The Moral Bases for Public Health Interventions

Members of the public health professions, practitioners and academicians alike, traditionally hold as their primary goals the development and dissemination of practices that will prevent disease and disability. Other aspects of public health, such as those relating to med? ical care access and costs, wax and wane in importance but remain secondary to disease prevention. This paper is focused on the traditional goals of public health. My principal purpose is to suggest the need for examining the moral underpinnings of the public health interven? tions that we endorse. I do not address the fashionable or timely intervention issues in public health but rather the permanent underpinnings that provide a framework for assessing the moral bases for a proposed intervention. There are three major reasons why most activities intended to prevent disease require an explicit moral justification: they are enforceable by the police power of the state; they are supported by taxes; and they are meddlesome or intrusive. Therefore, I suggest that a preventive intervention should be endorsed only by a person who can justify it to himself, or herself, in explicit moral terms. I describe the four major types of prevention activi? ties: education, policy advocacy, legislation, and re? search. The potential moral justifications for programs of these types are also presented and evaluated. The enhancement of the will of the individual, used to justify health education, is a highly moral justification when it is adhered to. Paternalism and the greatest for the greatest number of people are also moral justifi? cations in most instances. Other justifications, such as conserving government resources and doing good with funds raised through taxes, have a limited moral basis. Little has been written of the need for fundamental rationales for prevention programs. This void appears to reflect a perception that activities that are intended to do have a self-evident justification. However, al? though widely subscribed to in the public health com-