Public Health Ethics

Medical ethics, as an object of systematic study, was born in the USA at the beginning of the 1960s. For the first forty years or so, medical ethics (and bioethics as the emerging discipline came to be known) largely focused on individual problems in the doctor-patient relationship, and on formulating responses to new technologies such as IVF or genetic engineering. Large-scale ethical questions about the role of governments in protecting the health of their citizens, and the fairness of a world in which some social groups — even within the same city — have markedly longer life expectancies than others, were barely considered.

This narrowness of vision has been comprehensively critiqued in the bioethics of the last fifteen years. It has become increasingly apparent that provision of healthcare is only one of a number of determinants of health. These other determinants include workplace stress, social exclusion, early nurturing environment and the inequality of distribution of income in society. 

This shift has been consolidated by the fact that many of the new technologies which have so excited bioethicists – such as gene therapy, “personalised medicine” and synthetic biology – have so far failed to deliver significant health improvements, whilst population level measures such as banning smoking in public places and improving road safety have had very significant effects.

Much of my research focuses on how states should protect and promote the health of their citizens. This is ethically and politically complicated for many reasons. For example: some citizens will not take kindly to their lives being interfered with; major health problems such as obesity or air pollution are complex and multifactorial and there is no “magic bullet” to solve them; and the resources available for health interventions are scarce. My monograph, Philosophy for Public Health and Public Policy: Beyond the Neglectful State (OUP, 2021), provides an authoritative and synoptic theory of this terrain, clarifying not only the nature of the philosophy of public health policy, but arguing for the distinctive claim that there is a right to public health, and that this should profoundly shape our understanding of the role of the state in protecting and promoting health.

Key publications on Public Health Ethics