The Goals of Public Health and the Value of Autonomy
Christian Munthe
Dept. of Philosophy, Göteborg University
Presented at Public Health 2004: Annual sacientific Meeting of the UK
Faculty of Public Health, Edinburgh, June 8-10, 2004
Public health is often distinguished from heaslth care in that it is
said to serve more 'collective' goals, such as 'the common good' rather
than the good of individual people. However, it is not clear what this
good is supposed to be (although it is supposed to be 'common'). In
regular health care we see in the West a gradual expansion of
traditional goals exclusively in terms of length and quality of life to
goals having to do more with autonomy - the ability of people to
control and direct their own lives. This has lead to a number of
questions regarding how such an ethical ideal of promotion of autonomy
may be construed, whether or not it really is an ideal, what practical
consequences it has etc.
A similar shift may be detected or at least anticipated in public
health, for example, when the goals (as in Sweden and a few other
countries!) are formulated not in terms of good health, but ability to
attain good health or something similar. Obviously, the ideal then is
that public health-work shopuld promote this ability but not
necessarily that it is actually used so that good health is in fact
attained. That is, it is seen as a value as such that people's
capacities of controlling and directing their own lives in relation to
health are promoted. However, in other countries, this expansion of the
goals towards a more autonomy-oriented approach cannot be found. This
means not only that a similar discussion as the one in regular medical
ethics regarding the nature, value and consequences of a goal to
promote autonomy is actualised also in public health, but also that, in
the public health field, we need to address the further issue of
whether or not differences between countries (for example, regarding
economic development) may justify differences as to wehtehr or not the
just mentioned expansion of the goals of public health is accepted and
implemented or not.
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