Introduction

In this chapter I present some of the implications of the political liberalism described in Chapter 10 for analysis in public health law and ethics. This book has demonstrated the need to commit to a political model or framework for any meaningful normative discussion to take place in relation to public health. Thus, even readers who are opposed to the political position that I take should be able to see and accept the wider analytic and ‘methodological’ point about political engagement with public health issues. The political context that I defend includes in its community people with and without their own decision-making capacity, and narrows the legitimate freedom people have to act on some of the decisions they would make. This applies not only where their actions themselves may cause harm to others, but also where a general and perhaps generally latent freedom that would allow them to perform harmful acts would lead to unacceptable harm amongst members of the wider population. In this sense, not only are people part of the environment, but their legal rights, freedoms, and so forth are too. Such a point is well demonstrated by a claim made by the British Medical Association’s (BMA) Board of Science in its report “Under the influence – The damaging effects of alcohol marketing on young people”. Alcohol regulation is one of the BMA’s four public health priorities. Core to the argument in the report is that excessive alcohol consumption is a public health problem, and that young people (by which it means people under 25) face particular problems. However, the Board of Science rejects the idea that simply targeting young people will provide a satisfactory response. Rather, it argues, regulations to protect this group must be targeted across the board. The report describes the regulatory system in the UK as providing a “pro-alcohol environment”, where advertising, popular culture, marketing, fiscal arrangements, and widespread availability are amongst the malign factors that conspire in sustaining an unacceptable public health problem. Elsewhere I have suggested that the BMA’s position is interesting:

What we see here then is the importance of the ‘context’ provided by general rights, which clearly can be mapped onto the concept of public discussed in Chapter 2. Likewise, we see an argument advanced by the BMA in favour of a specific manifestation of ‘collateral paternalism’ in the context of public health policy. More generally, much of the recent upsurge of interest in the fields of public health law and ethics is evidenced in works that address the sorts of observations underpinning the BMA report, and develop or criticise the sorts of arguments that it raises. There are disputes about the understandings of, rationales for, and means of allocating responsibilities when we understand the community to comprise people who can not always take responsibility for themselves. And beneath these disputes is the problem of there being something inherently contestable in claims about what constitutes harm and benefit, and by implication in terms such as ‘health’.