Public health: ethical issues

Some people object to the ‘nanny state’ whilst others want more measures to tackle problems like obesity and binge drinking.

This report considers what the Government, industry and individuals should do to enable people to lead a healthy life.

  • Measures to tackle excessive alcohol consumption

    The Government should implement tougher measures to tackle excessive alcohol consumption, such as increasing tax on alcohol and restricting hours of sale.

  • Responsibility for preventing harm to health

    Producers, advertisers and sellers of alcohol should take more responsibility for preventing harm to health. They should not understate the risks, or exploit the desirability of drinking, especially to young people.

  • Adoption of an effective the food labelling scheme

    The food industry should adopt the food labelling scheme that is most effective in helping people make healthy choices. Where industry fails to do this, there is an ethical justification for introducing legislation

  • Regulation of advertising food to children

    Stronger regulation of advertising food to children should be considered

  • Planning to encourage physical activity

    Town planners and architects should be trained to encourage people to be physically active through the design of buildings and public spaces.

  • Access to NHS treatment

    People should not be denied NHS treatment simply on the basis of their obesity. However, encouraging them to change their behaviour could be justified.

  • Intervention and risk from passive smoking

    There may be exceptional cases where children would be at such a high risk of harm from passive smoking in the home that intervention might be ethically acceptable.

  • Selling and advertising tobacco policies

    Policies on selling and advertising tobacco that provide the greatest protection to consumers should be adopted by tobacco companies worldwide.

  • Stringent policies for childhood vaccination

    Introducing more stringent policies for childhood vaccination (for example, penalties for those who do not comply) would not be justified at present in the UK.

  • Monitoring of infectious diseases by developing countries

    The Government should seek to improve the capacities of developing countries to effectively monitor infectious diseases.

  • Better information on fluoridation of water

    There is a lack of good-quality evidence on the potential benefits and harms of adding fluoride to the water supply. There is a need for better and more-balanced information for the public and policy makers.

  • Democratic decision-making procedures

    The most appropriate way of deciding whether fluoride should be added to water supplies is through democratic decision-making procedures at the local and regional level.

  • Appropriate goals and constraints

    A ‘stewardship model’ that outlines the appropriate goals and constraints of public health measures.

  • Programmes should not coerce adults

    Public health programmes should not attempt to coerce adults to lead healthy lives.

  • Minimise interventions without individual consent

    Public health programmes should minimise interventions that are introduced without individual consent of those affected, or without procedural justice arrangements which provide adequate mandate.

  • Minimise interventions that are unduly intrusive

    Public health programmes should seek to minimise interventions that are perceived as unduly intrusive and in conflict with important personal values.

  • Intervention ladder approach

    We propose the ‘intervention ladder’ as a useful way of thinking about the acceptability and justification of different public health policies.

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