Public Health Ethics: Mapping the Terrain

30 (2002): 170 –178.© 2002 by the American Society of Law, Medicine & Ethics.ublic health ethics, like the field of public health itaddresses, traditionally has focused more on practiceand particular cases than on theory, with the resultthat some concepts, methods, and boundaries remain largelyundefined. This paper attempts to provide a rough concep-tual map of the terrain of public health ethics. We begin bybriefly defining public health and identifying general fea-tures of the field that are particularly relevant for a discussionof public health ethics.Public health is primarily concerned with the health ofthe entire population, rather than the health of individuals.Its features include an emphasis on the promotion of healthand the prevention of disease and disability; the collectionand use of epidemiological data, population surveillance,and other forms of empirical quantitative assessment; a rec-ognition of the multidimensional nature of the determinantsof health; and a focus on the complex interactions of manyfactors — biological, behavioral, social, and environmental— in developing effective interventions.How can we distinguish public health from medicine?While medicine focuses on the treatment and cure of indi-vidual patients, public health aims to understand andameliorate the causes of disease and disability in a popula-tion. In addition, whereas the physician-patient relationshipis at the center of medicine, public health involves interac-tions and relationships among many professionals andmembers of the community as well as agencies of govern-ment in the development, implementation, and assessmentof interventions. From this starting point, we can suggestthat public health systems consist of all the people and ac-tions, including laws, policies, practices, and activities, thathave the primary purpose of protecting and improving thehealth of the public.