January
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7 HEALTH PROMOTION PRACTICE / January 2006
Ethics
Improving Our Application
of the Health Education Code of Ethics
The Health Education Code of Ethics
was designed to provide a frame-
work of shared values within which
health education might be prac-
ticed. However, an informal survey
conducted on a limited sample in
November 2004 indicated that ethics
and how to apply the code are topics
not readily taught formally within
all health education programs.
There is, however, an expressed
interest among health educators in
understanding the code and its ap-
plication. Because of the immense
import of ethics, affecting responsi-
ble professional conduct at all lev-
els, this article is designed to intro-
duce the topic to health education
practitioners who have had little for-
mal exposure to ethics curricula, as
well as to faculty who would like to
teach this subject. The authors spe-
cifically review several resources
that might be especially helpful in
fostering a better understanding of
this essential but often underesti-
mated aspect of health education
practice and research, namely, its
ethical application.
Keywords: ethics; health education;
code of ethics; profes-
sional preparation; en-
forcement
Health Promotion Practice
January 2006 Vol. 7, No. 1, 23-25
DOI: 10.1177/1524839905276039
©2006 Society for Public Health Education
Downloaded from hpp.sagepub.com at UCSF LIBRARY & CKM on April 7, 2015
Steven E. Shive, EdD, MPH, MTS, MA
T
he Health Education Code of
Ethics, which has developed
progressively from its incep-
tion as the Society for Public Health
Education Code of Ethics in 1976,
was designed to provide a frame-
work of shared values within which
health education might be practiced
(see the Society for Public Health
Education Code of Ethics at http://
www.henod.org/sophethics.html).
The Health Education Code of
Ethics was specifically designed to
• Regulate the practice of practi-
tioners
• Delineate the relationship that
should exist between a practi-
tioner and students/clients
• Define the nature and ideals of
the profession
• Establish internal rules for regulat-
ing the practice of the profession
However, based on an informal sur-
vey on a limited sample conducted
in the fall of 2004, it is clear that
• Ethics, and specifically the appli-
cation of the Health Education
Code of Ethics, is not readily
taught as a formal subject in cur-
rent health education undergrad-
uate and graduate programs,
although it is studied more for-
mally in schools of public health
and nursing.
• There is, however, interest in
instituting ethics courses, and
debate about the code and its
application does appear to take
place quite consistently, even in
the absence of a formal curricu-
lum on this topic.
Ray Marks, EdD
Other related issues eloquently
brought to bear by Dr. Mal Goldsmith
at the National Society for Public
Health Education Meeting in the fall
of 2004 include the following: there
is no existing set of guidelines for
implementing, governing, or regulat-
ing the adequacy of the existing code;
there are no specific mechanisms for
enforcing the code; there are no stan-
dardized sanctions processes that
prevail for those contravening the
code; and there is no mechanism for
monitoring ethical conduct in pro-
fessional preparation. Moreover,
although some global statements are
included in the preamble to each of
the six articles of the code, these do
not specify precisely how the overall
objective of each can be consistently
attained or what will occur if any of
the subobjectives of the six articles
are not upheld.
• Because of the immense import
of ethics and responsible pro-
fessional conduct to the entire
health education profession at all
levels, regardless of practice type
as outlined by Clark (1983) and
Forster and Khan (2002), it is our
view that it is not only essential
but also imperative that learners
have some formal process in
place to ensure they can readily
attain the goal of becoming ethi-
cal practitioners, faculty mem-
bers, or researchers. In particular,
those in the field must have ac-
cessible to them more specific
guidelines to ensure they have
some view of how to “behave”
ethically under a variety of con-
ditions and ever-changing and
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 oftentimes highly challenging
and controversial circumstances.
More attention needs to be paid
to who should enforce the Health
Education Code of Ethics and
whether having a code can pro-
mote ethical practice if there is
no careful preparation and dis-
cussion. What is clear is that
those who have no exposure to
the Health Education Code of
Ethics in the formal setting at the
present time indicate these two
topics might be included in fu-
ture curricula.
To begin this process, especially
for health educators who have had
little formal access to ethics curric-
ula, as well as faculty who would
like to teach this subject, we recom-
mend the following resources. Al-
though many texts and sources of
information exist, in this brief re-
view we offer a perspective on two
that may begin to assist in helping to
raise awareness of the many com-
plex issues that surround contempo-
rary health education practice.
The first, Moral Moments: Very
Short Essays on Ethics by Joel Marks
(2000), is based on Marks’s popular
course on ethics at the University
of New Haven, which is distinctive
for its highly accessible style. This
is a book suited for the general read-
ing public as well as students and
The Authors
Ray Marks, EdD, is an adjunct asso-
ciate professor of health education at
Teachers College, Columbia Univer-
sity, New York City, and is cochair of
the Society for Public Health Educa-
tion Ethics committee.
Steven E. Shive, EdD, MPH, MTS,
MA, is a professor in the Department
of Health at East Stroudsburg Univer-
sity, East Stroudsburg, Pennsylvania.
24 HEALTH PROMOTION PRACTICE / January 2006
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teachers of philosophy and ethics • What it means when one says, “I
and its content consists of 33 very know this is wrong, but I must do
short essays, some of which have it anyway.”
been published as newspaper op-ed • Whether ethics is just another
consideration in the decision-
pieces. The style is conversational
making process to be weighed in
and personal yet theoretical. Topics the balance along with economic
range from everyday life to headline and other factors.
news. • Whether ethics is subjective.
Against the social scientific spirit • Who should decide what is right.
of the age, Marks (2000) defended a • And finally, whether we keep our
distinct role for ethics in decision ethical beliefs to ourselves lest
making. Central themes of the book we infringe on the right of others
are to hold theirs and whether we
should avoid arguing about right
• ethics is not subjective and wrong.
• ethics has relevance to business
and the professions as well as to In terms of Web site–based infor-
everyday life mation on ethics, Marks’s Moral
• there is no more practical ques- Moments site at http://www.
tion than asking, What is ethics? moralmoments.com/ contains infor-
mation relating to his book and its
The book is suitable for adoption essays about ethical situations and
as a supplementary textbook in in- issues in everyday life. The site has
troductory courses on ethics or phi- excellent links to a variety of topical
losophy and is likely to be appre- class discussions along with sample
ciated by faculty for its insights on book chapters, students’ writings,
how to convey the essence of the and mentoring methods.
subject to novices in philosophy and A second resource by Sudhir
future practitioners in a variety of Anand, Fabiene Peter, and Amartya
professional fields. Sen (2004), titled Public Health, Eth-
According to Kristin Aronson, ics, and Equity, has wide-reaching
assistant professor of philosophy at implications for health educators,
Western Connecticut State Univer- especially those with an interest in
sity (personal communication, 2000), health and social justice. A sample
Marks’s (2000) experience will ap- of this book can be downloaded from
peal to students. Jack Davis, emeri- http://www.oup.co.uk/isbn along
tus professor of English, University with detailed information on the
of Connecticut (personal communi- book’s contents and contributors.
cation, 2000), too implied that the Also recommended is Philosophy
book situates ethics squarely in the Now (http://www.philosophynow.
center of our lives and regardless of org/), which is a rich resource of past
subject, he felt that Marks kept articles, editorial commentary, and
things lively and provocative from philosophic discussions.
beginning to end. In conclusion, to successfully
Part I for example, closes with prepare future health educators for
some debate on selected issues that the complex challenges they will
could be applied quite fruitfully to undoubtedly face in daily practice,
a discussion of ethical health edu- we urge all faculty who are not yet
cation practice and research situa- teaching ethics to begin to do this
tions. formally. Those who are active in
For instance, Marks (2000) asked the field also need to be aware of
us to consider the Health Education Code of Ethics,

and all should assist in keeping the
code up to date as time progresses
and circumstances and trends
change, as well as in debating how
it should be implemented and en-
forced. As a start, we suggest the
present resources might prove help-
ful for advancing this essential but
often underestimated aspect of health
Downloaded from hpp.sagepub.com at UCSF LIBRARY & CKM on April 7, 2015
education practice and research,
namely, its ethical application.
REFERENCES
Anand, S., Peter, F., & Sen, A. (2004). Public
health, ethics, and equity. London: Oxford
University Press.
Clark, K. R. (1983). The implications of
developing a profession-wide code of eth-
Marks, Shive / HEALTH EDUCATION CODE OF ETHICS
Ethics
ics. Health Education Quarterly, 10, 120-
125.
Forster, J. L., & Khan, J. P. (Eds.). (2002).
Ethical challenges in public health educa-
tion research and practice [Special issue].
Health Education & Behavior, 29(1).
Marks, J. (2000). Moral moments: Very short
essays on ethics. Lanham, MD: University
Press of America.
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