Abstract
This paper constructs a conceptual framework for the normative study of public health. It argues that to develop discussions of ethics in public health without paying attention to the broader theoretical and ideological context of public health controversies and social conflicts will be of limited value. In defining that context, the author distinguishes three main types of ethical theory-utilitarianism, contractarianism, and communitarianism; and several varieties of political theory -liberal welfarism, liberal egalitarianism, libertarian liberalism, deliberative democracy, civic republicanism, and cultural conservatism. The meanings and interconnections of these theory formations are discussed. Illustrations to particular public health programs and issues are given. The paper also distinguishes four different types of applied ethical discourse in public health-professional ethics, advocacy ethics, applied ethics, and critical ethics. Each of these modes of ethics is important, but the development of work in critical ethics is the most important priority within the normative study of public health at present.
Highlights
In this essay I propose one conceptual framework to guide the development of normative and interpretive studies in public health
Some of the best examples of public health practice, from this point of view, grow out of efforts to support communities in being places of mutual support, respect, and self-esteem, thereby reinforcing health promoting behaviors among their individual members[37]. These different types of ethical analysis distinguish between the ethics of public health, and the ethics within public health
There may well be a tension between the general values of society and the special values of public health
Summary
Resumen: Este texto construye un marco conceptual para el estudio normativo de la salud pública. Argumenta que desarrollar discusiones sobre la ética en salud pública será de escasa utilidad si no se presta atención al contexto más amplio, teórico e ideológico, de las controversias en salud pública y a los conflictos sociales. En la definición de ese contexto, el autor distingue tres tipos principales de teorías éticas –utilitarianismo, contractarianismo y comunitarianismo– y diversas variantes de teoría política –liberalismo del bienestar, liberalismo igualitario, liberalismo libertario, democracia deliberativa, republicanismo cívico y conservatismo cultural–. El artículo también distingue cuatro tipos de discurso de ética aplicada en salud pública: ética profesional, ética de la abogacía, ética aplicada y ética crítica. Cada uno de ellos es importante, pero el desarrollo del trabajo en ética crítica constituye la prioridad más importante dentro del estudio normativo de la salud pública en la actualidad. Palabras clave: Salud pública, ética, liberalismo, derechos, comunitarianismo, utilitarianismo, contractarianismo, promoción de la salud, vigilancia en salud pública
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