Open Access Debate

Ethics in occupational health: deliberations of an international workgroup addressing challenges in an African context

Leslie London1*, Godfrey Tangwa2, Reginald Matchaba-Hove3, Nhlanhla Mkhize4, Remi Nwabueze5, Aceme Nyika67 and Peter Westerholm8

Author Affiliations

1 Centre for Occupational and Environmental Health Research, University of Cape Town, Cape Town, South Africa

2 University of Yaounde and Cameroon Bioethics Initiative (CAMBIN), Yaounde, Cameroon

3 School of Public Health, University of Botswana, Gaborone, Botswana

4 University of KwaZulu-Natal, Durban, South Africa

5 University of Southampton, Southampton, United Kingdom

6 Public Health Projects in Africa, Harare, Zimbabwe

7 Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

8 University of Uppsala, Uppsala, Sweden

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BMC Medical Ethics 2014, 15:48  doi:10.1186/1472-6939-15-48

Published: 23 June 2014



International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process.


Firstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address workplace hazards demand that actions for occupational health extend beyond just the workplace.


A stronger articulation of occupational health practice with advocacy for prevention should be an ethical norm. Ethical codes should ideally harmonize and balance individual and community needs so as to provide stronger moral authority guidelines. There is a need to consider an African Charter on Bioethics as complementary and strengthening of existing codes for the region.

Ethics; Occupational health; Occupational health practitioner; African philosophy; Globalisation; Stigma; Consent; Culture; Autonomy; Ubuntu; Harmony; Identity