It is an exciting time in the nascent field of public health ethics. This feeling seems to exist among those approaching these issues from a more theoretical perspective as well as those with a more practical or practitioner point of view. The thing that unites us is a sense that there is something missing from traditional medical ethics. This feeling may in turn be explained in three possible ways. First, many topics central to public health are missing from the list of issues tackled in mainstream medical ethics. Second, there is concern about the adequacy of the theoretical approach or assumptions that have been used in medical ethics once they are applied to examples in public health. Or, third, both of these may be true. The danger is that while we can agree that we are involved in a common project, it remains the case that we have different aims, languages and priorities, and the opportunity for genuine communication and collaboration is missed.

This chapter is a preliminary exploration of some of the issues that arise as we attempt to bring these different perspectives together. It is common to use the metaphor of a ‘gap’ between theory and practice when trying to articulate this problem. I choose not to do so, because I think it both overestimates and underestimates the problem. It overestimates because the very best work in applied ethics is both theoretically rigorous (or at least defensible) and of practical importance. It underestimates the problem because we do not just have two clear camps (the ‘theorists’ and the ‘practitioners’). Even if it makes sense to think of them as distinct groups, no unity exists in either category. Theorists (in the sense intended) will include philosophers from different schools (realist, pragmatist, postmodern and so on) and advocates of different normative theories (consequentialism, deontology, virtue theory and others), but will also include perspectives from other disciplines (psychology, communication studies, sociology, anthropology, history, political sciences and so on). The practitioners are also a diverse bunch (and will include front-line public health physicians and nurses, dieticians, politicians, policy advisors, health promoters, charities, environmental scientists, food inspectors, water engineers, dentists and others).