Public Health Ethics
Volume 8 Issue 1 April 2015
http://phe.oxfordjournals.org/content/current

Public Health: Beyond the Role of the State
Angus Dawson*
University of Birmingham, UK
Marcel Verweij
Wageningen University, The Netherlands
Extract
Most of the papers in this issue of Public Health Ethics—more generally a large part of academic work in our field—are concerned with ethical problems of disease prevention and health promotion activities within nation states. Such discussions often involve reflection on the exact obligations of governments and public health officials acting on behalf of the state while pursuing these ends. In liberal approaches to such discussions, it is common to see a minimal role for the state and a focus on promoting the freedom and responsibility of individual citizens. Indeed, some choose to see public health ethics as being centrally about the conflict between individuals and the state (Holland, 2007; Nuffield Council on Bioethics 2007; Krebs 2008). In various places we have argued that public health ethics should not be conceptualized as being centred on conflicts between individual liberty and the responsibility of the state to protect health (Dawson 2010; Dawson 2011; Verweij & Dawson 2013, Verweij 2014). In this editorial, we suggest that we can see another problem that arises from the individual-vs-state way of structuring such discussions. Public health as an activity goes beyond the role of the state.
Some may argue that public health necessarily involves state action (Rothstein, 2002). This makes some sense, as it is certainly true that many interventions to protect health involve the exertion of power over citizens or even coercive policies, through, for example, the enforcement of legislation. In a previous paper, we have taken and argued for a broader view of public health, legitimate public health activity and public health ethics (Verweij and Dawson, 2007). There we argued that public health ought to be seen as involving collective interventions to protect and promote population health…