Abstract
Spectacular achievements in the health of individuals have not been matched by equivalent improvement in the health of whole populations. Indeed it is against the background of deterioration in levels of population health in some parts of the world and the emergence and re-emergence of infectious diseases in association with powerful globalizing forces that there has been a recrudescence of interest in ‘Public Health'. Here attention is drawn to the dominant values that have shaped our world, to the differences between broad and narrow definitions of public health, to some values that need to be promoted, and to an ethic of public health that considers both human rights and human needs.
Highlights
Spectacular achievements in the health of individuals as a result of the application of many major biomedical advances are the hallmark of medicine at the beginning of the 21st century
The world is changing rapidly, with new threats arising to human health at both individual and population levels, and new ideas are needed to make moral and social progress
The recent report from the US Council of Foreign Relations and the Milbank Memorial Fund acknowledges the relationships between health and social capital, political stability, the economy and war[41].This could facilitate deeper commitment by the USA and other nations to the moral and strategic importance of improving global health
Summary
Spectacular achievements in the health of individuals as a result of the application of many major biomedical advances are the hallmark of medicine at the beginning of the 21st century. Extension of the ethics discourse beyond the doctor-patient relationship should include considerations of order and fairness within institutions that serve the communities in which individuals are socially embedded and in which medical practice is ‘constructed’(4,18) The responsibility of physicians here must be viewed more broadly to include concern for equitable access to health care, for improved public health and for the allocation of scarce resources in ways that promote the common good. Essential steps will include: firstly, acquiring deeper insight into the upstream causal factors influencing public health; secondly acknowledging the need for a new balance between individual and population health; thirdly, developing the political will to undertake ambitious projects (for example, seeking ways of reducing poverty and dependency and of increasing access to health care); and, placing high value on the longer term economic and social justice required for meaningful and sustainable progress. A theory of human need provides the justifying framework for such an approach[40]
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