reis A. Public Health Ethics: Global Cases, Practice, and Context: Chapter 1. In: Barrett et al. (eds.) Public Health Ethics: Cases Spanning the Globe, Health Ethics Analysis 3. Springer Open, 2016:1-35. DOI: 10.1007/978-3-319-23847-0-1.

Petrini C. Theoretical Models and Operational Frameworks in Public Health Ethics. Int J Environ Res Public Health 2010;7:189-202. DOI: 10.3390/ijerph7010189.

ten Have M, de Beaufort ID, Mackenbach JP, van der Heide A. An overview of ethical frameworks in public health: can they be supportive in the evaluation of programs to prevent overweight. BMC Public Health 2010;10:638. http://www.biomedcentral.com/1471-2458/10/638 (accessed: 17 April, 2017).

Laaser U, Schröder-Bäck P. Towards a Code of Conduct for the European Public Health Profession! SEEJPH 2016;5. DOI 10.4119/UNIBI/SEEJPH-2016-88.

European Parliament, Strassbourg: Directive 2005/36/EC of the European Parliament and of the Council of September 2005. http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2005:255:0022:0142:en:PDF (accessed: 18 February, 2016).

European Parliament, Strassbourg: Directive 2013/55/EU of the European Parliament and of the Council of November 2013. eurlex.europa.eu/LexUriServ/LexUriServ. do?uri=OJ:L:2013:354:0132:0170:en:PDF (accessed: 18 February, 2016).

The UK Faculty of Public Health. www.fph.org.uk/ (accessed: 19 February, 2016).

Czabanowska K, Laaser U, Stjernberg L. Shaping and authorising a public health profession. SEEJPH 2014;2. DOI 10.12908/SEEJPH-2014-23.

Faculty of Public Health: Good Public Health Practice framework 2016. London, United Kingdom. http://www.fph.org.uk/uploads/Good%20Public%20Health%20Practice%20Framework_%202016_Final.pdf (accessed: 5 August, 2016).

ASPHER, the Association of Schools of Public Health in the European Region. www.ASPHER.org (accessed: 19 February, 2016).

EUPHA, the European Public Health Association. https://eupha.org (accessed: 19 February, 2016).

Public Health Leadership Society (PHLS). Principles of the Ethical Practice of Public Health, Version 2.2.2002. http://nnphi.org/uploads/media_items/principles-of-the-ethical-practice-of-public-health-brochure.original.pdf (accessed: 5 September, 2015).

Chambaud L., Tulchinsky T. (eds.) Ethics in Public Health. Public Health Reviews 2015;36:1ff. https://publichealthreviews.biomedcentral.com/articles?query=ethics&volume=36&searchType=&tab=keyword (accessed: 1 December 2017).

Laaser U. A plea for Good Global Governance. Front Public Health 2015;3. DOI: 10.3389/fpubh.2015.00046. http://journal.frontiersin.org/article/10.3389/fpubh.2015.00046/full (accessed: 3 March, 2017).

Verkerk MA, Lindemann H. Theoretical resources for a globalised bioethics. J Med Ethics 2010;37:92-6.

Stapleton G, Schroeder-Baeck P, Laaser U, Meershoek A, Popa D. Global health ethics: an introduction to prominent theories and relevant topics. Glob Health Action 2014;7:23569. http://www.globalhealthaction.net/index.php/gha/article/view/23569 (accessed: 8 January, 2015).

ASPHER, the Association of Schools of Public Health in the European Region. The global dimension of education and training for public health in the 21st century in Europe and in the world. Charter of the Association of Schools of Public Health in the European Region (ASPHER) at the occasion of the 6th European Public Health Conference in Brussels, Belgium, November 13-16, 2013. www.aspher.org (accessed: 15 December, 2015).

WFPHA, the World Federation of Public Health Associations. A Global Charter for the Public’s Health; 2016. http://www.wfpha.org/wfpha-projects/14-projects/171-a-global-charter-for-the-public-s-health-3 (accessed: 12 April, 2016).

Childress JF, Faden RR, Gaare RD, Gostin OL, Kahn RJ, Bonnie NE, et al. Public Health Ethics: Mapping the Terrain. J Law Med Ethics 2002;30:170-8.

Council of Europe, Committee of Ministers: Recommendation CM/Rec (2010) 6 of the Committee of Ministers to member states on good governance in health systems (adopted 31 March 2010). Attachment I to the Guidelines appended to recommendation CM/Rec (2010) 6. www.europeanrights.eu/public/atti/sanit_ing.doc (accessed: 1 May, 2017).

Laaser U, Lueddeke G, Nurse J. Launch of the ‘One Health Global Think-Tank for Sustainable Health & Well-being’ - 2030 (GHW-2030). SEEJPH 2016;6. DOI 10.4119/UNIBI/SEEJPH-2016-114.

Schröder-Bäck P, Duncan P, Sherlaw W, Brall C, Czabanowska K. Teaching seven principles for public health ethics: towards a curriculum for a short course on ethics in public health programmes. BMC Med Ethics 2014;15:73. DOI: 10.1186/1472-6939-15-73. http://www.biomedcentral.com/1472-6939/15/73 (accessed: 19 March, 2016).

Laaser U, Donev D, Bjegovic V, Sarolli Y. Public Health and Peace (editorial). Croat Med J 2002;43:107-13.

Institute for Global Ethics: Building a Code of Ethics. https://www.globalethics.org/What-We-Do/Consulting/Code-of-Ethics.aspx (accessed: 3 July, 2016).

Nuffield Council on Bioethics: Public health: ethical issues. London: Nuffield Council on Bioethics, 2007.

Council of the European Union: Council Conclusions on Common values and principles in European Union Health Systems. Official Journal of the European Union 2006/C 146/01. http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2006:146:0001:0003:EN:PDF (accessed: 19 March, 2016). In a later version as: Council Conclusions on Equity and Health in All Policies: Solidarity in Health. 3019th Employment, Social Policy, Health and Consumer Affairs Council meeting. Brussels: 8 June 2010. http://www.consilium.europa.eu/uedocs/cms_data/docs/pressdata/en/lsa/114994.pdf (accessed: 19 March, 2016).

World Health Organization. Global Health Ethics: Key Issues. Geneva, Switzerland: WHO, 2015.

Coughlin SS. How Many Principles for Public Health? Open Public Health J 2008;1:8-16. DOI: 10.2174/1874944500801010008.

Prainsack B, Buyx A. Solidarity: reflections on an emerging concept in bioethics. London: Nuffield Council on Bioethics, 2011.

Ter Meulen R. Solidarity and Justice in Health care. A Critical Analysis of their Relationship. Diametros 2015;43:1-20. DOI: 10.13153/diam.43.201.710. http://www.diametros.iphils.uj.edu.pl/index.php/diametros/article/view/710 (accessed: 1 May, 2017).

Whitehead M. The concepts and principles of equity and health. Copenhagen, Denmark: WHO, 1991.

O’Neill O. Public health or clinical ethics: Thinking beyond borders. ‎Ethics Int Aff 2002;16:35-45.

Daniels N. Just health: Meeting health needs fairly. Cambridge: Cambridge University Press, 2008.

Boorse C. On the distinction between disease and illness. ‎Philos Public Aff 1975;5:49-68.

Anomaly J. Public health and public goods. Public Health Ethics 2011;4:251-9.

Dawson A. Herd protection as a public good: Vaccination and our obligations to others. In: Dawson A, Verweij M (Eds.) Ethics, prevention and public health. Oxford: Clarendon Press, 2007:160-178.

McConnell T. Moral Combat in An Enemy of the People: Public Health versus Private Interests. Public Health Ethics 2010;3:80-6. DOI: 10.1093/phe/php029.

Ménard JF. A ‘nudge’for public health ethics: libertarian paternalism as a framework for ethical analysis of public health interventions?. Public Health Ethics 2010;3:229-38.

Anderson FWJ, Johnson TRB, de Vries R. Global Health Ethics: The case of Maternal and Neonatal Survival. Best Practice & Research Clinical Obstetrics and Gynaecology; 2017 (in press). http://dx.doi.org/10.1016/j.bpobgyn.2017.02.003.

Velji A, Bryant JH. Global Health Ethics. In: Markle WH, Fisher MA, Smego RA, (Eds). Understanding Global Health. McGraw Hill, Lange Companies; 2007:295-317.

Frenk J, Moon S. Governance Challenges in Global Health. N Engl J Med 2013;368:936-42. DOI: 10.1056/NEJMra1109339.

Nixon S, Forman L. Exploring synergies between human rights and public health ethics: A whole greater than the sum of its parts. BMC Int Health Hum Rights 2008;8:2. DOI: 10.1186/1472-698X-8-2. http://www.biomedcentral.com/1472-698X/8/2 (accessed: 12 April, 2017).

Suri A, Weigel J, Messac L, Basilico MT, Basilico M, Hanna B, et al. Values in Global Health. In: Farmer P, Kim JY, Kleinman A, Basilico M, (Eds). Reimagining Global Health: An Introduction. Berkeley, Los Angeles: University of California Press, 2013:245-86.

Otenyo NK. The relevance of ethics in the European Union’s second public health programme. SEEJPH 2017;7. DOI: 10.4119/UNIBI/SEEJPH-2017-138.

Callahan D, Jennings B. Ethics and public health: Forging a strong relationship. Am J Public Health 2002;92:169-76.

Stikova E. R 2.8 Disaster preparedness. In: Laaser U, Beluli F. A global Public Health Curriculum. Lage Germany: Jacobs Verlag, 2016:121. http://www.seejph.com/index.php/seejph/article/view/106/82 (accessed: 5 July, 2017).

Martin-Moreno J, Harris M. R 3.4 Universal health coverage including the private sector and traditional medicine. In: Laaser U, Beluli F. A global Public Health Curriculum. Lage Germany: Jacobs Verlag, 2016: 226. http://www.seejph.com/index.php/seejph/article/view/106/82 (accessed: 5 July, 2017).

Knights J. Transpersonal Leadership Series: White Paper One: How to Develop Ethical Leaders. Tylor and Francis: Routledge, 2016.

Rogers WA. Virtue ethics and public health: A practice-based analysis. Monash Bioeth Rev 2004;23:10-21. DOI: 10.1007/BF03351406.

Mooney G. Public health – virtue ethics versus communitarianism: A response to Wendy Rogers. Monash Bioeth Rev 2004;23:21-4. DOI:10.1007/BF03351410.

United Nations. Sustainable Development Goals. http://www.un.org/sustainabledevelopment/sustainable-development-goals/ (accessed: 5 May, 2017).

Kahn L. Protecting the planet and sustainable development. SEEJPH 2017;7. DOI 10.4119/UNIBI/SEEJPH-2017-135.

Rüegg SR, McMahon BJ, Häsler B, Esposito R, Nielsen LR, Speranza CI, et al. A Blueprint to Evaluate One Health. Front Public Health 2017;5:20. DOI: 10.3389/fpubh.2017.00020

One Health Commission. One Health: Linking Human, Animal and Ecosystem Health. Available from: https://www.onehealthcommission.org/ (accessed: 4 May, 2017).

McKee M, Stuckler D. “Enemies of the People?” Public Health in the Era of Populist Politics. Comment on “The Rise of Post-truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy”. Int J Health Policy Manag 2017;6:1-4. DOI: 10.15171/ijhpm.2017.46

DOI: 10.4119/UNIBI/SEEJPH-2017-177

Copyright (c) 2017 Ulrich Laaser, Peter Schröder-Bäck, Eliudi Eliakimu, Katarzyna Czabanowska, The One Health Global Think-Tank for Sustainable Health & Well-being (GHW-2030)7

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.