Public health: ethical issues

This report considers what the government, industry, other organisations and individuals should do to enable people to lead a healthy life. It uses four case studies to illustrate the ethical issues involved:

• infectious disease
• obesity
• alcohol and smoking
• fluoridation of water

The report sets out the duty of the state to provide conditions that allow people to lead a healthy life. Everyone should have a fair opportunity to lead a healthy life, and therefore governments should try to remove inequalities that affect disadvantaged groups or individuals. To support this duty, our report proposes a ‘stewardship model’ that outlines ethical principles that should be considered by public health policy-makers; and sets out a series of public health goals. In seeking to attain appropriate public health goals, the state should minimise the degree of intrusion or coercion in people’s private lives and choices.

Our report also presents an ‘intervention ladder’ as a way of thinking about the acceptability and justification of different public health policies. Any intervention should be proportionate to the effect that it is intended to achieve, and should be supported by evidence (or, in the absence of robust evidence, should be accompanied by an evidence-gathering programme). Interventions that are higher up the ladder are more intrusive and therefore require a stronger justification.