Established patterns of public health emergencies tend to disproportionately impact communities that experience health disparities and inequities. Therefore thorough, systematic attention should be given to health equity considerations in all coordination activities and Lines of Effort , in every information-sharing processes, and during every Operational Phase.
In addition to descriptive population health data, health equity considerations should include consideration of how social policies, structures, conditions, and characteristics defining specific places may create differences in exposure risks, social vulnerability, and resilience among diverse populations in emergencies.
Resolving Ethical Issues
The response to and recovery from a biological incident may also entail complex ethical considerations. Recognizing and anticipating these potential conflicts provides an opportunity to create ethical guidelines in advance. A proactive approach to creating ethical guidelines for disasters can be found in the publication Mass Medical Care with Scarce Resources: A Community Planning Guide. The following questions should be considered when creating ethical guidelines:14
- Who are the stakeholders? Think broadly and include not only persons and categories of persons but institutions, organizations, professions, and communities.
- What is the full range of duties, obligations, and authority of all impacted stakeholders? Think of stakeholders as not only individuals but also institutions and groups.
- How might the various duties and obligations of the principal stakeholders conflict? Be mutually supportive?
- What might be the short- and long-term consequences, both positive and negative, of each possible course of action? How confident is the party in the accuracy of predictions?
- What ethical principles are at stake (e.g., respect for persons, beneficence, non-malfeasance, justice, truth telling, liberty, opportunity, and reciprocity)? Which are in tension?