Public Health Ethics
Volume 5 Issue 3 November 2012
http://phe.oxfordjournals.org/content/current

Editorial
Risk, Risk Groups and Population Health
Marcel Verweij and Angus Dawson
Public Health Ethics (2012) 5(3): 213-215 doi:10.1093/phe/phs032

Excerpt
A central issue in public health is whether preventive activities are best aimed at groups held to be at high risk or at the population as a whole. Such a decision is often an issue in discussions about policies relating to vaccinations, health promotion, infectious disease control as well as protection from risks relating to toxic agents or radiation, etc. There are a number of interesting conceptual issues that can be explored such as what we mean by risk, how we define a ‘risk group’, and how subgroups relate to each other and to a larger population. For example, how do we determine what level of risk is sufficient for calling some subpopulation a ‘high-risk’ group? Suppose we can identify a group of children who run a risk of developing complications from varicella that is 10 times higher than the average, but it is also possible to identify even smaller subgroups that run a 50- or even 100-fold risk of developing severe complications if infected? Which group is ‘high risk’? How do we decide what our priorities ought to be? Judgements in this case would be influenced, perhaps, by what the options are for preventive care. Clearly, the identification of risk groups is just as much a normative judgement as decision making about the content of any policies relating to a high-risk group. This suggests that policy decisions are, and ought, to be not only dependent on which strategy is most efficient or cost-effective, but equally require consideration of ethical issues relating to justice, equity and solidarity.

Twenty years ago, Rose (1992) published his book The Strategy of Preventive Medicine, offering an in-depth exploration of these issues in relation to public health. Rose argued that in many cases a population strategy, focused on reducing average risk within the whole…