The Ethics of Public Health Paternalism

Abstract

The Ethics of Public Health Paternalism is about policies that try to stop people damaging their own health. From the point of view of public health advocates, if people did not smoke, or drank less alcohol, or kept off junk food and sugary liquids, they would tend to be healthier. Hence such tactics as taxing tobacco, restricting the sale of alcohol, and limiting the density of fast-food outlets. These tactics are often pejoratively described as the actions of a ‘nanny state’ that overvalues health and wrongly infringes on the autonomy of adults. But many of us want to be healthy rather than ill, and alive rather than dead. Does a state really nanny us when it uses its power to make us healthier? If it does, should it stop? Some public health policies might reduce inequities of health, or save costs in medical treatment, or correct market failures. But, as this book shows, many would not. The best case for many public health interventions is paternalistic, aiming to steer people away from making unhealthy choices against their own interests. But even though it is the best case, it often fails. It advocates overvalue health and undervalue autonomy. They exaggerate the influence of addiction and the marketing of unhealthy products. Except for smoking, we do not have the evidence needed to show that unhealthy choices are so mistaken as to justify the interventions. Many public health interventions probably make their targets worse off and infringe on their autonomy without having compensating benefits to other people.