A bioethical review of public health communication policies through equity lens: Gaps, harms and opportunities for reform

Public health communication plays a critical role in shaping health behaviors, public trust, and policy effectiveness, yet ethical and equity considerations remain inconsistently integrated into communication practice. This study conducts a systematic review of public health communication policies through a bioethical equity lens, examining how contemporary communication strategies align with core principles of autonomy, beneficence, non-maleficence, and justice. Synthesizing 24 peer-reviewed sources published between 2015 and 2025 across bioethics, public health, and communication studies, the review identifies persistent gaps between normative ethical frameworks and real-world implementation. Findings indicate that non-transparent and overly persuasive messaging practices are widespread and often undermine trust, particularly among marginalized populations. Communication strategies frequently fail to account for structural inequities, resulting in unequal access to information, cultural and linguistic exclusion, and unintended harms such as stigmatization and blame. The review further highlights how digital communication technologies, while expanding reach, introduce new ethical risks related to manipulation, surveillance, and differential access. Although emerging equity-oriented frameworks and participatory models offer promising pathways for reform, empirical evidence of their implementation and effectiveness remains limited. The study concludes that technical improvements in messaging are insufficient without deeper institutional commitment to transparency, accountability, and community partnership. Advancing equitable public health outcomes requires reimagining communication as an ethical and justice-centered practice rather than a solely instrumental tool for behavior change