Yesterday I attended a symposium on public health ethics held at my university. It was an interesting experience, as like most sociologists I am not very familiar with the literature on public health ethics, although I have drawn upon some of it from time to time. However I am very interested in the moral, political — and yes, sometimes the ethical dimensions — of public health, and a great deal of my research has focused on these issues (for example, Lupton, 1995, 2012; Petersen and Lupton, 1997).
When listening to the presentations defining public health ethics, and later following up some of the literature mentioned in the symposium, it was apparent to me that academics writing in the public health ethics field also do not appear to read sociological analyses of public health (or if they do, they not cite them very often). So neither field is currently engaging with the other to any great extent. Why this lack of interaction, given that there are clear overlaps between the critical sociology of public health and public health ethics? The approach known as ‘critical public health ethics’ is especially close to the concerns of the critical sociology of public health as it tends to focus to a greater extent on the politics and power relations inherent in public health (Callaghan and Jennings, 2002). Both critical public health ethics and the critical sociology of public health are interested in how public health strategies and models affect individuals and populations; both want to engage in a critique of the taken-for-granted assumptions that pervade public health; both pay attention to the potential for injustice, excessive paternalism and constraint of freedom within public health approaches; both address the issue of why certain issues are identified as ‘public health problems’ and why others are ignored; and both draw attention to the focus on individuals’ health-related behaviours in public health and the need to highlight the broader social, cultural and political causes of ill-health and disease.
Probably the main reason for the lack of recognition of the literature on both sides is the different histories of public health ethics and the critical sociology of public health. Public health ethics is a very new field that grew from bioethics, a type of applied ethics. Public health ethics and bioethics are based very strongly on the underpinnings of traditional moral and political philosophy (Carter et al., 2012). As a result a lot of writing in public health ethics is preoccupied with distinguishing between the various philosophical approaches that can be used to evaluate public health strategies: for example, what insights a utilitarian, libertarian, human rights or distributive justice perspective may offer. Public health ethicists weigh up these various perspectives when evaluating the claims of public health and make decisions on what is the most ethical action based on their reasoning. They tend to publish their work in mainstream journals of public health or in specialist medical or public health ethics journals.
The critical sociology of public health has less of an applied focus than public health ethics, tending to focus more on the social structural features underpinning public health approaches and engaging in a more overtly political critique. Sociologists writing in this area usually position themselves outside of public health, while in contrast public health ethicists often position themselves inside public health as part of their role of attempting to advise on the best course of action. While sociologists may often refer to ‘ethics’, they are not generally concerned with comparing different ethical perspectives and evaluating them. They tend to have a far more relativist approach to ethics, and indeed may engage in an analysis of medical or public health ethical discourse itself as a socially constructed phenomenon (see, for example, Jallinoja, 2002).
Further, while the critical sociology of public health is also informed by philosophy, sociologists have taken up different theorists to conduct their analyses, drawn largely from what is often termed ‘grand theory’. In particular sociologists have employed the political economy approach influenced by Marxism and more recently the writings of Foucault on biopolitics, biopower, governmentality and the care of the self. The critical sociology of public health also has somewhat of a longer history than critical public health ethics. It has been in existence for some decades, as found particularly in articles published in the journal Critical Public Health, established in 1979 under the original title of Radical Community Medicine, but also in several other sociology journals. Sociologists of public health and public health ethicists therefore tend to publish in very different journals and as a result do not tend to routinely see each other’s work.
Despite their major differences (and perhaps because of these differences) it would be interesting to see how each field could gain from a greater engagement with and acknowledgement of each other’s work. It is intriguing to think about what synergies may be generated by such an engagement. I hope that this post represents one small step in this direction.
Callaghan, D. and Jennings, B. (2002) Ethics and public health: forging a strong relationship. American Journal of Public Health, 92, 169—76.
Carter, S., Kerridge, I., Sainsbury, P. and Letts, J. (2012) Public health ethics: informing better public health practice. NSW Public Health Bulletin, 23(5-6), 101—6.
Jallinoja, P. (2002) Ethics of clinical genetics: the spirit of the profession and trials of suitability from 1970s to 2000. Critical Public Health, 12(2), 103—118.
Lupton, D. (1995) The Imperative of Health: Public Health and the Regulated Body. London: Sage.
Lupton, D. (2012) Fat. London: Routledge.
Petersen, A. and Lupton. D. (1997) The New Public Health: Health and Self in the Age of Risk. London: Sage.