How to Think about Health Promotion Ethics
Author: Stacy M. Carter, BAppSci, MPH(Hons), PhD Alan Cribb, BA, PhD, John P. Allegrante, BS, MS, PhD
Carter SM, Cribb A, Allegrante JP. How to think about health promotion ethics. Public Health Reviews. 2012;34: epub ahead of print.


Health promotion ethics is moral deliberation about health promotion and its practice. Although academics and practitioners have been writing about ethics, and especially values, in health promotion for decades, health promotion ethics is now regaining attention within the broader literature on public health ethics. Health promotion is difficult to define, and this has implications for health promotion ethics. Health promotion can be approached in two complementary ways: as a normative ideal, and as a practice. We consider the normative ideal of health promotion to be that aspect of public health practice that is particularly concerned with the equity of social arrangements: it imagines that social arrangements can be altered to make things better for everyone, whatever their health risks, and seeks to achieve this in collaboration with citizens. This raises two main ethical questions. First: what is a good society? And then: what should health promotion contribute to a good society? The practice of health promotion varies widely. Discussion of its ethical implications has addressed four main issues: the potential for health promotion to limit or increase the freedom of individuals; health promotion as a source of collective benefit; the possibility that health promotion strategies might “blame the victim” or stigmatise those who are disabled, sick or at higher risk of disease; and the importance of distributing the benefits of health promotion fairly. Different people will make different moral evaluations on each of these issues in a way that is informed by, and informs, their vision of a good society and their understanding of the ends of health promotion. We conclude that future work in health promotion ethics will require thoughtfully connecting social and political philosophy with an applied, empirically informed ethics of practice.

Keywords: Ethics, health education, health promotion, moral philosophy, political philosophy, public health,

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Stacy M. Carter, BAppSci, MPH(Hons), PhD

NHMRC Career Development Fellow, Centre for Values, Ethics and the Law in Medicine, School of Public Health, The University of Sydney, Australia.

Alan Cribb, BA, PhD

Professor of Bioethics and Education, Centre for Public Policy Research, King’s College, London, UK.

John P. Allegrante, BS, MS, PhD
Professor of Health Education and Deputy Provost, Teachers College, Columbia University, USA.
Adjunct Professor of Sociomedical Sciences in Public Health, Mailman School of Public Health, Columbia University, USA.

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