Journal of Public Health | Vol. 39, No. 3, pp. 427–428 | doi:10.
1093/pubmed/fdx104
Guest Editorial
Promoting the ethics of promoting the
public’s health: a call for papers; a call for
debate
It is well established that moral mandates sit at the core of
good public health policy and practice.1 Though they may
sometimes prove to be competing commitments, the key
aims of public health—promoting overall levels of health
and addressing inequitable health inequalities—are goals
derived directly from ethical commitments to ideas of just-
ice.2 As the field of public health ethics has emerged,3 it has
become clear that moral values, rationales, imperatives and
constraints may be found in quite distinct sources: the ethics
of the profession itself; the ethics of advocacy for the pub-
lic’s health; and from philosophical theory.4 It is clear, fur-
thermore, that given its focus on populations and on
governmental and institutional power, public health ethics is
about politics.5 As suggested in the subtitle to Lawrence
Gostin and Lindsay Wiley’s celebrated textbook on public
health law, attention must be paid to political and legal
‘power, duty and restraint’.6 Here in the UK, as elsewhere,
we need to meet the challenge of establishing the contours
of ethical public health practice and policy, and explain how
far public health ethics should bear on overall social and pol-
itical agendas.
If public health is to provide a voice—to provide leader-
ship—political disagreement is inevitable. This is only heigh-
tened in a context of increasing fiscal pressures on public
health authorities, and concerns about the fragmentation of
the public health workforce and its overall independence.
Across the political spectrum, furthermore, we find an array
of views of where public responsibilities begin and purely
personal responsibilities end. Without an identifiable ethical
core, public health becomes an eclectic range of technical
specialities, serving diverse technical, organizational, political,
and corporate interests and outcomes. In a scathing com-
ment piece calling for stronger public health leadership, and
criticizing the relationship of public health’s leadership with
government, Richard Horton wrote in 2011:
There was a time when public health in England was dri-
ven by passionately articulated values and compelling
research, a time when its leaders were concerned about
social reform and political change. […] Public health is
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the science of social justice, overcoming the forces that
undermine the future security of families, communities
and peoples. Public health leadership in England is failing.
It is time for those leaders to discover courage and
purpose.7
Some representatives of the targets of these powerful
words offered a response.8 And we do, of course, find cru-
cial bases of public health leadership such as the Academy
of Medical Science’s ‘Improving the Health of the Public by
2040’.9 An important lesson to take from the above reflec-
tions, though, and the exchanges on public health leadership,
is that debates and practical argument are required on how
we understand the substance and scope of ethical public
health agendas, recognizing both their inherently political
nature and the wider social, political, and economic contexts
in which they exist. This means examining questions such
as:
• The substance of ethical public health goals: to what ends
should public health activity be directed?
• The means by which public health agendas should be
achieved: what methods of intervention may, or may not,
be justified, and what further, non-health-related values
might sometimes take precedence?
• The reach of public health ethics: is an ethical mandate
from a public health perspective a compelling social and
political mandate overall?
• The relationship of public health practitioners, leaders and
advocates with communities and political agencies: what
interests are being represented, and what is the right level
of political independence?
• The need for ethics education and the development of
ethics as a competency: how do we understand such a
competency, and how is it best promoted within the pub-
lic health workforce?
We do not suggest that any of these questions will receive a
single, unanimously agreed answer. But consensus and lead-
ership are needed where they can be found, and such ques-
tions must be visited and revisited as the political and social
landscapes change, and as public health emergencies and
challenges arise. This editorial is a call to advance such
427
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discourse on public health ethics and law, with a view to pro-
viding both a point of reflection and a call to action.
The Journal of Public Health is accordingly planning a spe-
cial section on the ethical foundations of public health ethics
and law, and the implications for policy and practice.
Scholars, practitioners, leaders and policy makers are invited
to contribute articles, including research articles, perspec-
tives, and Chekhov’s corner. If you wish to submit a piece,
you are encouraged to consult Farhang Tahzib, farhang.
tahzib@gmail.com, on your proposed submission. However,
submissions will be made through the journal’s usual
Manuscript Central portal, by 15 January 2018.
John Coggon1, Farhang Tahzib2
1 7 Horton R. Offline: Where is public health leadership in England?
University of Bristol
2 Lancet 2011;378(9796):1060.
Public Heath Ethics Committee, Faculty of Public Health
Address correspondence to Farhang Tahzib, E-mail: farhang.
tahzib@gmail.com.
References
1 Thomas J, Sage M, Dillenberg J et al. Editorial—a code of ethics for
Public Health. Am J Public Health 2002;92(7):1057–9.
2 Coggon J, Viens AM. Public Health Ethics in Practice: A background
paper on public health ethics for the UK Public Health Skills and Knowledge
Framework. London: Public Health England, 2017.
3 Dawson A, Verweij M. Public health ethics: a Manifesto. Public Health
Ethics 2008;1(1):1–2.
4 Jennings B. Frameworks for ethics in public health. Acta Bioeth 2003;
9(2):165–76.
5 Coggon J. What Makes Health Public? Cambridge: Cambridge
University Press, 2012.
6 Gostin L, Wiley L. Public Health Law: Power, Duty, Restraint, 3rd edn.
Berkeley: University of California Press, 2016.
8 Davies L, Atherton F, Karunanithi S et al. Correspondence—
Leadership and public health. Lancet 2011;378(9805):1776.
9 Academy of Medical Sciences. Improving the Health of the Public by
2040. London: AMS, 2016.

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