An Ecological Public Health Ethics: Intersections of Ethics, Law and Environment

A Health in all Policies approach to public health helps to foster a broader ecological understanding of the complex interaction among health and social systems and practices, legal and ethical norms, and environments and support more robust ethical decision making in public health. Legal and ethical standards for guiding public health decision making must take account of communities and the public value that resides in communities. While public health has historically recognized critical social determinants of health such as education, income, neighborhood, race, ethnicity, literacy and culture, there has been a firm and settled resistance among Americans to accepting limitations upon personal autonomy in the balancing of individual and social interests, often to the detriment of communities and especially resource-poor communities. The adoption of an ecological perspective and ecological ethics in public health planning must drive policy formulation as we move into the next decades, accounting for the needs of diverse peoples and communities and the just allocation of resources in both non-emergency and emergency situations across the globe. Investments must be made in building citizen-friendly environments that will increase the capacities of communities to support global health and the concomitant goals of increased access to competent professional and lay workforces, clean air and water, green space, good foods, essential medicines, and basic palliative care to relieve pain and suffering so widely prevalent in all parts of the world. Making communities and their ecological contexts and concerns central to the foundations of twenty-first century public health policy will advance a global ecological ethics that is attuned to persons as well as nonanthropocentric life and process.