Stanford Encyclopedia of Philosophy: Public Health Ethics
 Public Health Ethics
At its core, public health is concerned with promoting and protecting the health of populations, broadly understood. For example, the Institute of Medicine defines public health as “what we, as a society, do collectively to assure the conditions in which people can be healthy” (IOM 1988). Often, but not exclusively, collective interventions in service of population health involve or require government action. In the United States, for example, the Centers for Disease Control and Prevention, the Food and Drug Administration, the Environmental Protection Agency and the Consumer Protection Agency are in part or in whole public health agencies. All states and most municipalities or counties have health departments whose various functions include everything from the inspection of commercial food service to the collection and use of epidemiological data for population surveillance of disease. Collective action to promote and protect population health also occurs at the global level, as exemplified by the activities of the World Health Organization.
One view of public health ethics regards the moral foundation of public health as an injunction to maximize welfare, and therefore health as a component of welfare (Powers & Faden 2006). This view frames the core moral challenge of public health as balancing individual liberties with the advancement of good health outcomes. Consider, for example, how liberties are treated in government policies that fluoridate municipal drinking water or compel people with active, infectious tuberculosis to be treated.
An alternative view of public health ethics characterizes the fundamental problematic of public health ethics differently: what lies at the moral foundation of public health is social justice. While balancing individuals' liberties with promoting social goods is one area of concern, it is embedded within a broader commitment to secure a sufficient level of health for all and to narrow unjust inequalities (Powers & Faden, 2006).[1]Thus, another important area of concern is the balancing of this commitment with the injunction to maximize good aggregate or collective health outcomes. Understood this way, public health ethics has deep moral connections to broader questions of social justice, poverty, and systematic disadvantage.
Within this general framework, this paper proceeds as follows: Section 1 lays out some of the distinctive challenges of public health ethics. Section 2 discusses different justifications for public health interventions, including the role of paternalism, its various interpretations and how these bear on the permissibility of public health interventions. Also discussed in Section 2 are broader questions of democratic legitimacy. Section 3 focuses on questions of justice and fairness in public health ethics. Finally, Section 4 surveys six broad areas of global justice concern that deserve further attention from a public health ethics point of view. Overall, this entry strives to provide a general lay of the land with regards to the central issues that drive public health ethics, as well as a more in-depth discussion of justice, fairness, and priority setting in public health.
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