Ethics of Public Health
- LAST REVIEWED: 05 May 2017
- LAST MODIFIED: 31 August 2015
- DOI: 10.1093/obo/9780199756797-0073
- LAST REVIEWED: 05 May 2017
- LAST MODIFIED: 31 August 2015
- DOI: 10.1093/obo/9780199756797-0073
Discussion of the ethics of public health today emerges from the confluence of two streams of writings. A small number of influential scholars in public health have written articles to characterize the general ethical orientation of public health and have produced analyses of particular issues as they have arisen. A second stream has emerged more recently in the work of established bioethicists, who have examined the differences between medical ethics and public health ethics. In these newer works, a key point is that, whereas medicine focuses on the health of the individual, public health is concerned with the health of the entire population. Thus, in contrast to a principal fiduciary duty to the individual patient, public health ethics is founded on the societal responsibility to protect and promote the health of the population as a whole. In the United States, the beginnings of the field of bioethics are commonly traced to the late 1960s and 1970s, when the issues of defining brain death, especially as it pertained to the emerging capacity to perform organ transplants, and the notorious Tuskegee syphilis trial gained prominent public attention. It was not until the early 21st century, however, that these ethicists turned their attention to the distinct issues that arise when the level of analysis shifts from moral considerations of individual well-being to that of the population as a whole.
Written by scholars who located themselves professionally within the field of public health, several notable works—Curran 1976, Faden and Faden 1978, Wikler 1978, and Lappé 1983—laid the foundation for how public health professionals have thought about the major ethical principles that orient the field of public health. One of the earliest pieces, Beauchamp 1976, is frequently given credit for the idea that the core ethical principle that guides public health is the cause of social justice. Curran 1976 introduces and debates the merits of the term “public health ethic” as distinct from medical ethics. Lappé 1983 is one of the first studies to make the case for the need for public health to go beyond utilitarianism (the greatest good for the greatest number, which is commonly criticized for its potential to sacrifice individuals rights for the common good), and for seeking to lay out criteria for determining when paternalistic policies (defined by the use of state powers to restrict individual choice, where the government assumes that it knows what is in the individual’s interest better than the individual himself) are justified. Faden and Faden 1978, Wikler 1978, and McGinnis 1985 set the terms for the debate about the degree to which individuals should be considered responsible for their own health, versus the degree to which it is beyond their control, with attendant implications for moral accountability and the problem of equity (e.g., the burden of tobacco taxes falls disproportionately on those who can afford it least).
Beauchamp, Dan E.. 1976. Public health as social justice. Inquiry 13.1: 3–14.
The seminal piece that is responsible for equating public health with social justice. Social justice is contrasted with “market justice,” which is said to characterize modern American society, with its emphasis on individual responsibility. In contrast, social justice holds that all individuals are entitled to equal protection from health hazards in the environment that are produced by the powerful.
Curran, William. 1976. Bioethics and health ethics: A critical examination of the new terminology. American Journal of Public Health 66.5: 497–498.
This article argues that people have public as well as private responsibilities for protecting health, such as getting immunized and not endangering the health of others. It also raises the question of the boundary between health behaviors that should be prohibited by law, and those that are part of the private sphere of individual freedom.
Faden, Ruth, and A. I. Faden. 1978. The ethics of health education as public health policy. Health Education Monographs 6.2: 180–197.
This article represents one of the first efforts to analyze the concept of voluntariness for public health audiences. It calls attention to the distinction between informational and persuasive communications, and their potentially distinct impacts on rationality and voluntariness. It also discusses the issue of “victim-blaming” (a popular term to indicate the absence of individual culpability).
Lappé, Mark. 1983. Values and public health: Value considerations in setting health policy. Theoretical Medicine & Bioethics 4.1: 71–92.
This article analyzes six issues of public health policy (such as immunizations, compulsory treatment of infectious diseases, and limiting access to tobacco and alcohol). The paper points out the complexity of determining a reasonable balance among conflicting value considerations. An important paper for challenging the field to address the problems with any simple-minded resort to utilitarian thinking.
McGinnis, Michael. 1985. The limits of prevention. Public Health Reports 100.3: 255–260.
The section on ethical considerations raises the question of the basis of public jurisdiction over private behavior. It argues that state policies to regulate individual health behaviors that can harm others (e.g., drunk driving) are uncontroversial, while issues such as raising taxes on cigarettes raise equity issues. It concludes that policies designed to change individual behavior must be conscientiously crafted.
Wikler, Daniel I. 1978. Persuasion and coercion for health: Ethical issues in government efforts to change life-styles. Milbank Memorial Fund Quarterly: Health and Society 56.3: 303–338.
This article provides an in-depth examination of the moral justification for the government’s role in promoting health behaviors, arguing that a simple-minded conclusion in favor of one side or the other is untenable. It cites the need to identify the conditions that would make such government policies morally acceptable, using examples that do not appear to be unreasonably coercive.
Users without a subscription are not able to see the full content on this page. Please subscribe or login.
How to Subscribe
Oxford Bibliographies Online is available by subscription and perpetual access to institutions. For more information or to contact an Oxford Sales Representative click here.
- Access to Health Care
- Action Research
- Active Aging
- Active Living
- Adolescent Risk-Taking Behavior in the United States
- Advocacy, Public Health
- Agricultural Safety and Public Health
- Air Quality: Health Effects
- Air Quality: Indoor Health Effects
- Alcohol Availability and Violence
- Alternative Research Designs
- Ambient Air Quality Standards and Guidelines
- American Perspectives on Chronic Disease and Control
- Antimicrobial Resistance (AMR)
- Asthma in Children
- Attachment as a Health Determinant
- Behavior Change Theory in Health Education and Promotion
- Behavioral Risk Factor Surveillance
- Bicycling and Cycling Safety
- Birth and Death Registration
- Birth Cohort Studies
- Board of Health
- Built Environment and Health, The
- Business and Corporate Practices
- Cancer Communication Strategies in North America
- Cancer Prevention
- Cancer Screening
- Capacity Building
- Capacity Building for NCDs in LMICs
- Capacity-Building for Applied Public Health in LMIC: A US ...
- Cardiovascular Health and Disease
- Child Maltreatment
- Children, Air Pollution and
- Children, Injury Risk-Taking Behaviors in
- Children, Obesity in
- Citizen Advisory Boards
- Climate Change and Human Health
- Climate Change: Institutional Response
- Clinical Preventive Medicine
- Community Air Pollution
- Community Development
- Community Gardens
- Community Health Assessment
- Community Partnerships and Coalitions
- Community-Based Participatory Research
- Complexity and Systems Theory
- Definition of Health
- Dental Public Health
- Design and Health
- Dietary Guidelines
- Ecological Approaches
- Enabling Factors
- Environmental Laws
- Environmental Protection Agency
- Ethics of Public Health
- Evidence-Based Public Health Practice
- Family Planning Services and Birth Control
- Food Safety
- Food Security and Food Banks
- Food Systems
- Frail Elderly
- Functional Literacy
- Genomics, Public Health
- Geographic Information Systems
- Geography and Health
- Global Health
- Global Health Diplomacy
- Global Health Promotion
- Guide to Community Preventive Services, The
- Health Administration
- Health Communication
- Health Disparities
- Health Education
- Health Impact Assessment
- Health in All Policies
- Health in All Policies in European Countries
- Health Literacy
- Health Literacy and Non-Communicable Diseases
- Health Measurement Scales
- Health Planning
- Health Promoting Hospitals
- Health Promotion
- Health Promotion Workforce Capacity
- Healthy People Initiative
- Hepatitis C
- High Risk Prevention Strategies
- Human Rights, Health and
- Immigrant Populations
- Immunization and Pneumococcal Infection
- Indigenous Peoples, Public Health and
- Indigenous Populations of North America, Australasia, and ...
- Indoor Air Quality Guidelines
- Internet Applications in Promoting Health Behavior
- Intersectoral Strategies in Low - Middle Income Countries ...
- Justice, Social
- Knowledge Translation and Exchange
- Knowledge Utilization and Exchange
- Law of Public Health in the United States
- Media Advocacy
- Mental Health
- Mental Health Promotion
- Migrant Health
- Motor Vehicle Injury Prevention
- Multi-Drug-Resistant Tuberculosis
- National Association of Local Boards of Health
- National Public Health Institutions
- Needs Assessment
- Obesity Prevention
- Occupational Cancers
- Occupational Safety and Health
- Oral Health Equity for Minority Populations in the United ...
- Ottawa Charter
- Parenting and Work
- Parenting Skills and Capacity
- Participatory Action Research
- Patient Decision Making
- Pesticide Exposure and Pesticide Health Effects
- Physical Activity and Exercise
- Physical Activity Promotion
- Polio Eradication in Pakistan
- Population Aging
- Population Determinants of Unhealthy Foods and Beverages
- Population Health Objectives and Targets
- Precautionary Principle
- Prenatal Health
- Program Evaluation in American Health Education
- Program Planning and Evaluation
- Public Health, History of
- Public Health Surveillance
- Public-Private Partnerships in Public Health Research and ...
- Public-Private Partnerships to Prevent and Manage Obesity ...
- Quantitative Microbial Risk Assessment
- Radiological and Nuclear Emergencies
- Randomized Controlled Trials
- Real World Evaluation Strategies
- Reducing Obesity-Related Health Disparities in Hispanic an...
- Rural Health in the United States
- Safety, Patient
- Sex Education in HIV/AIDS Prevention
- Skin Cancer Prevention
- Smoking Cessation
- Social Determinants of Health
- Social Epidemiology
- Social Marketing
- Statistics in Public Health
- Systems in the United States, Public Health
- Systems Theory in Public Health
- Traditional, Complementary, Alternative, and Integrative M...
- Translation of Science to Practice and Policy
- Traumatic Stress and Post-Traumatic Stress Disorder
- Tuberculosis among Adults and the Determinants of Health
- Unintentional Injury Prevention
- Urban Health
- Vaccine Hesitancy
- Violence Prevention
- Water Quality
- Water Quality and Water-Related Disease
- Weight Management in US Occupational Settings
- Worksite Health Promotion