Health Education & Behavior

That individuals are responsible for staying healthy is becoming a truism of health promotion and health policy. However, it is unclear what the slogan means, whether it is true, and what the consequences would be or should be if it is. A careful examina tion of the contexts in which the notion of personal responsibility for health occurs re veals a number of distinct arguments for different policy ends, each relying in turn on key unstated assumptions whose validity is doubtful. There is no disputing the minimal claim that most of us would be healthier if we took better care of ourselves. However, assignment of responsibility for health to the individual is usually part of a more far- reaching reassessment of obligations and entitlements in health care and health policy. A assessment of the concept of personal responsibility for health should precede any attempt to draw broad conclusions on rights and duties in maintaining health.

Health communications campaigns are a major strategy used by governments to promote health. This article discusses key issues in the ethics of health communica tions campaigns, including the compatibility of health campaigns with the principle of respect for autonomy and how conflicts with this principle can be justified. Five potential justifications for state-sponsored health communications campaigns are re viewed : (1) the public's health as an independent value; (2) collective efficiency and majoritarian preferences; (3) third party or state's interests; (4) harm to the health of others; and (5) countering the short-term contingencies of a market.

Economic considerations constitute a significant factor in businesses' interest in adopting health promotion (HP) programs and in the wellness community's attempts to sell such programming to business. Substantial elements of both the business and wellness communities believe that HP programs are financially profitable, in addition to, and as a result of, improving employees' health. Examination of the foundation of this belief, however, leads to the conclusion that underlying analyses have been techni cally flawed and have ignored important costs of HP programs. This article discusses the limitations of these analyses and outlines the framework of a model that could provide a sound assessment of the economics of workplace HP programs. In general, it is expected that resultant analyses would find less direct profit potential in work place HP programs but would emphasize the cost-effectiveness of many such efforts. The latter would force recognition that health, and not profit, is the principal benefit of health promotion programming. The distinction between the cost-effectiveness and cost-saving potential of health promotion is one that all interested parties should master.

As relatively new innovations in the workplace, employee assistance and wellness/ health promotion programs have not yet established clear identities. Thus ethical prac tices have not been fully considered or discussed. Based on extensive research exper ience with employee assistance programs, ethical issues are considered at three levels. Of primary concern are ethical issues affecting the individual employee, of which the scope of perceived or expected service relationships between employees and EAP coordinators is critical. There are tendencies to transfer models of community or private practice to the worksite, but the relationships both prescribed and implied at the worksite require that a different pattern of clinical relationships obtain. At the organizational level, it is critical for the worksite practitioners to be conscious of their authority in translating scientific data into recommended practices at the worksite and in transforming equivocal data and health practices into organizational norms. Finally, at the level of interorganizational relationships the worksite health program practi tioner needs to be aware of the risks of becoming drawn into overly intimate relation ships with external organizations who may come to benefit by special treatment that such relationships generate.

This case study describes the establishment and operation of a community-based health promotion consortium. The ethical implications of membership criteria, use of mailing lists, public education and policy, and communications are examined. The organization's responses to questions raised in these areas are discussed. Increased com munication and sharing of ideas and experiences among health promotion consortia are recommended. Issues in the activities of health promotion consortia which require further philosophical and sociological examination are identified.

In 1984, the Society for Public Health Education (SOPHE) and the Association for the Advancement of Health Education (AAHE) convened a joint committee to de velop a profession wide code of ethics for health education. The following article is a compilation of the Committee's work over two years. The Committee's report appears first. It presents the Committee's position on how a code of ethics is developed and constitutes guidelines for future refinements in the code. Appendix A is the SOPHE code of ethics produced in 1976. It is included to show the evolution of the code into its current form as presented in Appendix B. Appendix B is the Code of Ethics devel oped by a SOPHE Committee in 1983. SOPHE and AAHE through a joint committee are continuing efforts to develop a code of ethics for the profession of health educa tion. We invite reader's reactions to the Code. Comments and questions can be di rected to the AAHE/SOPHE Ethics Committee, c/o the Editors of Health Education Quarterly.

In the nine years since an entire issue of Health Education Quarterly (then Health Education Monographs) was devoted to considering ethical issues in health education, several important social changes have occurred which have substantially influenced the practice of that discipline. New practice contexts and ethical issues have resulted, which require a fresh look at both these new issues as well as those addressed in the earlier monograph. The importance of understanding the principles underlying the eth ical dilemmas raised by the authors is emphasized as a concern for both the individual practitioner as well as the profession of health education itself. Recommendations for personal and professional action are made by the authors.