120507 PUBLIC HEALTH ETHICS: INTRODUCTION

Lecture for 4th year medical students by Prof Omar Hasan Kasule Sr.

1.0 CONCEPT OF GOOD HEALTH Health is a positive state of being and not just absence

of disease. Individuals who are disease-free may not be healthy.

The components of good health are spiritual health, physical health, psychological and mental health, and social health.

Islam looks at health in a holistic sense. If any part of the body is sick the whole body is sick If a member of a family is sick the rest of the family are

affected emotionally and psychologically. Any sickness in the community will sooner or later have

some negative impact on all the members. The holistic outlook also means that physical, emotional,

psychological, and spiritual health are considered together.

2.0 CONCEPT OF ILLNESS Definition of disease considers several dimensions that may

operate singly or in combination: moral or spiritual, biological or pathological, psychosocial, or normative statistical.

Overall disease is a state of dis-equilibrium, khuruuj al badan ‘an al i’itidaal.

A distinction must be made between disease as a pathological manifestation and illness that is a subjective feeling.

There is a 2-way interaction between diseases of the heart, amradh al qalb, and diseases of the body, amradh al badan.

The Islamic position is to approach most diseases empirically and to be guided by experimental science.

Islam rejects superstitious beliefs and practices in all their various forms and manifestations.

3.0 CONCEPT OF FAMILY HEALTHA healthy family promotes the health of all its members. There is

no alternative to the family for child up-bringing. The family teaches trust, loyalty, a sense of belonging, and rights and responsibilities.

It is is an economic unit.

It is the main source of primary health care.

It is a source of calmness and tranquility.

Threats to the family are extra-marital sexual relations, neglect of family duties in pursuit material goods, extreme individualism and self-interest, and bad socio-economic circumstances.

Dysfunctional families are not healthy in the physical and psychological sense and have long-term impact on the children.

The causes of family dysfunction are multiple: economic pressures, a hedonistic life-style, and decline of moral and religious values in the society.

 

5.0 CONCEPT OF COMMUNITY HEALTH 1Private and public efforts of individuals, groups, and

organizations to promote, protect, and preserve the health of those in the community.

Involves community development, community organization, community participation, and community diagnosis. Community health is affected by physical factors (geography, the environment, community size, industrial development, socio-cultural factors (beliefs, traditions, prejudices, economic status, politics, religion, and social norms, individual behavior, and community organization .

Whereas public health is government-driven, community health is community-driven. Communities both in pre-history and the historical era undertook measures to protect health.

Before the 1980s emphasis was on public health. After that the importance of community health and community participation were recognized.

6.0 CONCEPT OF COMMUNITY HEALTH 2 The Qur’an has described good and bad communities in the

past. It described communities that were punished or destroyed by Allah sue to moral deviations. No community is destroyed or is punished until it receives a warning from Allah.

Community diagnosis is identifying and describing health problems in a community with a view to initiating public health interventions.

Many communities are unhealthy in the physical and social or mental sense.

Underlying causes of poor community health are social and moral such as social injustice, immorality, sexual promiscuity, over-nutrition, and addiction to alcohol and drugs.

Community health can be improved by having healthy individuals in the community, fulfilling communally obligatory functions, and establishing mutual cooperation and mutual complementation.

7.0 CONCET OF PREVENTIVE MEDICINE, TIBB WIQA’I :

Preventive medicine, tibb wiqa’i, is covered under the Qur’anic concept of wiqayat. Prevention is therefore one of the fixed laws of Allah in the universe and its application to medicine therefore becomes most obvious.

The concept of prevention, wiqayat, does not involve claiming to know the future or the unseen, ghaib, or even trying to reverse qadar. The human using limited human knowledge attempts to extrapolate from the present situation and anticipates certain disease conditions for which preventive measures can be taken.

Only Allah knows for sure whether the diseases will occur or not. The human uses knowledge of risk factors for particular diseases established empirically to predict disease risk. Preventive action usually involves alleviation or reversal of those risk factors.

 8.0 CONCEPT OF HEALTH PROMOTION

Most diseases can be prevented using spiritual approaches. These involve aqiidat, ibadat, avoiding haram and promoting halaal.

Spiritual promotion at the community level involves enjoining the good and forbidding the evil.

Physical health promotion at the individual level includes immunization, good nutrition, personal hygiene, and disinfection.

Physical promotion at the community level involves environmental sanitation.

Health promotion involves pro-active measures that make health better such as exercise, good nutrition; adequate rest; mental calmness; tranquility of family life, iman and spiritual calmness.

9.0 ETHICAL ISSUES IN SCREENING

The benefit of screening must outweigh the harm

The efficacy of screening must be proved in a proper trialConfidentiality must be maintainedInformed consent must be obtained .

 10.0 ETHICAL ISSUES IN VACCINATION

Autonomy vs compulsionMass immunization of childrenMass immunization in epidemicsIndividual risk vs public benefit (concept of

herd immunity) 

11.0 ETHICAL ISSUES IN INFECTOUS DISEASE CONTROL

Isolation, quarantine Compulsory treatment / immunization Notification (confidentiality) Contact tracing

12.0 ETHICAL ISSUES IN ADDICTIONS

Personal autonomy vs public interestRestriction of smokingPassive smokerSociety bears costs of treating diseasesDrug addiction: criminal vs victim

 13.0 ETHICAL ISSUES IN DISASTERS

Triage: who has priorityShort term vs long termMedical intervention vs respect for local culture

and customs

14.0 ETHICAL ISSUES IN HEALTH ECONOMICS

Monetary value of human life and human lifeEquity: access, accessibility, coverage, qualityPublic vs privateSubsidizing unhealthy life styles