Public Health Ethics Resources

Dear Ask the Ethicist:

I regularly advise students who are working on field-based projects (practica and Capstones) in a high need community. Their work has involved engaging with community health leaders in conducting needs assessments and generating ideas among community members about how to address public health problems within the community. However, the students almost always leave the program before they can help the community develop viable solutions to the problems. I worry that the communities we work with may feel that they are giving more than they are getting in providing learning opportunities for students with little or no help in addressing the challenges uncovered by the students’ field work. At some point, they may decide to stop engaging with the school in this way – a loss for future students and also creating a bad name for the institution within the state. Is it ethical for us, as a school, to continue to send our students into these communities without a clear plan for how we, as a school, will help the communities once the students have moved on?

Response:

Critical attention to the problem of “voluntourisum” or “health tourism” has increased over the last few years, as the weight of the evidence began to suggest that so-called “helicopter service approaches” might well do more harm than good in many resource-poor settings. Especially given the significant power differences that often attend people learning with and working in resource-poor contexts, there are powerful concerns related to justice and equity at stake. The possibility that field-based projects could actually end up leaving high-need communities worse off than they would have otherwise been is sobering and must be taken seriously given the evidence. And, even if not worse off, the community may have expended scarce resources to support the student with little gain returning to the community.

Principles of asset-based community engagement would suggest that the community itself shld have a large role in determining what a sustainable program for service-learning would actually look like. With such a program in place, there is a stronger justification for permitting students to complete individual projects under the ambit of the program. This should be accompanied by a regular opportunity to assess benefits and costs to the community as well as those to the university. Absent such a clearly defined process of community-engagement and careful monitoring, there are good reasons to question the ethics of continuing this model of individual service-learning.

What ethical principles apply here?

Principles of social justice are critical here—a central goal of public health. A related and important value is that of the equitable treatment of communities so as to assure that the benefits to the community outweigh the loss of resources or power. The school should maintain regular mechanisms of communication to assure that both students and the community are being treated with fairness.