Public Health as a Common Good

Abstract

The dominant concept in the moral philosophy of the past three centuries in Western countries has been the pursuit of happiness. The main interpretation of this concept, which found complete expression in neo-liberalism , is the conception of John Locke, according to whom the pursuit of happiness can be obtained in particular through private initiative, i.e. the private use of land and natural resources. This is at the root of some of the moral dilemmas facing us today, which come from what we could call the “individualist turn” of neo-liberalism. This tendency is translated at the level of government/institutions in the individualised promotion of health rather than in structural actions to prevent disease; in the at times uncritical spread of predictive medicine (including genetic tests); in the privatisation of water; and even in the patentability of genes and parts of the body. Another philosophical issue—related to liberal thinking—that is relevant to health and particularly to primary prevention is the interference of the State with individual choices, which is contemptuously defined “the role of the nanny-State ”. Stuart Mill coined the “harm principle ”; i.e. as a general rule a government cannot exercise coercion on the individual to protect her from herself. The only purpose for which power can be exercised on any member of a civilised community, against her will, is to prevent harm to others. The debate around the nanny-State has become hot in recent years after the implementation of public health measures, e.g. in New York. This chapter discusses critically the concept of “freedom of choice ”, which is often at odds with public health promotion. Also, following the teaching of a contemporary American philosopher, Michael Sandel, we have to reflect whether by entrusting the potential of biomedical technologies only to market forces we want to aim more for the individual skill of adaptation and self-promotion or reinforce everyone, including the less fortunate.