Public Health Ethics: A UK Perspective

Some public health measures restrict personal freedom more than others and deciding what kind of measure will be appropriate and effective has long been a problem for policy makers. Existing bioethical frameworks are often not well suited to address the problems of public health.
The UK-based Nuffield Council on Bioethics set up an expert Working Party in January 2006 to examine the ethical issues surrounding public health. Following evidence gathering and a public consultation, the Council published its conclusions and recommendations in the report Public health: ethical issues in November 2007.

A spectrum of views exists on the relationship between the state’s authority and the individual. The Council set out a proposal to capture the best of the libertarian and paternalistic approaches, in what it calls the Stewardship Model. The Model suggests guiding principles for making decisions about public health policies and highlights some key principles, including: Mill’s harm principle, caring for the vulnerable, autonomy and consent. An ‘intervention ladder’ is also proposed, which provides a way of thinking about the acceptability of different public health measures. The report then applies these principles to a number of case studies: infectious disease, obesity, alcohol and tobacco, and fluoridation of water supplies. Recommendations for policy and practice were given for each.
In the year after publication, there were significant UK policy developments in each of the case study areas, many of them along the lines of the recommendations in the Nuffield report. This talk will summarise those developments and also what further action the Council would like to see from the UK Government and others in future.