Public health focuses on the prevention of disease and the promotion of health on a collective level, that is, the health of the population. This distinguishes public health from medical care and the doctor-patient relationship.
In a clinical setting, the doctor discusses treatments with the patient directly and risks and benefits are assessed in relation to that individual. In contrast, public health agencies need to base their analysis on a collectivist risk-weighing principle, weighing risks of the population against benefits of the population. One example could be taxation of cigarettes or information concerning ways to reduce obesity.
Although the generalizations involved and the collectivist focus is necessary in public health, and although the overall intentions are good, there is always a risk that individual interests, values and rights are threatened. One example is the way current national and international breastfeeding policy affects non-breastfeeding mothers and possibly gay and adoptive parents. The norm to breastfeed is very pervasive, and studies show that women who cannot breastfeed feel that they may harm the baby or that they are inadequate as parents. It is possible to think of a couple who want to share parenthood equally and for that reason choose to bottle-feed their baby due to their values. The collectivist focus is based on a utilitarian rationale where the consequences in terms of health-related benefits of the population are the primary goal of successful interventions. In such efforts, the most important value is efficacy.
In addition to the underlying utilitarian perspective on health, there is also a somewhat contrasting human rights perspective in public health: the idea that all humans have certain rights, and that the right to life and health are of utmost importance. Finally, health is also discussed in terms of local and global justice, especially since inequalities in terms of socio-economical and educational differences have been acknowledged during recent years.
One could conclude that all aspects of the ethics of public health are covered by these different approaches. However, I would argue that there is one dimension missing in these analyses, namely, virtue ethics, and more specifically the virtues of responsibility, compassion and humility.
As mentioned above, there is a risk that the interests, values and rights of particular individuals and minorities are neglected by ever so well-intended collectivist policies. The power involved in more and less coercive public health policies calls for a certain measure of responsibility. A balance should be struck between the aim to promote the collective good and the respect for the choices and values of individuals.
In addition, a certain measure of compassion is needed. Compassion could be seen as a disposition to think and act in an emotionally engaged way in order to understand and acknowledge the effects of policy on individuals. This is clear when reflecting on the effects of breastfeeding policy on individuals who cannot breastfeed their babies.
Finally, since public health policy is not only a matter of evidence and science, but also about values, a certain degree of humility should be exercised, acknowledging also the provisional character of scientific evidence. This is the case with measles vaccination. The safety and efficacy of the vaccine can, and has been, established by science. However, the question whether to introduce mandatory vaccination is a matter of values. It should be possible to acknowledge and respect the values and perspectives of individuals without compromising what scientific evidence suggests in terms of safety and efficacy.
The virtues of responsibility, compassion and humility could be understood in terms of values of public health professionals, and they should be encouraged by the agencies for which such professionals work.
- Nihlén Fahlquist, J. 2019. Public health and the virtues of responsibility, compassion and humility. Public Health Ethics. doi:10.1093/phe/phz007
- Nihlén Fahlquist, J. 2017. Vaccine hesitancy and trust. Ethical aspects of risk communication. Scandinavian Journal of Public Health 46(2): 182-188
- Nihlén Fahlquist. 2016. Experience of non-breastfeeding mothers, norms and ethically responsible risk communication. Nursing Ethics 23(2):231-41