Membership of the Faculty of Public Health (MFPH) Ethics, Law and Professional Practice in Public Health Syllabus

List the eight Caldicott Principles for handling confidential patient information.

1) Justify the purpose. 2) Don't use personal confidential data unless necessary. 3) Use the minimum necessary. 4) Access on a strict need-to-know basis. 5) Everyone must be aware of their responsibilities. 6) Comply with the law. 7) The duty to share information can be as important as the duty to protect it. 8) Inform patients and service users about how their data is used.

Under what circumstances may patient confidentiality be lawfully breached without consent?

When required by law (e.g. notifiable diseases, court order), or when justified in the public interest where the benefit of disclosure outweighs the duty of confidentiality (e.g. preventing serious harm to others). Disclosure should be limited to the minimum necessary.

What are the six lawful bases for processing personal data under UK GDPR?

Consent; Contract; Legal obligation; Vital interests; Public task; and Legitimate interests. At least one basis must apply to all processing of personal data.

Under UK GDPR, what is 'special category data' and what extra requirement applies?

Special category data includes health, genetic, biometric (for ID), racial/ethnic origin, sex life/orientation, religious or political beliefs, and trade union membership. Processing requires both a lawful basis (Article 6) and a separate Article 9 condition (e.g. explicit consent, health/social care, public health, or scientific research).

List the seven key principles of UK GDPR (Article 5).

1) Lawfulness, fairness and transparency. 2) Purpose limitation. 3) Data minimisation. 4) Accuracy. 5) Storage limitation. 6) Integrity and confidentiality (security). 7) Accountability.

What is the difference between anonymisation and pseudonymisation in data protection?

Anonymised data cannot be linked back to an identifiable individual and falls outside data protection law. Pseudonymised data has identifiers replaced with a key/code but can be re-identified using additional information held separately; it remains personal data under UK GDPR.

What is a Data Protection Impact Assessment (DPIA) and when is it mandatory?

A DPIA is a process to identify and minimise data protection risks of a project. It is mandatory for processing likely to result in high risk to individuals, e.g. large-scale processing of special category (health) data, systematic monitoring, or use of new technologies.

What are the nine protected characteristics under the Equality Act 2010?

Age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation.

What is the Public Sector Equality Duty (PSED) under the Equality Act 2010?

A duty (Section 149) requiring public bodies to have due regard to: eliminating discrimination, harassment and victimisation; advancing equality of opportunity; and fostering good relations between people who share a protected characteristic and those who do not.

Distinguish direct discrimination, indirect discrimination and a reasonable adjustment under the Equality Act 2010.

Direct discrimination: treating someone less favourably because of a protected characteristic. Indirect discrimination: a provision/criterion/practice that disadvantages a protected group and cannot be objectively justified. Reasonable adjustment: a duty to alter practices/premises to avoid putting a disabled person at a substantial disadvantage.

Which articles of the European Convention on Human Rights (Human Rights Act 1998) are most relevant to public health?

Article 2 (right to life), Article 3 (prohibition of inhuman/degrading treatment), Article 5 (right to liberty—relevant to quarantine/detention), Article 8 (right to private and family life—relevant to confidentiality and bodily autonomy), and Article 14 (prohibition of discrimination).

What is the function of a Research Ethics Committee (REC), and which body coordinates them in the UK?

A REC independently reviews research involving human participants, their tissue or data to protect their dignity, rights, safety and wellbeing. In the UK, RECs are coordinated by the Health Research Authority (HRA).

What is the difference between research, audit and service evaluation in terms of ethics approval?

Research aims to generate new generalisable knowledge and usually needs REC/HRA approval. Clinical audit measures practice against a standard, and service evaluation judges current service; both inform local care, do not test hypotheses, and generally do not require REC approval (though governance review may apply).

What core information must be covered in informed consent for research participation?

Purpose and nature of the study, what participation involves, foreseeable risks and benefits, voluntariness and the right to withdraw without penalty, how data/confidentiality will be handled, any alternatives, and contact details. Consent must be informed, voluntary and given by a person with capacity.

Name the key international declaration governing ethics of medical research involving human subjects.

The Declaration of Helsinki, developed by the World Medical Association (first adopted 1964 and periodically revised). It sets ethical principles for medical research involving human subjects, including identifiable data and tissue.

What are the four widely cited forms of research misconduct?

Fabrication (inventing data/results), Falsification (manipulating data, equipment or processes), Plagiarism (using others' work/ideas without attribution), and (often added) failure to follow ethical/governance requirements such as undisclosed conflicts of interest. The core trio is fabrication, falsification and plagiarism (FFP).

Define a conflict of interest in research and public health practice.

A conflict of interest exists when a secondary interest (financial, professional, personal or academic) could improperly influence, or be perceived to influence, judgement or actions regarding a primary interest such as patient welfare or research integrity. Management requires declaration, and where needed, recusal or independent oversight.

What are Wilson and Jungner's classic criteria for appraising a screening programme (key examples)?

The condition should be an important health problem with a recognisable latent/early stage; there should be an accepted, effective treatment; a suitable, acceptable test exists with an agreed policy on whom to treat; the natural history is understood; facilities for diagnosis/treatment are available; and the programme should be cost-effective and continuous, with benefits outweighing harms.

What are the principal ethical harms of screening that must be weighed against benefits?

Overdiagnosis and overtreatment, false positives (anxiety, unnecessary investigation), false reassurance from false negatives, physical harms of the test, and opportunity cost. The duty to ensure informed choice is heightened because screening targets asymptomatic people.

What ethical principles govern public health surveillance?

Surveillance should have a legitimate public health purpose, collect the minimum necessary data, protect confidentiality and security, be proportionate, and balance the public good against individual privacy. Transparency and, where feasible, public engagement support its legitimacy.

What ethical tensions are heightened during a public health emergency response (e.g. pandemic)?

Balancing individual liberty against collective protection (quarantine, isolation), fair allocation of scarce resources (triage), proportionality and necessity of restrictions, maintaining transparency and public trust, protecting the vulnerable, and ensuring measures are time-limited and evidence-based.

What are the elements of the 'duty of candour' for health professionals in the UK?

A professional and statutory duty to be open and honest with patients when something goes wrong: tell the patient/family promptly, offer an apology, provide a truthful account of what happened, explain short- and long-term effects, and report incidents through appropriate systems.

What is meant by professional accountability for a public health practitioner?

Being answerable for one's decisions, actions and omissions—to patients/the public, employers, professional regulators (e.g. GMC, GDC, or UKPHR for the wider workforce), and the law—and maintaining competence, integrity and adherence to professional standards and codes of conduct.

What is the difference between equality and equity in public health practice?

Equality means treating everyone the same or giving everyone the same resources. Equity means allocating resources according to need to achieve fair outcomes, recognising that different groups start from different positions—'proportionate universalism' is one operational approach.

What is 'proportionate universalism' (Marmot) and how does it relate to EDI?

Proposed in the Marmot Review (Fair Society, Healthy Lives, 2010), it means delivering actions universally but with a scale and intensity proportionate to the level of disadvantage, to reduce the social gradient in health rather than focusing only on the most deprived.

What are the four stages of Kolb's experiential learning cycle, used to structure critical reflection?

1) Concrete experience (doing/having an experience). 2) Reflective observation (reviewing/reflecting on it). 3) Abstract conceptualisation (learning/concluding from it). 4) Active experimentation (planning/trying out what was learned). The cycle then repeats.

What is Gibbs' Reflective Cycle and its six stages?

A structured model for reflection with six stages: Description (what happened), Feelings (thoughts/emotions), Evaluation (what was good/bad), Analysis (sense-making), Conclusion (what else could have been done), and Action plan (what you would do next time).

What is continuing professional development (CPD) and why is it a professional requirement?

CPD is the ongoing maintenance, updating and development of knowledge, skills and competence throughout a professional's career. It is required by regulators (e.g. for GMC revalidation/UKPHR re-registration) to ensure continued fitness to practise and safe, effective, up-to-date practice.

What is the IMRaD structure used in scientific writing?

Introduction (why the study was done, the question), Methods (how it was done), Results (what was found), and Discussion (what it means, limitations, implications). It is the standard structure for reporting original research.

What principles guide effective communication of evidence and risk to the public?

Use clear, plain language; present absolute (not just relative) risks; use natural frequencies (e.g. '1 in 100') rather than abstract percentages; avoid framing bias by giving both benefits and harms; acknowledge uncertainty honestly; tailor to the audience; and use visual aids where helpful to support informed decision-making.

Why are relative risk reductions potentially misleading when communicating evidence, compared with absolute risk reductions?

A relative risk reduction can sound large while the absolute benefit is small. For example, a reduction in event rate from $2\%$ to $1\%$ is a $50\%$ relative reduction but only a $1\%$ absolute reduction (number needed to treat $\text{NNT}=\frac{1}{0.01}=100$). Reporting absolute figures and NNT gives a truer picture of impact.