PoPulationand Public HealtH etHics

intervention (say reduction in mortality or decrease in disability or quality
adjusted life years.) Consequentialism seems a natural analog to the metricdriven
aspects of public health practice rooted in epidemiology.
Liberalism, on the other hand, is rooted in the claims of individuals to have
inherent value and worth. Originating in the deontological perspective of
Immanuel Kant, liberalism places high value on protecting and promoting
individual liberty. This is manifest concretely in the wide range of rights that
are protected and promoted under international human rights codes.
Communitarianism focuses on the qualities and characteristics of communities
that make them salutary. It focuses on the structure of communities
that are health promoting and analyzes the character traits and virtues that
should be aspired to and encouraged in citizens.
There are now a wider variety of normative theories relevant to public health
ethics. Feminism brings a lens of gender to the analysis of ethical issues in
public health. How do policies and programs work toward promoting gender
equality and reducing the oppression of women? Paul Farmer has argued for
the importance of integrating social sciences perspectives, particularly anthropology,
to examine the role of oppression in understanding health issues. 5
Recently, considerable attention has been devoted to the existence of inequities
leading to disparities in access to health and health outcomes. 6 Many of these
disparities are rooted in the social determinants of health. The existence of
marked disparities has lead to the analysis of the relationship between social
justice and public health. Powers and Faden elaborate a theory of social justice
capable of informing the moral foundation of public health ethics. 7 They are
critical of accounts of justice in public health that focus exclusively on outcomes
derived from considerations of utility. Instead, they argue that a social justice
perspective addresses the twin moral impulses that animate public health:
“to improve human well being by improving health and to do so in
particular by focusing on the needs of those who are the most disadvantaged.
A commitment to social justice…attaches a special moral
urgency to remediating the conditions of those whose life prospects
are poor across multiple dimensions of well being. Placing a priority
on those so situated is a hallmark of social justice” [p.82]. 7
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