Public Health Ethics: Theory, Policy, and Practice: Edited by Ronald Bayer, Lawrence O. Gostin, Bruce Jennings, and Bonnie Steinbock

Abstract

Theory, Policy, and Practice (5) is edited and composed by scholars who are internationally recognized for their work in public health policy, ethics, and health law. This anthology provides an engaging overview of the emerging field of public health ethics. It includes selected articles that were previously published over the period 1985-2004, including articles written by one or more of the editors. An introductory chapter provides an overview of public health ethics and describes the rise of interest in this field in recent decades. As the editors explain, ''Today there is rapidly growing interest within the field and profession of public health in those ethical issues and perspectives that may be said to be distinctive to public health and to set it apart from the perspective of clinical medicine'' (5, p. 4). Key concepts such as ethical relativism and ethical theories (for example, utilitarianism and Kantian ethics) are also briefly described. The remainder of the book is divided into six parts: 1) the public health perspective, 2) autonomy and paternal-ism, 3) justice and health, 4) infectious disease: coercion and the protection of society, 5) regulation and environmental and occupational health, and 6) genetics and public health. Part 1, on the public health perspective, includes articles that do not directly relate to public health ethics-for example, Geoffrey Rose's classic article ''Sick individuals and sick populations'' (6)-but were included by the editors in order to explain the broader context to persons who may not be intimately familiar with public health concepts and perspectives. The articles included in part 2 deal more directly with important issues in public health ethics, such as the need to avoid blaming individuals for illnesses that are probably due to a variety of causes, including societal influences. The most valuable section of the book is likely to be part 3, which includes several excellent articles on justice and health written by British and American authors. As the editors note, ''Ethical questions of justice are central to the design and workings of various institutions and programs (whether involving service delivery, education, or access to resources), and these are often the key objectives of policy analysis and implementation in public health'' (5, p. 167). Articles by Angus Deaton (7), Richard Wilkinson (8), and Norman Daniels and colleagues (9), which provide insights for classroom discussion and debate, highlight the social determinants of health disparities, including the linkages between income, education, social class, and health identified in epidemiologic studies. The article by Daniels et al. (9) draws upon the theory of justice proposed by John Rawls (10) in examining ethical considerations in health inequalities and inequities, as well as policy questions about how best to address socioeconomic inequalities. These important articles (7-9) do not have the benefit of more recent scholarly works on public health, justice, and health equity (11, 12), which highlights the potential disadvantages of an anthology of articles published during an earlier time period. With respect to other limitations, the book largely ignores the sizeable body of literature on professional ethics in epidemiology and other public health disciplines, which arguably constitutes an important part of the literature on public health ethics. The literature on the ethics of human subjects research in epidemiology and public health is also neglected. Despite these oversights, this book is likely to interest a broad range of readers, including many practicing epidemi-ologists and other public health professionals and students in graduate training programs. The book is likely to be a useful adjunct to courses on public health theory and practice, health policy, public health ethics, and health equity. ACKNOWLEDGMENTS