It is an imperative within health care, medicine, and public health to restore, preserve, and enhance health. Therefore, it is important to determine what kinds of enhancement are increases in health and what kinds are not. Taking as its point of departure two conceptions of health, namely, “manifest health” and “fundamental health,” the paper discusses various means used to enhance ability and well-being, and if those means, such as wheelchairs, implants, medicines, stimulants, or narcotics, enhance health. The fact that some (...) means that enhance ability or well-being are not usually considered health enhancing, for example, narcotics, constitutes a problem. The paper ends with a discussion of some suggestions about how to distinguish between those enhancements that are health related and those that are not. One plausible idea holds that an enhancement is health related when the substance, or aid, increases ability or well-being, is integrated into the body, and does not harm the individual’s fundamental health. (shrink)

There are several strategies to promote health in individuals and populations. Two general approaches to health promotion are behavior change and empowerment. The aim of this article is to present those two kinds of strategies, and show that the behavior-change approach has some moral problems, problems that the empowerment approach (on the whole) is better at handling. Two distinct ‘ideal types’ of these practices are presented and scrutinized. Behavior change interventions use various kinds of theories to target people’s behavior, which (...) they do through information, persuasion, coercion and manipulation. Empowerment is a collaborative method where those ‘facilitated’ participate in the change process. Some ethical problems with the behavior-change model are that it does not sufficiently respect the right to autonomy of the individuals involved and risks reducing their ability for autonomy, and that it risks increasing health inequalities. Empowerment, on the other hand, respects the participant’s right to autonomy, tends to increase the ability for autonomy, as well as increasing other coping skills, and is likely to reduce inequalities. A drawback with this approach is that it often takes longer to realize. (shrink)

One important ethical issue for health promotion and public health work is to determine what the goals for these practices should be. This paper will try to clarify what some of these goals are thought to be, and what they ought to be. It will specifically discuss two different approaches to health promotion, such as, behavior change and empowerment. The general aim of this paper is, thus, to compare the behavior-change approach and the empowerment approach, concerning their immediate goals or (...) aims, and to morally evaluate the strengths and weaknesses of these two goal models, in relation to the ultimate goal of health promotion. The investigation shows that the behavior-change approach has several moral problems. First of all, it is overly paternalistic and often disregards the individual’s or group’s own perception of what is important—something that also increases the risk of failed interventions. Furthermore, it risks leading to ‘victim blaming’ and stigmatization, and to increased inequalities in health, and it puts focus on the ‘wrong’ problems, i.e., behavior instead of the ‘causes of the causes’. It is thereafter shown that the empowerment approach does not have any of these problems. Finally, some specific problems for the empowerment approach are discussed and resolved, such as, the idea that empowering some groups might lead to power over others, the objection that the focus is not primarily on health, and the fact that empowered people might choose to live lives that risk reducing their health. (shrink)

Although employed throughout health-related rhetoric and research today, prevention it is an ambiguous and complicated category when applied to mental and behavioral health. It is analyzed here, along with four ethical issues arising when public health preventative methods and goals involve mental health: age of intervention; resource priorities between prevention and treatment; substantive issues in preventive pedagogies and trade-offs framed by differences of approach. Illustrations include some of the most widespread and ambitious recent preventive models: those aiming to avert subsequent (...) mood disorders of depression and anxiety; those that would curb self-harming behavior, and efforts to anticipate and avoid or delay psychosis. To suppose that public mental health can be entirely modeled on other public health programs is mistaken. Instead, it must proceed with awareness of the particular features typifying many mental disorders. These include features of the disorders themselves; the preliminary nature of scientific knowledge about them; the contested applicability of traditional disease models to them; the dearth of established research data available about preventive interventions currently in place or proposed; and the effects of stigma and discrimination on any such interventions. (shrink)

Attention to individual choice is a valuable dimension of public health policy; however, the creation of effective public health programmes requires policy makers to address the material and social structures that determine a person’s chance of actually achieving a good state of health. This statement summarizes a well understood and widely held view within public health practice. In this article, we (i) argue that advocates for public health can and should defend this emphasis on ‘structures’ by reference to citizen autonomy (...) and not simply by emphasizing concern for counter-balancing values such as ‘population health’ or ‘fairness’, (ii) map and critically explore the contrasting conceptions of autonomy that feature in such debates, with particular attention to conceptions of autonomy that might feature in the defence of an emphasis on structures. We draw on (i) a relational conception of autonomy and (ii) the distinction that can be made between autonomous deliberation and autonomous action to suggest that offering people the opportunity to make choices about their health without also supporting their capability to achieve the object of these choices falls short of what is often considered to be morally and politically important about promoting autonomy in relation to health. (shrink)

This article highlights the limitations of the tendency to frame health- and wellbeing-related digital tools (mHealth technologies) as empowering devices, especially as they play an increasingly important role in the National Health Service (NHS) in the UK. It argues that mHealth technologies should instead be framed as digital companions. This shift from empowerment to companionship is advocated by showing the conceptual, ethical, and methodological issues challenging the narrative of empowerment, and by arguing that such challenges, as well as the risk (...) of medical paternalism, can be overcome by focusing on the potential for mHealth tools to mediate the relationship between recipients of clinical advice and givers of clinical advice, in ways that allow for contextual flexibility in the balance between patiency and agency. The article concludes by stressing that reframing the narrative cannot be the only means for avoiding harm caused to the NHS as a healthcare system by the introduction of mHealth tools. Future discussion will be needed on the overarching role of responsible design. (shrink)

In the case discussion, ‘Equity in Public Health Ethics: The Case of Menu Labelling Policy at the Local Level’ , Mah and Timming state that menu labelling would ‘place requirements for information disclosure on private sector food businesses, which, as a policy instrument, is arguably less intrusive than related activities such as requiring changes to the food content’. In this commentary on Mah and Timming’s case study, I focus on discussing how menu-labelling policy permits governments to avoid addressing the heart (...) of the problem, which is high-calorie, high-sodium restaurant food. Menu labelling policy does not address food content in a way that is meaningful for change, instead relying on individuals to change their behaviour given new information. Besides having questionable efficacy, this raises concerns about moralizing food choices. (shrink)

Social networking sites (SNS) are of increasing importance for adolescents’ social life. As adolescents are prone to display risky health behavior in the offline world, it is likely that they use their online profiles and communications to report on unhealthy behaviors, too. This may in turn enhance the perceived attractiveness of risky behavior within the adolescent cohort. Drawing on the insights of impression management theory, we argue in this article that adolescents use a variety of impression management tactics in their (...) SNS profiles and communications. Following this assumption, our empirical analysis of 5851 Facebook posts (profile texts, comments, photographs, etc.) shows that the users tend to associate risky health behaviors with positive attributes, such as accomplishment or sociability, to present themselves in an attractive way to their online peer audience. We argue that this raises two ethical issues relevant to health promotion: Adolescents’ health may be challenged by interaction on SNS, as their engagement in online impression management blanks out any health problems or critical assessments of risky health behavior. At the same time, the semi-public nature of the communication arena re-enforces the tendency to value unhealthy behavior as more attractive than in offline social interactions. (shrink)

Health communication researchers and practitioners continue to debate about the types of influence that are appropriate in health promotion. A widely held assumption is that health campaigns and communicators should respect the autonomy of their audiences, and that the most appropriate way to do so is to persuade them by means of truthful substantive information. This approach to ethical persuasion, though, suffers from certain blind spots. To account for circumstances when respecting autonomy might take a back seat to other ethical (...) considerations, a comprehensive framework for the ethics of health communication needs to acknowledge types of communication that aim to do something other than provide substantive information (disclosive and directive communication), and subjective circumstances when people are not motivated to process information or make active choices (low processing motivation and decision aversion). (shrink)

Health-promoting nudges have been put into practice by different agents, in different contexts and with different aims. This article formulates a set of criteria that enables a thorough ethical evaluation of such nudges. As such, it bridges the gap between the abstract, theoretical debates among academics and the actual behavioral interventions being implemented in practice. The criteria are derived from arguments against nudges, which allegedly disrespect nudgees, as these would impose values on nudgees and/or violate their rationality and autonomy. Instead (...) of interpreting these objections as knock-down arguments, I take them as expressing legitimate worries that can often be addressed. I analyze six prototypical nudge cases, such as Google’s rearrangement of fridges and the use of defaults in organ donation registration. I show how the ethical criteria listed are satisfied by most—but not all—nudges in most—but not all—circumstances. (shrink)

Fear appeals are used in many domains. Cybersecurity researchers are also starting to experiment with fear appeals, many reporting positive outcomes. Yet there are ethical concerns related to the use of fear to motivate action. In this paper, we explore this aspect from the perspectives of cybersecurity fear appealdeployersandrecipients. We commenced our investigation by considering fear appeals from three foundational ethical perspectives. We then consulted the two stakeholder groups to gain insights into the ethical concerns they consider to be pertinent. (...) We first consulteddeployers: (a) fear appeal researchers and (b) Chief Information Security Officers (CISOs), and then potential cybersecurity fear appealrecipients:members of a crowdsourcing platform. We used their responses to develop aneffects-reasoning matrix, identifying the potential benefits and detriments of cybersecurity fear appeals for all stakeholders. Using these insights, we derived six ethical principles to guide cybersecurity fear appeal deployment. We then evaluated a snapshot of cybersecurity studies using the ethical principle lens. Our contribution is,first, a list of potential detriments that could result from the deployment of cybersecurity fear appeals andsecond, the set of six ethical principles to inform the deployment of such appeals. Both of these are intended to inform cybersecurity fear appeal design and deployment. (shrink)

There is a large literature exploring the concept of ‘health promotion’. However, the meaning of the term remains unclear and contested. This is for at least two reasons. First, any definition of ‘health promotion’ is going to have to outline and defend an account of the notoriously controversial concept of ‘health’, and then suggest how (and why) we should promote it. Second, health promotion clearly has some overlap with ‘public health’, but it is far from clear how they are related. (...) Is health promotion part of public health or is health promotion a radically different type of activity from public health? Answering this question requires engaging with tricky professional as well as contentious conceptual issues. Some advocates of health promotion talk as though public health is problematic: seen as medical, physiological in focus and reductionist in approach, whereas health promotion, on this view, is focused on the whole person in a social environment. However, to an outsider this looks more like an attempt to artificially (and rather crudely) define and protect professional boundaries, rather than a contribution to conceptual analysis. There seems no good reason why public health cannot take into account the role of social, political, economic and cultural factors and their impact on health. Indeed, much work in public health does precisely this, and uses a wide range of methodologies drawn from non-medical disciplines such as geography, sociology and psychology, not just epidemiology. It seems much more sensible to see health promotion as being one vitally important aspect of the work of public health, rather than something markedly distinct. We will assume here that this is the case and focus instead on the first issue: what is health promotion? (shrink)

In this paper I provide a critique of a set of assumptions relating to agency, choice and the legitimacy of actions impacting health that can be seen in some approaches to health promotion. After a brief discussion about the definition of health promotion, I outline two contrasting approaches to this area of health care practice. The first is focused on the provision of information and the second is concerned with seeking to change people’s preferences in a particular way. It has (...) been argued by a number of critics of health promotion that only the first approach is ethical, as it is for individuals to make their own lifestyle choices and adopt their own conception of the good life. I argue against this ‘information’ approach to health promotion on two grounds. First, I suggest that given the aims of health promotion, the provision of information is, as a matter of fact, of limited effectiveness in achieving these aims. Second, I argue that we have good reasons to question the appropriateness of respecting many of the preferences that individuals happen to have, given the origins and quality of such preferences. I then go on to argue, that by contrast we have good reasons to focus on changing at least some of the preferences that people have related to their lifestyle choices. This involves a commitment to both paternalism and a defence of a certain conception of the good life, but both can be defended. I use the example of potential responses to the growing problem of obesity to illustrate my argument, arguing that only policy that, at least sometimes, aims at preference change will be both effective and ethical. (shrink)

According to some philosophers and social scientists, mainstream economic theories currently play an unprecedented role in shaping human societies. This phenomenon can be linked to the dissemination of methodological individualism, where common goods are interpreted as reducible to aggregates of individuals' well-being. Nonetheless, some emergent difficulties of economics in coping with global institutional issues have encouraged some authors to revise that paradigm. In the last three decades, there has been a parallel growing philosophical interest in investigating social sciences' epistemological and (...) ontological foundations. Unfortunately, these two research trends have often not communicated systematically enough to understand the specific ontology of collective aims. It is still unclear whether some irreducible social goods exist and how the answer to this question can set up a consistent understanding of cooperative actions. This dissertation addresses this issue, drawing on philosophical investigations about collective intentionality. It claims that a coherent ontological taxonomy of irreducible and reducible social goods is theoretically viable and can reframe prevailing approaches to collective action dilemmas influenced by the traditional economic categorisation of goods. The research begins by analysing how the influential theory of public goods has paved the way for some social and moral impasses. Furthermore, some theoretical proposals suggesting the existence of relational goods and common-pool resources are scrutinised. Hence, a refutation of the ontological reduction of all social goods to individual ones is developed, arguing that a specific form of cooperation, grounded in we-intentions and we-reasoning, shows the plausibility of the existence of some kinds of irreducible collective goods. Expanding on that view, a refinement of this categorisation of social goods is put forward by underlying the function of some relational entities, such as trust and shared sensemaking processes, in making cooperation robust in uncertain environments. Finally, by applying the taxonomy to collective action gridlocks regarding climate change, digital information, and public education, the consistency of this hypothesis is tested, showing that a pluralistic ontological account of social goods might improve the moral understanding of current social dilemmas. (shrink)