Judith MacKay: self-made scourge of the tobacco industry

Is public health just science? Values, politics and varied but collective practices to secure better health with justice

This paper asks: Is public health just science? That question invites analysis from the field of public health ethics of how we might distinguish public health as being built simply on scientific evidence bases and its being founded on science and ideas of justice. In conducting the analysis, the paper explores the essentially political nature of public health as well as reasons why members of the public health community might aim not to 'be political' in their practice: in particular, considering professional competence/expertise, democratic legitimacy and the possibly damaging consequences of being seen as engaged in politics. Such considerations, while valid, do not stop public health from being political in nature and directed to the realization of ethical aims. The paper, therefore, then explores how members of the public health community might seek to realize the moral mandates of public health. Although that requires political outcomes, it does not mean there is an ethical requirement to be as directly politically engaged as possible. On the contrary, we find good reason to look to public health as a collective enterprise, with individual roles and activities within it being more or less directly activist.

Beyond the Golden Era of public health: charting a path from sanitarianism to ecological public health

The paper considers the long-term trajectory of public health and whether a 'Golden Era' in Public Health might be coming to an end. While successful elements of the 20th century policy approach need still to be applied in the developing world, two significant flaws are now apparent within its core thinking. It assumes that continuing economic growth will generate sufficient wealth to pay for the public health infrastructure and improvement needed in the 21st century when, in reality, externalised costs are spiralling. Secondly, there is evidence of growing mismatch between ecosystems and human progress. While 20th century development has undeniably improved public health, it has also undermined the capacity to maintain life on a sustainable basis and has generated other more negative health consequences. For these and other reasons a rethink about the role, purpose and direction of public health is needed. While health has to be at the heart of any viable notion of progress the dominant policy path offers new versions of the 'health follows wealth' position. The paper posits ecological public health as a radical project to reshape the conditions of existence. Both of these broad paths require different functions and purposes from their institutions, professions and politicians. The paper suggests that eco-systems pressures, including climate change, are already adding to pressure for a change of course.