 As we noted in section 1.2, a distinctive feature of public health is the large role that government policy and government power play in its promotion. Although private non-profit actors, as well as pan-national organizations, make major contributions to advancing public  health,[16]  much of the work of public health occurs within nation-states and is backed by governmental enforcement and the exercise of police powers. A substantial literature in public health ethics focuses on the legitimacy of these state actions.