The Philosophy of Public Health.
Article Type: Book review
Subject: Books (Book reviews)
Author: Zahradnik, Anne
Pub Date: 06/22/2010
Publication: Name: Journal of Health and Human Services Administration Publisher: Southern Public Administration Education Foundation, Inc. Audience: Academic Format: Magazine/Journal Subject: Government; Health Copyright: COPYRIGHT 2010 Southern Public Administration Education Foundation, Inc. ISSN: 1079-3739
Issue: Date: Summer, 2010 Source Volume: 33 Source Issue: 1
Topic: NamedWork: The Philosophy of Public Health (Nonfiction work)
Persons: Reviewee: Dawson, Angus
Accession Number: 250033494
Full Text: The Philosophy of Public Health, Angus Dawson, editor. Ashgate Publishing, Burlington, VT, 2009. 194 pages; $99.95, online $89.96 at; Hardback; ISBN 978-0-7546-6043-9.

This book is a compilation of papers originally presented at a 2006 UK conference of the Society for Applied Philosophy. The theme was the philosophy of public health. The editor's intent with this volume is to back up his, "... claim that there is something that we can coherently call a 'philosophy of public health'" (p. 3). Read individually, the wide-ranging collection of essays on topics as diverse as measuring the effects of public health activities, common good vs. privacy considerations, and equipoise in public health research does not obviously support Dawson's claim to coherence. Halfway through the book this reviewer was thinking it a bit disjointed. By the end of the volume, however, the essays taken as a whole come together to make up pieces of a quilt that does indeed help to position public health as, ".a rapidly growing area of applied ethics in its own right." (p. 10).

An introduction by Dawson cogently sets the stage, with his lucid arguments justifying a discussion of public health ethics connected to, but separate from, the existing discussion of both health care ethics and public administration ethics. For those who may be a bit rusty on the history of philosophy, he also provides a primer on the basic approaches to philosophical debate. The introduction by itself is a valuable addition to a course on public health ethics.

King's essay on Luck, Risk and Prevention (pp. 27- 36) is a particularly interesting in-depth examination of making hard choices to balance the social good derived from proactive public health preventive actions against the possible harm and problems resulting from preventive measures. King uses the construct of luck-egalitarianism to lead the reader through a lively discussion of luck v. choice as they affect health status, then brings in the affects of government intervention through public health policies intended to promote distributive equality.

A discussion of justice and individual choice within the context of public health policy is a frequent theme in other essays as well. For example, Holm, in Global Concerns and Local Arguments: How a Localized Bioethics may Perpetuate Injustice (pp. 63-72) considers the many potential negative side effects of the current applications of global bioethics. He presents the pros and cons of a universal approach to public health policy decisions from an objectivist viewpoint, proposing that a truly effective universal ethical framework prioritizes local needs and concerns. He states that most globalization efforts are insufficiently context sensitive, instead pushing, "specific answers to specific ethical questions" rather than taking into account the local sociocultural backdrop for the public health intervention, thereby ignoring the potential harm we may inadvertently cause.

Categories of Constraint and Avenues of Freedom: Proposing Collective Agency for Addressing Problems of Obesity by Womack (pp. 133-143) also considers the difficult balance between private choice and public health policy, focusing on the example of obesity. She addresses the interplay between causation, choice, and human agency in regard to obesity as they are balanced against the high social costs of this problem. In particular, she discusses the complex causality of obesity and the role of public health in controlling the presence of social cues without violating our cherished Western culture beliefs regarding individual rights. She argues, "Research that focuses on the features of the social structures in the community, rather than merely those of the individual, can better promote the general good of its members." (p. 143).

A major part of the engagement with this book springs from the current social context. It is interesting to get a mostly UK perspective on topics such as achieving true social equity in public health offerings and measuring the effects of public health programs while the over-charged rhetoric of the debate on health care reform swirls through the US. The specific examples in the essays make a fascinating counterpoint to the sweeping, often inaccurate, generalizations about other countries' health care systems in the daily news. The emphasis on thinking about preventive care instead of acute care is a particularly important lesson for those in the process of developing US health care policy. A recurring theme in cost-savings discussion is moving our system from an acute care to a preventive care emphasis. Balancing individual choice and public good decisions is an emotional undercurrent in that debate.

Virtually every private and nationalized health care system in the world is currently under the microscope due to resource scarcity. Therefore, the book's strengths lie in its timeliness as we grapple with such important issues as individual choice v. cost-saving social good while we consider health policy reform and the role of public health. The book's weakness lies in the breadth of the topics covered. The essay's far ranging ideas necessarily mean the examination of each topic is just a taste of the issues rather than an in-depth discussion. Generally, however, the examples provided are engaging and the arguments presented are readable and directly relevant to current debates. This book is a worthwhile tour of topics for the policy analyst, public health professional or interested academic. It would also be useful as dialogue-inspiring text in a graduate health policy or public health ethics class.


Long Island University--Brooklyn
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