How far should we go in protecting and promoting public health? Can we force people to give up unhealthy habits and make healthier choices? Should we stop treating smokers who refuse to give up smoking, for example, or put a tax on fatty foods and ban vending machines in schools to address the ‘obesity epidemic’? Or can we nudge people towards healthy options without compromising their freedom to choose?
Such questions are at the heart of public health ethics. In this second edition of his well respected textbook, Stephen Holland shows that to understand and debate these issues requires philosophy: moral philosophies, including utilitarianism and deontology, as well as political philosophies such as liberalism and communitarianism. And philosophy informs other aspects of public health, such as epidemiology, health promotion, and screening.
The new edition has been fully revised and updated to reflect recent developments in the field. There is a new chapter on the ethics of 'harm reduction', looking at policies which aim to reduce the harmful effects of unhealthy behaviour, such as using illicit drugs, as opposed to trying to get people to abstain.
Additional material has been added on the recent interest in 'nudging' people towards more healthy choices in a new theoretical section on libertarian paternalism, as well as more on debates on the ethics of other current public health policies, such as using financial incentives to get people to take more responsibility for their own health.
Public Health Ethics provides a lively, accessible and philosophically informed introduction to such issues. As well as being an ideal textbook for students taking courses in public health ethics, Holland’s systematic discussion of the ethics of public health will engage and inform the more advanced reader too.
Part 1 Moral and Political Philosophy 11
Introduction to Part 1 13
1 Consequentialism 17
2 Non-consequentialism 28
3 Liberal Political Philosophy 48
4 Beyond Traditional Liberalism 63
Part II Public Health Activities 81
Introduction to Part II 83
5 Epidemiology 86
6 Health Concepts and Promotion 109
7 Health Promotion as Behaviour Modification 133
8 Harm Reduction 160
9 Immunization 186
10 Screening 211
Concluding Remarks 238
Stephen Holland’s second edition is an important milestone in the emerging field of public health ethics. It has a rich population-based perspective, demonstrating the foundational importance of safeguarding the public’s health. His analysis is rigorous and systematic, applying the major theories in moral and political philosophy to the public health enterprise. By explaining the major forms of public health interventions, Professor Holland shows the sometimes irreconcilable tensions between individual interests and the common good. This book will inform scholars in multiple fields, including philosophy, law, epidemiology, medicine, and nursing.
Lawrence Gostin, Georgetown University Law Center
Stephen Holland brings the rigor of analytic ethical analysis to bear on public health and makes an important contribution to clear thinking in this vital area. His discussion is conceptually rich and factually well-informed. His careful and lucid views on practical policy questions in public health also make this book essential reading.
Bruce Jennings, Yale University
Public Health poses normative problems that necessarily require an interdisciplinary perspective. Readers of Holland's lucid introduction with a background in moral or political theory will gain valuable insights from his convincing analysis of case studies. Practitioners will like the normative instruments Holland provides, which will help them to query and justify public health interventions. Holland makes a good case for structuring his introduction along the potential conflict between community and the individual. It is hence a modern, topical and widely suitable approach to public health ethics.
Thomas Schramme, Hamburg University