A healthy environment with adequate sanitation, clean water and good air quality requires the coordinated activity of the whole community, through the day-to-day action of relevant civil or public agencies. This may impose significant cost on some industries and individuals. Health promotion can seek to change people’s preferences in relation to issues such as smoking, exercise and food choices, with the aim of reducing the chronic disease burden in a population through the promotion of healthier lifestyles.
Many public health research activities are focused on populations, where epidemiological work to determine risk factors for disease may require the analysis of personal health information without the consent of individuals. Preparing for and responding to public health emergencies may require infrastructure for disease surveillance and legal structures to compel behaviour and seize property (in at least some circumstances).
Health inequities are the result of many different socio-economic determinants and can often be addressed only through structural and societal level policy initiatives (that may in turn restrict or negate individual choice). If the currently dominant views in contemporary medical ethics are applied to these public health activities there is a danger that such routine public health actions will be seen to be wrongly prioritizing population over individual interests. One possible response is to accept this critique and argue that much public health activity is actually unethical because it fails to prioritize individuals and their choices, as well as the moral principles that have evolved within the field of medical ethics to protect these considerations such as informed consentand patientconfidentiality.
