It would be very odd to insist that clinical health professionals should be mindful of, and conscientious about, the ethical issues raised in their one-to-one clinical encounters without setting similar expectations for those who work with whole populations. But – as I will suggest (and indeed this book shows more generally) – public health ethics raises many deep-seated and testing philosophical and practical challenges and those who work in, and are concerned with, public health have plenty of important things to be getting on with, without getting bogged down in an academic ethics seminar. So can we develop the field of public health ethics in a way that does justice to the imperatives of ethics and the imperatives of public health? Can we have an ethics for public health? With these questions in mind I will use this chapter to briefly review some of the philosophical, methodological, professional and policy challenges raised by the project of public health ethics.

Ethics avoidance

One way to deal with the many challenges inherent in public health ethics is to engage in what I will call – just to be slightly provocative – ‘ethics avoidance’. This is a widespread phenomenon both inside and outside public health contexts. Ethics avoidance encompasses a range of potential strategies. Here I will just mention three popular strategies which can be combined in various ways. First, there is ‘technicism’ – this means treating all issues as if they were fully susceptible to technical reasoning and practical problem-solving techniques. For example, given that we are committed to reducing population levels of morbidity and mortality (and/or some other end) then we must focus on identifying and implementing the best evidence-based methods of achieving this (or other) end. This latter can then be treated essentially as a scientifictechnical question which we can – and arguably should – address without being distracted by ethical speculations. Second, there is an approach that might be called ‘conformism’ or ‘compliance’ and rests on an appeal to social and political authority. This approach consists in saying “It is not up to me to decide what ought to be done. Other people (managers, official agencies, the government) are properly charged with that kind of responsibility.