Ethical issues in public health promotion

Abstract

Health promotion is a key element of public health practice. Among strategies aiming to deal with public health problems, health promotion purports to help people achieve better health. Health promotion can significantly alter people's lifestyles, and three main ethical issues relate to it: (i) what are the ultimate goals for public health practice, i.e. what 'good' should be achieved? (ii) how should this good be distributed in the population? and (iii) what means may we use to try to achieve and distribute this good? The last question is the subject of this article. Concerns raised about health promotion can be divided into two groups: (i) efficacy-based considerations - are they cost-effective or costineffective? and (ii) autonomy-based concerns - (to what extent) do they interfere with free choice, i.e. do they attempt to direct social values and lifestyles? Ways in which an individual's autonomy may be compromised by means of influencing behaviour change are considered.