Health promotion and the common good: Towards a politics of practice

One of the ethical dilemmas facing health promotion and disease prevention (HP/DP) practitioners is ensuring that programmes undertaken in the name of health as a ‘common good’ do not unnecessarily restrict individual liberties. This dilemma is compounded by theories of the common good being essentially normative and broadly categorized as libertarian (individual rights) or social justice (collective responsibilities). Both of these common good theories are described and critiqued. While the libertarian theory offers an important caution against the tendency of state institutions to undermine individual autonomy, a social justice theory is more consistent with research on health determinants and the historical practice of public health. The problem of individual liberties becomes most acute when HP/DP is restricted to efforts to curb or proscribe individual health behaviours. A social justice approach to HP, however, must be complemented by a ‘deliberative democratic’ practice. Such a practice recognizes the contingency involved in most HP/DP decision making, and the need for inequalities in opportunity for poor or socially disadvantaged (oppressed) groups in order to achieve greater equality in health outcomes. The argument presented draws primarily from debates within the public health, health promotion and disease prevention literature, and is illustrated by reference to two recent attempts in Canada to formulate ethical principles for health promotion practice.