Towards a Normative Framework for Public Health Ethics and Policy
This paper aims to shed some light on the difficulties we face in constructing a generally acceptable normative framework for thinking about public health. It argues that there are three factors that combine to make theorising about public health difficult, and which when taken together defeat simplistic top down and bottom up approaches to the design of public health policies. The first factor is the problem of complex systems, namely that the distribution of health both affects and is affected by the distribution of other goods. The second is the difficulty of defining the goals of public health: we still need to get clear about what we should mean by health in this context, and what the goals of public health should be. The third is that we stand in need of an account of how important health is relative to the importance of other goods that a just society should be trying to secure for its citizens. The paper argues that these problems should lead us to abandon the search for a one size fits all' normative framework for thinking about public health. Rather, different approaches will be appropriate at different levels of abstraction.