PRIVATE CHOICES, PUBLIC ISSUES. THE ETHICS OF HEALTH POLICY IN THE FACE OF DIET RELATED DISEASES.

The epidemic of diet related disease is a fundamental fact of epidemiology that our societies are increasingly facing. It calls for policy responses and amendments of our systems of health care. These actions and reforms intersect several loci of moral and political disagreement in the public sphere: the acceptability of public paternalism, the appropriate consideration of personal responsibility in health care and the moral and political significance of social health inequalities. I offer a treatment of these three broad normative issues in order to inform discussions about appropriate responses to diet related diseases. (1) I argue that antipaternalism is overstated if not understood in welfarist terms: within the latter framework, evidence for poor capability in dietary choices is a sound reason for intervention. (2) I distinguish distributive and efficiency concerns regarding personal responsibility for health, arguing that there is no defensible conception of the former. (3) I dismiss efforts to understand the moral importance of social health inequalities in terms of health entitlements and reject investment-like approaches to inequalities framed in terms of “equality of opportunity”: the fight against health inequalities is vivified by a renewed interest in the social goods attached to robust socio-economic egalitarianism. Together, these three theses lead away from policies focused on individuals, their responsibility and their productive importance for society and support both public health interventions on the environment where people live and continuous defense of traditional unconditional health care provision.