PoPulationand Public HealtH etHics

For these reasons, further discussion of research ethics will not be explored,
with the caveat that this is not meant to deny the ethical importance of these
issues; it is merely to signal that for those with perspectives from population
health and public health practice and policy, the core moral dilemma of
this case is the imposition of a new screening tool as a fait accompli. A new
policy has been adopted and appears to be binding on PHDs unless they are
willing to forego implementation funding. This raises some distinct and distinctly
challenging questions
Key values and concerns
It may be that the change of tools is motivated by concern for a combination
of equity, universality and efficiency. In this best possible light, the change
is related to social justice: it is designed to enhance the sensitivity of the
screening program by reducing false negatives and accurately pairing highrisk
children and families with support programs, presumably with more
support going to those with greater need.
In a climate of fiscal restraint and austerity, it is just as reasonable to suppose
that the change is part of a deliberate cost-management strategy. The
least-sinister version of this possibility holds that the new tool is simply
more efficient: a streamlined universal screen is quicker to administer, reducing
staff time and resources for the program as a whole. Such a reform
might even ensure genuine universality and equity of the intervention (all
children and families are screened to ensure none go without needed support)
and might also allow the reallocation of public health professionals
and resources in support of other important population health goals or interventions.
The more-sinister version, however, holds that the tool will detect fewer
at-risk families because it is less sensitive or will result in fewer high-risk
classifications because it employs a higher risk threshold, both of which
would alter the number and profile of families referred for support. To
understand why a screening tool that alters the number or profile of families
eligible for services is not morally neutral, consider various forms of
child disability or chronic illness: these will often have profound impacts
on development, impacts unlikely to be mitigated without significant and
costly medical and social programs. The result of the under-provision of
Research Ethics and Conflicts of Interest at a Local Public Health Department
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