What is Public-Health-Ethics?

Public health ethics deals with all topics in the field of public health, i.e. population-related health, from an ethical perspective. It incorporates empirical findings, e.g. from the fields of public health, sociology, medicine, psychology, politics, and also works empirically itself (e.g. by means of qualitative interviews). It always includes normative theories and concepts (e.g. from the field of political philosophy, theories of justice, ethics) and discusses ethical values and possible tensions.

A core topic of public health ethics is the discussion of justice, or also: "health equity". What does justice mean in relation to health? What health inequalities are unjust? How can "justice" as a value be better implemented in health? Related to this, the relationship between the individual and society is also discussed. How do individual values relate to collective, community-oriented values? Who bears responsibility for health or for healthy living conditions and equitable opportunities for health?

Public health ethics also stands at the interface between health policy and population health and can thus play a mediating and constructive role.

The public health ethics perspective is particularly interesting in many respects with regard to the Corona pandemic or climate change. The more individualistically oriented medical ethics reaches its limits here. Public health ethics with its population-based perspective, including issues such as participation, policy/governance, proportionality of measures, marginalisation of disadvantaged groups, etc., can make a significant contribution here. But the role of physicians also comes into view: What responsibility does this profession bear in the face of such social crises?

Prominent topics in public health ethics are, for example:

  • Ethical issues in environmental factors and climate change; digitalised health; obesity; tobacco use; communicable diseases; mental health; migration, etc.
  • Ethical discussion of interventions: e.g. prevention, vaccination, health incentives, nudging, mobile health applications (health apps, social media), public health research, surveillance, screening, etc.
  • Theories of public health ethics
  • Methods of public health ethics
  • History of public health ethics
  • Definition and delimitation of public health ethics
  • Health and personal responsibility
  • Paternalism and freedom
  • Health and justice
  • Vulnerability, stigmatisation, discrimination in public health
  • Social determinants of health and health equity
  • Right to health / health as a human right
  • Norms and implementation of health policy and governance
  • Ethics and justice in global health
  • Ethics in humanitarian operations and disaster management
  • Allocation and resource justice
  • Participation and inclusion as substantive and procedural values in public health

Public health ethics is also a component of medical studies at the University of Augsburg. The aim is to show that medicine always takes place in a larger social, political and health context. The public health ethics perspective opens the view beyond the individual clinical setting and integrates the population-related dimension. In Germany, the public health ethics perspective is still a novelty in medical studies.

Public health ethics is also taught in public health degree programmes. However, there are few structured curricula in Germany so far. A very good example can be found at the University of Bremen.

Public health ethics is often also part of philosophy/ethics education, especially in English-speaking countries.

The English-language literature in the field of public health ethics is already very differentiated, although the subject is comparatively young. The current state of research is reflected in the journal Public Health Ethics ( https://academic.oup.com/phe). The entry in the Stanford Encyclopedia on Public Health Ethics ( https://plato.stanford.edu/entries/publichealth-ethics/) is a very good introduction to the field and also lists many relevant literature sources. The expertise in Germany is still being developed, but there are already good German-language sources:

  • Mielck Andreas, Wild Verina. Gesundheitliche Ungleichheit – auf dem Weg von Daten zu Taten: Fragen und Empfehlungen aus Sozial-Epidemiologie und Public Health-Ethik. Weinheim: Juventa; 2021.
  • Schröder-Bäck, Peter, and Joseph Kuhn. 2016. Ethik in den Gesundheitswissenschaften: Eine Einführung. 1st ed. Weinheim Basel: Beltz Juventa.
  • Buyx, Alena, and Stefan Huster. 2010. Ethische Aspekte von Public Health. Themenheft Ethik in der Medizin. Band 22, Heft 3. Sept 2010
  • Schröder-Bäck, Peter. 2014. Ethische Prinzipien für die Public-Health-Praxis: Grundlagen und Anwendungen. 1st ed. Frankfurt am Main: Campus Verlag.
  • Strech, Daniel, and Georg Marckmann. 2010. Public Health Ethik. 1., Aufl. Münster: LIT.