Despite an instinctive preference for social justice among the doctors, nurses and policy experts working in public health, as it stands now, the system keeps doing things that make life more difficult for the poor, the homeless, prisoners and other marginalized populations, observes Diego Silva.

Silva points to a health advisory put out by the State Department of Health in Indiana which warned homeless people not to use the shelter system during flu season because of increased risk of catching the bug. But winter nights outdoors in the Midwest are no picnic. They might not get the flu but freezing to death becomes a real possibility, said Silva.

The problem is that public health workers are often ill equipped to think consciously about the ethics of what they’re doing and why they’re doing it, said Silva.

“It’s not that ethics isn’t there in public health. Most schools of public health teach ethics. It’s usually one course,” said Silva.

Ethics needs to be taught at a foundational level and then weaved into every aspect of public health education, said Silva.

Silva makes three recommendations for ensuring the poor and marginalized aren’t accidentally disadvantaged by public health policies and procedures.

He encourages more community engagement — “actually talking to people and getting their perspective” — more ethics and philosophy of science courses in graduate schools of public health, and formalized tools such as health equity impact assessments to help people on the job think about the ethics of what they are doing.

Silva concedes his commentary is critical, “but it’s intended to be constructive,” he said.

There’s nothing unusual about a Catholic hospital paying a researcher with a PhD in public health and an MA in philosophy to spark debate about ethics in the field of medicine which relates most directly to the poor, said Silva.

“The Catholic Church is mandated to care for the poor,” he said. “How do we best reduce poverty? What is the scope of public health?”

The Golden Rule may sound simple, but it’s not simple when applied in public health.

“What does it mean for me to understand what it means to be an aboriginal person in Toronto living on the street? We’re trying to create policies and programs for that population. What does it mean to do what’s best for them?”