Ganges, Cambridge, Chicago, Edinburgh, Cambridge... Values and Public Health

Abstract

In the Indian epic, Mahabarata, on the eve of battle Arjuna, a great warrior, argues with Krishna, a deity in human form. The battle that is to take place is in the just cause of ousting usurpers to the throne. The problem for Arjuna is not the justice of the cause, but the fact that he will be responsible for great misery and slaughter. It is made worse in that some of the usurpers, that he will undoubtedly slay, are his relatives. Duty calls for him to fight. Concern at the consequences of fighting gives him pause. Krishna argues that he must do his duty regardless of the consequences. Arjuna worries about conse quences [1]. In traditional Indian religious thinking, Krishna's side of the argument - duty rather than consequences - is seen to have won. Amartya Sen takes issue with this. He lays claim to the importance of consequences in evaluating human action [2]. This debate of whether social action should pri marily be driven by concern with outcomes, the state of the public's health for example, or by doing the right thing such as respect for individual rights, is one of the great issues that Johan Mackenbach's Euro pean travels lead him to contemplate [3]. The other is the role of altruism in public health action. Both bear further examination. If Mackenbach's travels to lands real and imaginary lead him to consider the role of ideology in public health, in such an important way, then we should all make sure he keeps his passport up to date. Perhaps the rest of us need to get out more.