“The health equity curse”: ethical tensions in promoting health equity

Abstract Background Public health (PH) practitioners have a strong moral commitment to equity and social justice. However, PH values often do not align with systems values, making it challenging for promote equity. In spite of growing range ethics frameworks theories, little is known about ethical concerns related promotion in practice. The purpose this paper examine the promoting context mental prevention harms substance use. Methods As part broader program public services research, we interviewed 32 practitioners. Results Using constant comparative analysis, identified four systemic tensions: [1] biomedical versus determinants agenda; [2] driven agendas situational care; [3] stigma discrimination respect persons; [4] trust autonomy surveillance control. Conclusions Naming these tensions provides insights into daily challenges an opportunity reflect on relevance frameworks. These findings highlight value relational as promising approach developing