The initiation of this study was informed by a number of things. First and foremost, having been involved in environmental health practice for over 30 years both in the field as a practitioner as well as in the teaching and reviewing of the environmental health curriculum in South Africa, I have observed that the practice of environmental health tended to emphasise legal enforcement with little attention paid to other essentials in this profession’s practice. To be more specific, environmental health practice in South Africa paid little attention to ethical practice compared to the professionalism and legal aspects. This focus created a lacuna in the development of ethically competent EHPs that are able to handle intricate ethical issues relating to the fulfilment of their professional responsibilities. I therefore argue that EHPs are likely to better serve the public and maintain higher standards of professional ethics when they have adequate knowledge of all three of the legal, professional and ethical aspects of environmental health. Hence, I carried out this study incorporating these three fundamental components of environmental health practice. This combination of the three aspects is rare, thus making the study a unique contribution to environmental health practice in South Africa.
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The difficulty in addressing ethical practice in particular, is aggravated by the apparent lack of ethics research studies on the practice of environmental health in South Africa. In this regard, research conducted on environmental health has focused much attention on the scope, developments and challenges EHPs faced as the profession evolved within the fast changing democratic political landscape in South Africa. To this end some authors have recorded trends in the development of practice of environmental health in South Africa. These authors highlighted the important role played by EHPs in the delivery of environmental health services under challenging conditions marked by lack of resources, inadequate support and the development of scope of practice (Mattee et al., 1999, Agenbag and Balfour-Kaipa, 2008, Balfour, 2013, Wright et al., 2014, Mathee and Wright, 2014).
In contrast, in my study, I explored how EHPs interpreted the provisions for environmental health from the context of practice on the ground. I then explored environmental health practice from the position of an EHP in relation to the policy and legal guidelines. I believe that this approach is important, given for instance findings that emerged from Heimer’s study titled “Wicked Ethics: Compliance Work and the Practice of Ethics in HIV Research” that examined the effect of formal policies and the practice on the ground conducted in four countries, namely the US, South Africa, Uganda and Thailand. Heimer’s study observed that there is tendency to pay more attention to the regulatory aspects of policies and disregard how these match the practice on the ground (Heimer, 2013). This finding has relevance for the focus of my study in exploring how the formal guidelines governing EHPs’ practice impact on their work on the ground. In addition, there is a gap in studies in the field of environmental health in South Africa that examine what really satisfies and concerns EHPs in their work. My study attempts to contribute towards knowledge on the how EHPs understand and view their practice.
Moreover, the premise of my study is that the monitoring role is central to the work of EHPs, as shown in the WHO definition of environmental health [more details in section 1.3] and in the scope of practice of environmental health. However, there seems to be no commissioning of studies by for example the Professional Board of Environmental Health to ascertain actual facts pertaining to how EHPs understand their role responsibilities on the ground and how local settings impact on their work. I regard such understanding to be important as the practice of Environmental health in South Africa is underpinned by provisions articulated in a number of legislative and policy guidelines. Key environmental health mandates18 are found:
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First, in the Constitution of the Republic of South Africa Act, no. 108 of 1996 as amended.
Accordingly, Section 24(a) provides that:
“Everyone has the right to an environment that is not harmful to their health or wellbeing…” Furthermore, Section 195(1) sets out ethical values and principles that must be upheld by all public servants and organs of state. These values and principles prescribe amongst others, that public servants’ conduct should demonstrate:
“the promotion and maintenance of a high standard of professional ethics, the promotion of efficient, economic and effective use of resources, the provision of services in an impartial, fair and equitable manner without bias, and accountability for public services”.
Second, EHP mandate which is the bedrock of environmental health practice in South Africa
is found in the National Health Act, no. 61 of 2003 as well as the National Health Amendment Act, 12 of 2013. In this regard, Sections 80-89 and related regulations mandate EHPs to amongst others:
“Monitor and carry out routine inspections and environmental health investigations to identify and deal with conditions that cause or have a potential to cause health nuisances”.
The above mandates necessitate that EHPs be well versed in professional ethics and other legal requirements governing their profession. They also encountered a myriad of challenges in the enforcement of laws, because some laws were not enforceable as they were not suitable for addressing some situations on the ground. Thus, necessitating reviewing of the laws, while in the meantime EHPs had no alternative strategies on which to rely.
In examining the literature, I observed that although there are professional guidelines in South Africa that provide for the legal and ethical issues, specific ethical guidelines within the workplaces of EHPs which can be used to guide environmental health practice were lacking. I ascribed this gap to the lack of ethics infrastructure19 which I believe could help EHPs with the know-how of identifying and using ethics provisions articulated in different policy guidelines. For example, those that pertain to service provisions like the Batho Pele principles in the Batho Pele White Paper (Republic of South Africa, 1997) and the Code of Conduct in the Local Government Municipal Systems Act, no. 32 of 2000 (Republic of South Africa, 2000a). The
19 In Chapter Eight reference is made to institutionalised ethics practice as having established and implemented systems for handling ethics issues. The Oxford Advanced Learner’s Dictionary defines infrastructure as “basic systems and services that are necessary in an organisation to run smoothly” (Horny, 2010, p.770). This context is the one I am referring to considering ethics practice within the environmental health in my case study.
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same applies to the professional and generic20 HPCSA ethical guidelines (Health Professions Council of South Africa, 2008b).
Many EHPs’ inability to apply ethical principles could be attributed to the lack of ethics training and lack of promotion of an ethics culture in the workplace. This situation necessitates the development of ethics practice programmes within environmental health workplaces with clear educational and implementation plans plus appointed lead agents and coordinating structures. Otherwise EHPs would continue to be exposed to challenges which without interventions, could lead them to commit unacceptable acts. Such conduct could be for example, succumbing to temptations to contravene the provisions of the same law they are meant to uphold by accepting bribes and failing to report unethical conduct. This state of affairs is exacerbated by the apparent absence of a specific code of ethics for Environmental Health Practitioners in South Africa which could encourage public professionals to account to the community they serve as suggested in the code of ethics for public health (Thomas et al., 2002). The King III Code suggests that organisations should ideally have ethical strategies that balance “rules-based” directional codes of conduct which prescribe acceptable and unacceptable behaviour with the aspirational “values-based” code of conduct that encourages personal responsibility (Institute of Directors in Southern Africa, 2009b).
This ethics inquiry seeks to understand the awareness of EHPs about their role responsibilities in fulfilling their mandates, particularly how ideals in policy guidelines match the actual behaviour on the ground.