title: Integrating ethics, health policy and health systems in low- and middle-income countries: case studies from Malaysia and Pakistan.
abstract: Scientific progress is a significant basis for change in public-health policy and practice, but the field also invests in value-laden concepts and responds daily to sociopolitical, cultural and evaluative concerns. The concepts that drive much of public-health practice are shaped by the collective and individual mores that define social systems. This paper seeks to describe the ethics processes in play when public-health mechanisms are established in low- and middle-income countries, by focusing on two cases where ethics played a crucial role in producing positive institutional change in public-health policy. First, we introduce an overview of the relationship between ethics and public health; second, we provide a conceptual framework for the ethical analysis of health system events, noting how this approach might enhance the power of existing frameworks; and third, we demonstrate the interplay of these frameworks through the analysis of a programme to enhance road safety in Malaysia and an initiative to establish a national ethics committee in Pakistan. We conclude that, while ethics are gradually being integrated into public-health policy decisions in many developing health systems, ethical analysis is often implicit and undervalued. This paper highlights the need to analyse public-health decision-making from an ethical perspective.
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America. ahyder@jhsph.edu
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Hyder
authors.forename: Maria
authors.initials: M
authors.lastname: Merritt
authors.forename: Joseph
authors.initials: J
authors.lastname: Ali
authors.forename: Nhan T
authors.initials: NT
authors.lastname: Tran
authors.forename: Kulanthayan
authors.initials: K
authors.lastname: Subramaniam
authors.forename: Tasleem
authors.initials: T
authors.lastname: Akhtar
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control; D003469:Culture; D003659:Decision Making, Organizational; D003695:Delivery of Health Care / Q000941:ethics*; D003906:Developing Countries; D014943:Global Health; D006291:Health Policy; D006292:Health Priorities; D006302:Health Services Research / Q000458:organization & administration; D019456:Health Transition; D006801:Humans; D008296:Malaysia; D019982:Organizational Case Studies; D010154:Pakistan; D011050:Policy Making; D011057:Politics; D011634:Public Health / Q000941:ethics*; D011635:Public Health Administration / Q000941:ethics*; D012945:Social Values / Q000208:ethnology
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