On Public Health Ethics

On Monday of this week one of the finest compendia of philosophy on the Web, the Stanford Encyclopedia of Philosophy, released an entry on public health ethics.  The entry is authored by Ruth Faden and Sirine Shebaya, is available full-text, and is worth reading in its entirety.  I was particularly interested to read the authors' treatment of the dynamic interplay between population and public health, an issue that is central to my own research.  An excerpt of this discussion:

Another issue that comes up in this connection is the following: are “public” and “population” interchangeable terms to designate the entity whose health we are concerned with? Is there a significant conceptual difference, a difference in moral valence, or a difference in attitude and orientation between public health ethics on the one hand, and population-level health ethics on the other? The literature presents three general ways of denoting the object of public health: community, the public, and populations. In one sense, the most morally laden manner of designating those who are subject to, and benefit from, public health measures, is to think about them as a community (Beauchamp & Steinbock 1999). Reference to “community” implies a uniform group, usually with a shared language, culture, history, and geographical location. Characterizing the concern of public health as being the health of the community renders more natural (and possibly more plausible) appeal to the common good as a way of justifying public health interventions. Reference to “the public” shares some of those same features but tends to be less morally laden. This is in part because “the public” is somewhat more anonymous than “the community” and does not necessarily signal a tight cultural connection. Rather, it connotes a relatively discrete unit with some common institutions and usually a shared political life. Thus, references to the public as well as to the community may encourage the perception that the good we are seeking to advance is that of a geographically bounded unit, with community connoting stronger cultural associations, and public connoting some kind of official political unit such as a state or a country.

Fascinating.  I may have more to say in the near future.

(h/t The Professor)

Comments

[ruth]

thanks for posting this. it's related to my own research as well (19th century public health), but I don't think the terms "public", "population" and "community" are used in the same sense in 19th century American public health. But its definitely good reading for thinking about such questions.

[Daniel S. Goldberg]

Hi Ruth,

We should talk -- 19th c. American public health is definitely part of my research agenda (I'm particularly interested in evolving conceptions of public health causality, such as the social determinants of health, and attitudes, practices, and beliefs along these themes in the 19th c.)

And I agree completely that contemporary meanings of "public" and "population" would have been understood very differently in the 19th c. Maybe less in the US than in Europe, but the term "population" had very strong Malthusian overtones, IMO. And the whole idea of social action in the name of public health would have been understood differently.

No?

Thanks for reading and commenting!