Ethical Considerations Guiding Prioritization in Health Promotion and Prevention Domains in Danish Municipalities

Background: This study explores the ethical considerations guiding the prioritization of services, focus areas and target groups within different domains of health promotion and disease prevention at a local level, a topic previously underexplored in the literature.
Methods: Qualitative data from interviews with decision-makers (n=21 participants) from a diverse representation of 15 Danish municipalities were analyzed thematically to uncover key insights into ethical dimensions of municipal prioritization of health services under Danish legislation.
Findings: When confronted with resource constraints, municipal decision-makers tend to prioritize patient-oriented prevention, often at the expense of broader health promotional initiatives or services targeting the general population at risk of disease. This decision is rooted in ethical considerations of assisting those deemed most in immediate and experienced need in the municipal population.
Discussion: Analyzed against the Principles of Justice by Cookson and Dolan and the broader literature on prioritization, the findings reflect a prioritization usually seen among practitioners in the hospital sector; the principle of need. This contrast with broader societal discussions of prevention and health promotion, which are often based on a principle of maximization of resources. The study highlights the importance of weighing diverse ethical factors when prioritizing among and within initiatives, considering the purpose of the different domains of prevention and health promotion.
Conclusion: This research contributes to an understanding of prioritization at a local level, emphasizing the need for nuanced ethical debates and informing future research to refine public health strategies.