PoPulationand Public HealtH etHics

certainly nothing in the ‘Millian’ paradigm that prevents
seeing harm in this way. Indeed, a plausible view about
harm is that we ought to define it as that which negatively
affects our interests. 4 Given the risks to health resulting
from exposure to smoke, it seems logical to see smoking
in public itself as being such a potential harm, through
its potential impact on others.
Third, restrictions on outdoor smoking can be supported
by the idea that this is the next natural step in the gradual
changing of norms relating to smoking in society. The idea
is that we want smoking to be seen as something that is
unacceptable, as this is the best way to help smokers give up. This, in turn,
makes it less likely that children grow up thinking of smoking as normal behaviour,
thus decreasing the likelihood that they will, in turn, become smokers
themselves. Such a view rejects the idea that it should always be liberty that
takes priority as a value in cases of dispute with other values (such as harm
prevention). Where we have good evidence about a potential harm, and we
can reduce the chances of such a harm occurring, it is perfectly legitimate
for a government to take action to seek to improve citizens’ health. If people
strongly object, within a democratic society, the government is, ultimately,
constrained by facing the public at an election.
Fourth, while it is, indeed, the case that the traditional ‘Millian’ picture
suggests that action motivated to bring about beneficial outcomes for competent
individuals against their will is paternalistic, and therefore morally
wrong, this argument is not so straightforward when applied to public health
measures targeted at whole populations. 5 For example, such public health
interventions do not aim (at least, directly) at individual benefit. Indeed, perhaps
the benefit can only exist as a result of focusing on the population (not
individual good at all). Likewise, if the justification of a policy for tobacco
restriction is through an appeal to justice, it would seem incoherent to argue
that this end could not be pursued because it was ‘paternalistic.’
2. The ‘Stigma and Injustice’ argument
The second argument in the case appeals to the idea that restricting smoking
in outdoor places will increase stigma for already marginalised groups, and
Equitable Consequences?
67
Where we have good
evidence about a
potential harm, and
we can reduce the
chances of such a
harm occurring, it is
perfectly legitimate
for a government to
take action to seek
to improve citizens’
health.