Bioethics is called to perform a comprehensive exercise, which allows it to identify elements of health around the dynamics of medical practice and public health. It is also important to position oneself from the theoretical, conceptual and empirical understanding of the human right to health, without losing sight of the fact that its starting point is social realities. It must take into account that in the meantime the field of policy moves forward into health, within the particular sphere framework (clinical-medical) or collective (public - community health).

From the concept of public - community health, we aim to place health at the center of social justice, without neglecting the context and its dynamics of implementation of bioethical systems, tackled from an analysis of the international context, Latin American until we reach the national sphere. It is necessary to include in this understanding specific aspects of the diversity, difference, multiculturality, socioeconomic and political conditions of health care in the context of the dizzying advance of science and technology of our society; which are also intertwined with conscience and moral action characteristic of a society that is in crisis due to the emergence of neo-conservatives and ethical relativisms that affect a hermeneutic of bioethical phenomenology.

This is how medical-clinical bioethics is understood as the individual sphere. This has been concerned with having in the center of the debate the aspects of medical practice within the framework of techno scientific advances and the doctor/patient relationship; from this point, bioethical dilemmas have emerged, been addressed and developed. The greater conceptual development, recognized as hegemonic in medical bioethics, has been given in analogy to models applied to this relationship. Thus, the interesting thing to retake subjects of medical bioethics is, precisely to analyze them from the contemporary social, political and cultural context characterized by the influence of moral paradigms, social practices, and divergent contexts, that in its interior and essence are bioethics, aspect that allows to understand them as emerging. In this sense, in Colombia, particular situations with bioethical implications such as the implementation of Law 1805 of 2016 in which organ donation is regulated, or gestation by substitution and in vitro fertilization in the light of the concept of family are some of the current issues in the analysis of Colombian medical bioethics, which require a bioethical research approach, without omitting micro-contexts and macro-contexts social, cultural, moral, religious, secular, economic, emotional.

On the other hand, public health, understood as the collective sphere, invites us to ask the question: is a bioethical analysis necessary to understand social, cultural or local practices around public health? Public health in itself is an emerging issue in the context of bioethics since in the different research trends of bioethics has been overlooked or only left as implicit when really must be a problem of bioethical research that merits explanation.

The emerging literature on bioethics of public health has reached the debates beyond the problems centered on the doctor-patient relationship, so that in the bioethics of public health are pending research, studies and approaches on the social causes of the health in the populations, structural corruption of the state policy with the management of resources for public health, the disconnection of the latter and the training of the health professional (still framed in a curative model), the commodification and stratification of health (one for the rich, the other for the poor), among other aspects. From public health, bioethics has been contextualized from the guidelines of the World Health Organization (WHO) with the Ethics and Health Initiative (2002), which guides public policies in the health sector. In Latin America, and in particular in Colombia, the commitments made in the Health Initiative of the Americas stand out, which include the development of essential public health functions, the agenda of agreements among the ministers of health of the Andean region, Millennium Development Goals and the International Health Regulations, as well as other international commitments on specific issues that converge in the Ten Year Public Health Plan (PDSP) (2012). These aspects serve as a basis for reflection on the social importance of policies and the scope of the action, based on the conceptual basis of public health knowledge and its relationship with bioethics.

In this sense, the decisions made in public health around health care, planning, clinical care and biotechnology should be framed from a bioethical perspective taking into account conceptual elements that emphasize in several approaches: differential, life cycle, gender, ethnic and population, among others. All these items always analyzed from the perspective of human rights, social determinants (CSDH) and social justice in health, an aspect that suggests the understanding, reflection and posture towards them (PDSP, 2012). In this respect, Bioethics represents a significant support for guiding decisions in public health, so that bioethical elucubrations based on moralisms or relativisms become articulating agents between social, cultural, political and economic reality, and public health with integrity and bioethical sense.

On the other hand, the Universal Declaration of Bioethics and Human Rights, issued by the United Nations Educational, Scientific and Cultural Organization (UNESCO) (2005), is one of the reference frameworks for establishing the bioethical guidelines that need to be incorporated into decision-making, intervention actions and strategic public health policies. From this perspective, health professionals (conceived as public health workers), in general, and the bioethicist, in particular, must analyze situations regarding human dignity, human rights, individual liberties, the right to exercise citizenship since equality, equity and collective consciousness, disregarding the processes of commodification of health, as well as their dogmatisms (including dogmatic relativism) and mental models that limit and castrate the understanding of other human and social realities in which the discourses of tolerance, "love your neighbor," the spirit of service and the bioethical vocation of the public health professional.

This is grounded in the light of the Universal Declaration of Bioethics and Human Rights (Unesco, 2005) when a holistic view of bioethics (where public health is implicit) is introduced, not anthropocentric, since it includes everything that is life and which has a close relationship with human, animal, biotic and non-biotic health. This in a nostalgic context for the well being of the ecological and the environment, where health is not only understood from an anthropocentric mechanistic paradigm, and which invites to develop new approaches to social responsibility in health, justice, and equity, away from all forms of stigma, discrimination, and intolerance. Also, betting on the understanding and inclusion of cultural diversity, health promotion and protection of the environment as a major responsibility of governments from the national, regional and local levels, which should strategically and contextually foster spaces for risk assessment and management of health, life sciences and technology (PDSP, 2012).

Bioethics in public health should emphasize in understanding and discussion from the linking of the problems and dilemmas posed by the context of public health, and thus try to link in a framework of moral conscience and ethical action, the empowerment in health of populations, as well as the linkage of this in the formulation of public health policies, where it is intended to generate awareness in the processes of change of social practices to provide elements of understanding to a socially contextualized bioethics. The debate from the WHO revolves around the social determinants (CSDH), an aspect that generates tension at the Latin American level with the emerging discussion on determinism and social determination. This is how the determinant (CSDH) -determinism-determination-social-indeterminacy (^{Breilh, 2013}; ^{Peñaranda and Rendón, 2013}) debate, places public health at the center of social justice (^{Venkatapuran and Marmot, 2009}) and opens the door to the emerging category of social justice in health (^{Venkatapuran, 2013}), which is essential for the development of bioethics in public health.