Let’s Talk Public Health with Assoc Prof Adeline Seow

Today we talk with Associate Professor Adeline Seow. Adeline’s academic career has focused on public health and epidemiology, particularly the influence on health of environmental and genetic factors. Her research has been primarily on the causes and prevention of cancer.

Recently, Adeline ventured into public health ethics as part of her sabbatical leave, including undertaking a research attachment with the Kennedy Institute of Ethics in Georgetown University, Washington DC. Adeline is also Acting Director at the Centre for Biomedical Ethics (CBmE) at NUS.

Adeline and colleagues at SPH and CBmE have just designed and delivered the first ‘Ethics in Public Health Practice’ module as part of the Master in Public Health course. We catch up with her on how the module has gone.

Public health ethics is a relatively new field, compared to its ‘older sibling’ of clinical and biomedical ethics, from which it borrows a great deal of the philosophical underpinnings, principles and values. The goals are inherently similar, but because public health aims to improve and maintain the health and wellbeing at the level of populations, there are unique ways in which ethical principles are considered and balanced in decision-making by policy-makers and those who plan and implement public health programmes.

It’s been fascinating to relate what has been written by experts in ethics to the very real challenges that public health practitioners face daily. Key public health issues that we face demand responses that need a deep consideration of factors beyond simple effectiveness and cost. The Coronavirus pandemic, the rise of lifestyle-related diseases, the use of technology in healthcare and many other complex challenges highlight the need for ethical considerations, a strong appreciation for context, more subtle forms of harm, justice and equity, and so on.

My hope, as we incorporate ethics more formally in the Masters of Public Health curriculum, is that our graduates will be able to recognise the moral dimensions of what is at stake in the decisions that are made, often intuitively, on a day-to-day basis, and to weigh these decisions in the context of principles and values that society, their institution, their profession and they themselves hold. Even when ethics is not an active consideration, there are unstated or unrealised assumptions in every decision.

During my career I have spent time on research ethics committees in the National Healthcare Group and in the School. I also was a member of the Ministry of Health’s transplant ethics committee for a few years. My involvement in preventive medicine specialist training also helped me better appreciate the practical needs and challenges in the field, and I realised this was an area that I had a great deal of interest in.

So together with colleagues in the CBmE, we set out on a research project to ask Singaporean public health practitioners about the ethical principles that guide their decision-making.

Some of the nuggets we gleaned from these conversations were the values that practitioners are guided by, often implicitly. Among the population, there’s also a high level of societal solidarity and trust in people who make decisions, and this has implications for the way that public health practitioners see their role – what is known as the stewardship model of healthcare.

Some of the findings from our research have fed into the new ‘Ethics in Public Health Practice’ module as content and in selecting topics for case studies.

The module is intended to be undertaken close to the last semester of the Masters in Public Health course. By this time, everyone would have studied the whole range of public health roles and functions both locally and globally, and that is a great starting point for the module.

The sessions are planned to start with a review of foundational principles encountered in the very first week of the Masters programme, followed by the application of these principles and values to real-world public health scenarios. I’m discovering many parallels between learning epidemiology and applied ethics in terms of how important it is to constantly work things out by ‘going back to first principles’.

Currently, we have structured the module to run over five sessions, two weeks apart, so that students can read and prepare for the case studies.

The case studies tease out nuances in ethical issues in the prevention of chronic diseases, communicable disease control, social justice and health systems, and population-based health innovations and research. Some examples are the use of quarantine measures in a pandemic and policies around e-cigarettes.

One of the main learning points we’ve taken away from the first run of the course is that both the content and the approach is new to many students. Most students found it challenging to spend time digesting the readings – moving beyond knowing facts and learning skills to thinking critically so they could prepare for the case presentations. Moving ahead, we’re planning to smoothen the didactic elements and the course assessment, so it will probably feel less like a ‘regular’ credit-bearing module in terms of its demands on time.

I’ll need to think about that after I’ve settled back into SSHSPH, having been seconded to various other roles in the university for the past 10 years!

My husband, Richard, and I have two grown-up children. Our daughter is married and has two daughters of her own, and we’re enjoying our role as grandparents. We also enjoy music, cycling, jigsaw puzzles, and walking the dog!