HLTH 6413 Module 4 Ethics in Practice Analysis Example

Sweet Tea, Shame and a Scoreboard Sponsor: Ethical Issues for a Health Educator Reducing Sugary Drinks in a Coalfield Community

Student Name

American College of Education

HLTH6413: Fundamentals in Health Education

Module 4 Assignment

Instructor Name

March 23, 2026

Introduction

Module 3 recommended a combination of interventions to cut sugary drinks in the homes of a composite coalfield county in eastern Kentucky: a community campaign through churches, schools and sports leagues; water testing and filters; filtered water stations in schools; short-term home water delivery with coaching; and voluntary price measures at events. Each of these choices raises ethical questions for the health educator who will lead it. Health education is not only a technical field; the practice analysis that defines the profession includes ethics and professionalism as one of its eight Areas of Responsibility (Knowlden et al., 2020). This paper identifies six ethical issues the program raises and analyzes them using two frameworks from public health ethics, then states how the program will handle each.

Two Frameworks

Kass (2001) asked planners to settle six matters for any public health program: its purpose, the evidence that it will achieve that purpose, the burdens it places on people, whether gentler alternatives exist, whether it will be applied fairly and whether its benefits outweigh its burdens. Childress et al. (2002) described the moral considerations at stake in public health, including producing benefits, preventing harms, distributing burdens and benefits fairly, respecting autonomy, protecting privacy, keeping promises, being transparent and building trust, and proposed five tests for overriding one of them: the action must work, its benefits must outweigh the infringement, it must be necessary, it must infringe as little as possible and it must be defended in public. The first framework structures the analysis of each program element; the second helps decide when a limit on choice can be justified.

Issue 1: Autonomy and Paternalism

Parents have the right to decide what their families drink, and many in the county value independence and resent being told how to live. Education and water access respect that autonomy, since they add options rather than remove them. Price measures and changes to what is sold at school events limit choice more directly. Applying the justificatory conditions, removing sugary drinks from school-controlled concession stands can be defended: the evidence for environmental change is moderate, the burden is small, the setting serves children in the school's care and the decision can be made publicly by the school board. A proposal to restrict what families buy with benefits would be much harder to justify locally, both because the burden falls only on low-income families and because the county has no authority over it. The program will therefore limit its restrictive measures to settings the schools and county control and will explain them openly.

Issue 2: Stigma Toward Parents and Culture

Health messages about children's drinks can easily imply that parents are neglectful. Weight-related messages carry a further risk: Puhl and Heuer (2010) reviewed evidence that obesity stigma is widespread, harms health through stress, avoidance of care and unhealthy eating and does not motivate healthy behavior, and they warned that public health campaigns can reinforce it. Appalachian communities also face national stereotypes about diet, teeth and poverty, and national media have mocked the region's soda habits. A campaign that shames parents or the region would violate the duty to avoid harm and would also fail, because shame erodes the trust the program needs. Messages will therefore avoid images of children's weight or decayed teeth, will focus on water and family routines rather than on fault and will be written with county parents.

Issue 3: Honesty About Water Safety

The program's strategy of building trust in tap and well water carries a serious ethical risk. Some wells in the county are contaminated, and some public systems have had violations. Encouraging families to drink water that is not safe would cause harm and destroy trust. Transparency and keeping promises require that the program never tell families their water is safe without testing it, that it share results fully, including uncomfortable ones, and that families with unsafe water receive bottled water and referral to repair programs rather than filters that may not remove the contaminant. If testing finds widespread problems, the program's role shifts toward advocacy for water infrastructure, even though that is slower and less comfortable for partners.

Issue 4: A Beverage Company Sponsor

The county's high school football scoreboard and concession stand are sponsored by a regional bottler, which also donates drinks to youth sports leagues. The bottler has offered to fund part of the campaign through its bottled water brand. Accepting would bring money but would create a conflict of interest, since the sponsor profits from the drinks the program aims to reduce, and it could shape messages or give the company favorable publicity. Using Kass's question about burdens and alternatives, the program would decline funding tied to messaging, disclose any existing school sponsorships to the steering group and seek alternative funding from the county, foundations and health systems. The school's existing sponsorship contract is a matter for the school board, but the health educator can provide evidence and options when it is next renewed.

Issue 5: Fairness of Price Measures

Taxes and price increases on sugary drinks fall most heavily on low-income households, who spend more of their income on them, raising a question of fairness. Supporters argue that low-income households also gain the most in health if consumption falls, and that revenue can be returned to the same communities. The county cannot levy a tax, so the question arises only for the program's voluntary measures. Discounts on water at participating stores and the removal of sugary drinks from event promotions add options without raising costs for families, which satisfies the fairness concern better than a surcharge would.

Issue 6: Consent and Privacy in Evaluation

Evaluating the program will involve surveys of parents and children, possibly dental data from the health center and home visits for families receiving water delivery. Children cannot give consent on their own, and parents may feel pressure to take part if the program is linked to schools or benefits. Privacy requires that data be collected only as needed, stored securely and reported without identifying families. Parents will give written permission, children old enough will give assent, participation will never be a condition of receiving water testing or filters and dental data will be used only with separate permission and in aggregate form.

The Health Educator's Own Position

One more issue concerns the health educator rather than the program. The educator leading this work grew up outside the region and is employed by a public agency, and many residents have reason to be wary of outsiders who arrive with advice about their diets and homes. Professional ethics asks health educators to be honest about the limits of their knowledge and to share decisions with the people affected. In practice that means asking parents and church leaders to review every message, being open about who funds the program, acknowledging when local knowledge contradicts the educator's assumptions and giving credit for the program's successes to the families and partners who carry it. The educator's standing in the county will depend less on credentials than on whether promises about testing, filters and follow-up are kept.

Balancing Benefits and Burdens

Kass's final question asks whether benefits and burdens are fairly balanced. The program's main benefits, lower sugary drink intake, less tooth decay and safer water, fall mostly on low-income families on wells, who carry the greatest burden now. Its burdens are small: time spent in surveys, the discomfort some families may feel at seeing their habits questioned and modest restrictions at school events. The balance favors going ahead, provided the safeguards above are kept and the program is open about what it does.

Conclusion

The ethical issues in a sugary drink program are not side concerns; they determine whether the program earns the trust it needs. Respecting autonomy, avoiding stigma, telling the truth about water, refusing conflicted funding, protecting fairness and securing consent together shape a program the county can accept.

References

Childress, J. F., Faden, R. R., Gaare, R. D., Gostin, L. O., Kahn, J., Bonnie, R. J., Kass, N. E., Mastroianni, A. C., Moreno, J. D., & Nieburg, P. (2002). Public health ethics: Mapping the terrain. Journal of Law, Medicine & Ethics, 30(2), 170-178. https://doi.org/10.1111/j.1748-720X.2002.tb00384.x

Kass, N. E. (2001). An ethics framework for public health. American Journal of Public Health, 91(11), 1776-1782. https://doi.org/10.2105/AJPH.91.11.1776

Knowlden, A. P., Cottrell, R. R., Henderson, J., Allison, K., Auld, M. E., Kusorgbor-Narh, C. S., Lysoby, L., & McKenzie, J. F. (2020). Health Education Specialist Practice Analysis II 2020: Processes and outcomes. Health Education & Behavior, 47(4), 642-651. https://doi.org/10.1177/1090198120926923

Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: Important considerations for public health. American Journal of Public Health, 100(6), 1019-1028. https://doi.org/10.2105/AJPH.2009.159491