A public health ethics framework for the geriatric community: a South African perspective
Loading...
Date
2021
Authors
Lategan, Laetus Oscar Kotze
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
At the end of her tenure (2007–2017) as Director-General for the World Health Organization (WHO), Margaret Chan (2017) published a report on the developments in public health during this period. She emphasised the growing role that social determinants can play to improve public health. The new thinking is that social determinants, and not physical challenges only, contribute to health. The downside of her comment is that social factors can also negatively influence quality of health and well-being of communities. Such a negative impact will increase the vulnerability of a community. Ethical challenges are often associated with vulnerability. This is particularly evident in thegeriatric community. A growing ageing and consequently an elderly or geriatric community will place more demands on the already challenged social and health services. This, in turn, will put more strain on the geriatric community. Statistics from the WHO’s World Report on Ageing and Health (2015) suggests that the world population older than 60 years will nearly double by 2050. This is a global phenomenon. The 2020 South African Mid-year Population Estimates Report approximates the people older than 60 years to be 9.1% of the population. This Report states that the population 60 years and above increased by 1.9 million people from 2002 to 2020. This growth represents an increase of 1.1% for the period 2002 to 2003, and 3.0% for the period 2019 to 2020. A review of literature relevant to the geriatric community obtained from databases such as Science Direct, Proquest, Taylor and Francis, Sabinet African Journal Collection and relevant National Department of Health policies, strategies and plans, suggest the apparent absence of a public health ethics framework for the geriatric community. The perspectives originating from the literature led to the research question for this study: What are the important ethical aspects to consider for a public health ethics framework for the geriatric community in the South African context? This study was based on a literature review as part of a qualitative method and the Qmethodology, which is qualitative in its information collection and data sampling but quantitative in terms of the method of analysis. Six geriatric institutions, two each from the Free State, Northern Cape and Northwest Provinces, participated in the data collection for the study. A questionnaire (Q-sort table) was completed, comprising 50 statements (Q-set) which were ranked (Q-sorting) by the twenty-two participants (P-set) from the six participating institutions. The collection of data derived from the ranking of statements was representative of three indexes: (a) an Index of Social Determinants (Questions 1 – 20); (b) an Index of Public Health Ethics (Questions 21 – 35); and (c) an Index of a Public Health Ethics Framework (Questions 36 – 50). The data collected from the ranking of statements was analysed using the Statistical Package for Social Sciences software. Information was produced based on the interpretation of the data against the literature review presented in Chapter 1. The research results are discussed in Chapters 2 – 4. From Chapter 2 it is evident that the lack of sufficient healthcare provision and the quality of healthcare provision are social determinants impacting negatively on the geriatric community’s health. These social determinants contribute to the ethical challenges experienced by the geriatric community. Chapter 3 addresses the question of what public health ethics implies for the geriatric community. Working with the geriatric community, the ethical principles of (a) respecting their vulnerability and fragility, (b) protecting their lives from abuse and neglect, and upholding dignity, (c) securing a safe environment to live in, and (d) providing quality access to healthcare and provision, were identified as the ethical basis of public health for the geriatric community. The chapter concludes that public health ethics is the application ofethical principles through a professional ethic resulting in care and relationship building. In Chapter 4 eight building blocks are identified that were used in the development of a framework for public health ethics. These building blocks are: Promote the core value of public health; • Identify the principles for public health ethics; • Recognise ethical challenges for agent and recipient of service; • Advance ethics leadership; • Introduce ethics education; • Promote social justice; • Develop ethical expertise; and • Practise care ethics. In Chapter 5 an integrated public health ethics framework for the geriatric community is presented. The perspectives presented in the literature review (cf. Chapter 1), the perspectives developed on social determinants having an impact on the geriatric community (cf. Chapters 1 & 2), and the ranking of statements (cf. Chapters 2 – 4) contributed to the development of a public health ethics framework. Based on the ranking of statements, building blocks were identified that contributed to the public health ethics framework for the geriatric community (cf. Chapter 5). These building blocks contributed to a public health ethics framework, and were grounded in normative and applied ethics and linked to virtue ethics, deontology and consequentialism. Four questions associated with ethics were posed to explain the application of the framework. These questions also assisted with the alignment of the building blocks to the basic purpose of public health, namely the organised strategies, interventions, and services to improve the health and well-being of the community or population. The questions are: (a) Are we doing things right? (b) Are we doing the right thing? (c) How can the common good be promoted? (d) What benefit is there?
Description
Thesis (Ph.D. (Community Health))-University of the Free State, 2021
Keywords
Ageing, Ethics, Care ethics, Professional ethics, Geriatric community, Public, Health, Public health ethics, Social determinants