Public health no longer needs to look to medicine for an ethical compass. In 2002, the American Public Health Association adopted a code of ethics developed under the guidance of the Public Health Leadership Society.1 The Code is based on values inherent to a public health perspective, such as interdependence between people in a community, and between people and their environment. Interdependence is a key principle in public health because public health has a mandate to promote and protect the health of whole populations; and the condition or actions of one person in a population affect others in the population. This principle stands in contrast to the principle of respect for autonomy which is inherent to a medical perspective born out of interactions between a clinician and a patient.2 The clinician's core ethical concern is patient centered and often involves the challenges of balancing respect for a patient's choices with promoting the patient's best interests.

The principles of the Public Health Code of Ethics provide a solid foundation for ethical deliberation in public health. The principles are intended to frame discussions and serve as a reminder of the bases that need to be touched. However, the theory-driven principles have needed practice-driven tools to help public health practitioners develop and maintain ethical policies and practices. An important part of that need was recently met with the development of a list of competencies and skills needed for the ethical practice of public health.

The competencies and skills were designed to dovetail with those developed for the broader field of public health by the Council on Linkages Between Academia and Public Health Practice. The council identified eight competencies, or clusters of skills, necessary for the broad practice of public health. They include, for example, analytic/assessment skills, communication skills, and cultural competency skills. A skill is a fairly specific task; it may be used by those in practice settings as a framework for hiring and evaluating staff.3

A group of national leaders in public health practice and public health ethics were convened to identify the skills in public health ethics.* Working with the public health skills identified by the Council the ethics group first placed existing skills relevant to ethics under each of the 12 ethical principles in the Public Health Code of Ethics. An additional number of existing skills were made relevant to public health ethics with some editing of the wording. Finally, skills that were important but missing altogether from the existing Council list were added.

As an example, the fifth ethical principle in the Public Health Code of ethics reads "Public health should seek the information needed to implement effective policies and programs that protect and promote health." One of the relevant skills from the Council's list that was already in line with this ethical principle was as follows: "Collects, summarizes, and interprets information relevant to an issue."

Another skill in the Council's list was modified (indicated with italics) to make it more explicitly ethical: "Articulates the health, fiscal, administrative, legal, social and political implications of each policy for vulnerable populations."

An example of an ethical skill that wasn't in the Council's list is as follows: "Determines research priorities with an understanding of areas of the community that have been underserved."

The full list of skills is available on the Web site of the Public Health Leadership Society (http://www.phls.org). Also on the Web site are the Public Health Code of Ethics and a list of resources available for teaching the principles and skills of public health ethics. Among the resources is a series of free on-line interactive modules on public health ethics that can be inserted into an existing course on public health or ethics, or used by public health agencies in the training of their employees. The modules are available at http://www.sph.unc.edu/oce/phethics/.

While it is important to articulate specific skills and train people in them, we must not get lost in the mechanics of ethical practice and lose sight of the bigger picture. Key objectives of the ethical practice of public health are to build a just society and to earn and maintain the trust of the populations we serve. Without public trust, public health policies and programs will be resisted and become ineffective. The principles in the Public Health Code of Ethics and the list of public health ethics skills point us toward ways to protect and promote the health of a population in ways that are just and that build the public trust.

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