 Challenges to the authority of public health institutions and the legitimacy of public health policies occur in a wide range of political contexts. In countries with distinctly illiberal political institutions, questions of state legitimacy are cashed out quite differently than in the liberal tradition. The public health ethics literature has focused largely on the latter, relying on the liberal tradition as the touchstone for most writing on political legitimacy in public health. In Section 3, we address the major themes in this literature. Section 3.1 considers how appeals to overall benefit, the necessity of collective action, and efficiency are used to justify the general mandate of public health agencies. Section 3.2 takes up the major strands of argument from within the liberal tradition that are used to assess the permissibility of particular policies or  intervention.[17]  After an overview of an influential heuristic developed to help map the relative impact of various types of public health interventions on individual  liberty,[18]  we turn to four different responses to concerns about the intrusiveness and legitimacy of public health policies and practices: paternalism (3.2.1); the harm principle, as attributed to John Stuart Mill (3.2.2), the “liberty tradition” (3.2.3) and libertarian paternalism (3.2.4)