Kalle Grill

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?

Drink driving causes great suffering and material destruction. The alcohol interlock promises to eradicate this problem by technological design. Traditional counter-measures to drink driving such as policing and punishment and information campaigns have proven insufficient. Extensive policing is expensive and intrusive. Severe punishment is disproportionate to the risks created in most single cases. If the interlock becomes inexpensive and convenient enough, and if there are no convincing moral objections to the device, it may prove the only feasible as well as the only justifiable solution to the problem of drink driving. A policy of universal alcohol interlocks, in all cars, has been proposed by several political parties in Sweden and is supported by the National Road Administration and the 2006 Alcohol Interlock Commission. This article assesses two possible moral objections to a policy of universal interlocks: (i) that it displaces the responsibility of individual drivers and (ii) that it constitutes a paternalistic interference with drivers. The first objection is found unconvincing, while the second has only limited bite and may be neutralized if paternalism is accepted for the sake of greater net liberty. Given the expected technological development, the proposed policy seems a commendable health promotion measure for the near future

Decisions in medical contexts have immediate and obvious consequences in terms of health and sometimes death or survival. Medical decisions also have less obvious and less immediate consequences, including effects on the long-term physical and mental well-being of patients, their families and of care-givers, as well as on the distribution of scarce medical resources. Some of these consequences are hard to measure and estimate. Even harder, perhaps, is the determination of the relative value of different consequences. How should consequences be evaluated? How do uncertainties and biases affect our evaluations of consequences? What influence should our evaluations of consequences have on our actions? These questions are all philosophical in nature.

Public health policy often limits people’s liberty for their own good. The very point of many types of public health measures is to restrict people’s options in order to stop them from doing unhealthy things, for example use harmful recreational drugs or drive without a seatbelt. While such restrictive public health policies enjoy widespread support, so does the traditional liberal idea that liberty (or autonomy) is a higher value, to be given priority in most, if not all, circumstances. In this text, I will defend the thesis that liberty is an important value, but with no claim to priority.

George Sher’s book Beyond Neutrality: Perfectionism and Politics has, he says, two main purposes. The first is to “defuse the main reasons to deny that the state may seek to promote the good”, the other is to “develop a conception of the good that is worth promoting” (1). In this article, I will not be concerned with either of these aims. Instead, I will focus on Sher’s preliminary discussion of the “scope and meaning” of neutralism (20). I consider Sher’s careful analysis of the structure of neutralism one of the book’s virtues, alongside his original theory of the good and his comprehensive and convincing arguments against neutralism. This careful analysis inspires me to attempt some critique and development. I will defend an account of neutralism according to which this doctrine puts a constraint on what reasons should enter into political reasoning. What I defend is not neutralism per se, but only this account of neutralism relative to competing accounts. I believe this account is an improvement over Sher’s, in terms of conceptual precision and normative plausibility, both in general and from the perspective of the doctrine’s proponents in particular.

This paper presents a framework for discussing issues of ownership in connection to virtual worlds. We explore how divergent interests in virtual property can be mediated by applying a constructivist perspective to the concept ownership. The simple solutions offered today entail that a contract between the game producer and the gamer gives the game developer exclusive rights to all virtual property. This appears to be unsatisfactory. A number of legitimate interests on part of both producers and gamers may be readily distinguished. More complex distributions of rights would allow many of these interests to be consistently respected.