This chapter is in two parts. The first asks what public health ethics is, and defends a conception of the subject. The second asks how we should go about doing public health ethics, and presents two lines of thought about methodologies.

What is public health ethics?

The central problematic

Public health ethics centres on a problematic triad. The members of the triad are governments, populations and individuals. The triad is problematic because populations and individuals sometimes clash: the rights and freedoms of individuals can come into tension with the need to protect and promote the health of the population. In such circumstances, the government has the role of adjudicating between the two claimants. Sometimes the government sides with individuals and protects their rights and freedoms at the expense of communal health benefits. Sometimes the government sides with a community by protecting and promoting its health at the expense of individual rights and freedoms. But whichever way it is resolved, this problematic triad is central to public health ethics (Holland, 2007, pp viii–ix).

To illustrate, smoking undermines the public's health by making smokers ill and threatening the health of bystanders. So there is a clash between the individual's freedom to choose to smoke and the need to protect the community from the detrimental effects of smoking. With which of these two claimants does the government side? Focusing on the UK, legislation was passed in 2007 banning smoking in certain public places. Evidently, this represents a shift towards prioritising the need to protect the health of the population over individuals’ rights to choose to smoke wherever they like. But note that this is no more than a shift in priorities, because the official rationale for the ban is that it will protect bystanders such as bar staff and restaurant workers from the effects of secondary smoking, hence it does not outlaw smoking altogether but allows smoking in some public buildings and outdoors. So, this is still a compromise between protecting individual freedoms and the public's health, albeit one that has shifted in favour of the latter (Nuffield Council on Bioethics, 2007, pp 99–117).