This chapter reframes the project of public health within a rights framework. It argues that there is a right to health, and this entails that individuals have a right to public health. Given that there is a right to public health, the state should undertake to reduce health risks. If a state does not take easy steps to reduce risks to health, and as a result allows significant numbers to come to harm or even death, then it violates individuals’ right to public health, and should be criticized as a Neglectful State. The ethical challenge of public health policy is therefore not the one-sided one of avoiding Nannying, but the more complex task of steering a course between Nannying and Neglect. Avoiding Neglect may involve restricting liberty in various ways.
An understanding of what influences policy decisions, what determines investments for specific public health interventions, and how agreements are made regarding new programs in public health is crucial for helping navigate the ethical implications of public health programs and interventions. This chapter provides an overview of the Public Health Policy and Politics section of The Oxford Handbook of Public Health Ethics. The section’s overall goal is to highlight ethical issues emerging from the work in, and study of, politics and policy development in public health, both within countries and globally. The chapters in this section analyze a set of ethical issues related to politics and public health policies, interventions, and programs, and emphasize the importance of communication among various disciplines, such as bioethics, political science, and development studies.
In recent years, a number of prominent scholars have touted the use of litigation as an effective tool for making public health policy. For example, Stephen Teret and Michael Jacobs have asserted that product liability claims against car makers have played a significant role in reducing automobile-related injuries, Peter Jacobson and Kenneth Warner have argued that litigation against cigarette manufacturers has advanced the cause of tobacco control, and Phil Cook and Jens Ludwig have suggested that lawsuits against the firearms industry can reduce gun violence. Critics have attacked this use of litigation as doing more harm than good to public health and as a misuse of the courts. This debate involves two distinct controversies: one over whether the public health benefits of litigation outweigh its costs and the other over the proper role of courts within our system of government.
The Public Health Responsibility Deal: how should such a complex public health policy be assessed?