‘The science of social justice’: assuring the conditions for ethics and equity at the heart of public health
John Coggon, Farhang Tahzib
Abstract
As Charles-Edward A. Winslow famously characterized it a century ago, public health is a science and an art. In fact, with its aims of protecting and promoting health through ‘organized community efforts’,1 public health is a multiplicity of sciences and arts, comprising and combining approaches and understandings from across many areas of the health and social sciences, as well as arts and the humanities.2 Public health recommendations, in what is generally considered the ideal, rest on the best attainable scientific evidence, with randomized controlled trials typically seen as the gold standard of this. But such science alone cannot tell us where to direct our health research agendas or what to prioritize within them. Nor without more can it determine policy aims, allow an assessment of the appropriate means and mandates of law and governance for the public’s health or mediate between health and the other priorities of government.3 In practice, furthermore, methods are required for resolving disputes within the public health community. For example, the question whether we should treat e-cigarettes as a positive public health intervention or a malign threat to the public’s health is not one that can be answered without making value judgments. Nor can we avoid informed, critical evaluation of what we ought to do when the paired moral mandates of public health—protecting and improving health and reducing unfair health inequalities4—come into conflict with one another: for example, where a public information campaign on a problem such as excessive consumption of obesogenic foods and drinks will improve aggregate health outcomes but in so doing disproportionately benefits groups who are already better off in socio-economic terms.