Ethical issues and dilemmas for the public health social worker: Promoting healthy individuals and communities

Both the American Public Health Association (APHA) and the National Association of Social Workers (NASW) have ethical codes and standards to guide their members in ethical practice (APHA, 2002, 2005; NASW, 2008). They share core social justice principles of promoting service to clients without discrimination and advocacy on behalf of the most vulnerable. Although there is much concurrence between public health and social work, in some situations the public health social worker may experience conflict at an individual case level when deciding whether the risk is greater for the individual or the community. Public health providers look to promote healthy populations and communities(Gabbier, Rosenstock, & Hernandez, 2003; APHA,2005), while the NASW Code directs social workers to give clients the right to make their own decisions except when there is a clear, foreseeable, and imminent possibility of risk to self and others (NASW, 2008). Because of the primary focus on populations, public health may minimize individual self-determination. For example public health workers stress immunization of all children as a way to prevent the spread of childhood diseases, while social workers would focus on the rights of individuals to make their own decisions about immunization. Public health stress reporting of infectious diseases as essential in combating diseases, while social workers would be concerned about individual rights to confidentiality. Does promoting the welfare of the community while preserving the rights of individuals create tension for the public health social worker? Examples that demonstrate possible conflicts will be discussed.