RESUMO
Background: Social determinants are defined as those nonmedical factors that influence health. Their influence is especially evident in vulnerable communities, such as the geriatric one. However, which social determinants will cause ethical challenges in geriatric healthcare in South Africa are not yet confirmed. Objective: This study first identified which social determinants influence geriatric care. The study then established which of these social determinants raises ethical challenges in geriatric care. Methods: Twenty statements were identified from the literature review and were grouped into 3 indexes, focusing respectively on i) a general view on public health and social determinants; ii) social determinants influencing geriatric people's health; iii) the consequences of social determinants on geriatric people's health. The rating was based on presenting the statements employing a 5- point Likert scale. Results: The rating of statements confirmed the generally accepted view that social determinants impact geriatric people's health. The responses to the statements were an additional confirmation that the quality and access to healthcare services influence geriatric care and lead to ethical challenges. Matters such as corruption, limited resources, and the COVID-19 pandemic contribute to the influence of social determinants and the expected but failed ethical behavior toward the geriatric community. Conclusion: The geriatric community is vulnerable because of the ongoing social factors that have a negative impact on health, of which healthcare quality and provision are significant contributing factors. These factors contribute to ethical challenges in healthcare for the geriatric community.
RESUMO
Background: A growing ageing community puts additional demands on the public health system. This will contribute to ethical consequences for the health care sector. A public health ethics framework can contribute towards addressing the ethical challenges faced by the geriatric community. Aim: This article intends to contribute to a public health ethics framework for the geriatric community from a South African perspective. Setting: Twenty-two participants from six geriatric institutions, two each in the three provinces, participated in the research. The provinces are the Free State, Northern Cape and North West. Methods: Fifteen statements were rated using a five-point Likert scale questionnaire. The statements were grouped into three indexes, namely what is ethics, what is public health ethics and what is public health ethics for the geriatric community? Results: Ethical behaviour is observable not only from person to person but also through systems, processes and practices. The need is to understand how to apply ethical principles to the working environment. A public health ethic can be understood from applied, professional and social ethics. Conclusion: Public health ethics is the application of health care principles through a professional ethic resulting in care and relationship-building. The core of what public health is should be the basis to identify a public health ethic where the focus is on the community and improvement of the quality of health and well-being of the community. Contribution: No evidence of a public health ethics framework for the geriatric community could be identified in South Africa.
RESUMO
BACKGROUND: The elderly population is steadily growing in South Africa. However, there is limited strategic planning or policy initiatives to address this group's vulnerability resulting in several public health ethical issues that need to be considered and addressed. This article aims to develop a public health ethics framework for the geriatric community with the purpose to review ethical implications when working with the geriatric community. METHODS: The Q-methodology was selected for data collection. Fifteen statements were ranked by means of a five-point Likert-scale questionnaire. Twenty-two participants from six geriatric institutions participated in the ranking of the statements. RESULTS: The ranking of the statements confirmed the need for a public health ethics framework to provide guidance when working with the geriatric community and to evaluate decisions about geriatric care. Such a framework should be application-based and practice-oriented which can assist in addressing unfamiliarity with public health ethics in general and can extend the capacity for decision-making. The ranking of these statements contributed to the scope of the planned framework, by considering the vulnerability of healthcare practitioners (as community of practitioners) and the geriatric community as a basis from which to promote justice in public health programmes. CONCLUSION: Based on the ranking of statements, eight building blocks for a public health ethics framework were identified. The building blocks are imbedded in professional ethics and care ethics. The proposed framework can give rise to social justice in public health and the ability to evaluate what the ethical implications are for public health policies, programmes and interventions aimed at the geriatric community.
