Population health has recently grown from a series of loosely connected critiques of twentieth-century public health and medicine into a theoretical framework with a corresponding field of research—population health science. Its approach is to promote the public’s health through improving everyday human life: affordable nutritious food, clean air, safe places where children can play, living wages, etc. It recognizes that addressing contemporary health challenges such as the prevalence of type 2 diabetes will take much more than good hospitals and public (...) health departments. -/- Blending philosophy of science/medicine, public health ethics and history, this book offers a framework that explains, analyses and largely endorses the features that define this relatively new field. Presenting a philosophical perspective, Valles helps to clarify what these features are and why they matter, including: searching for health’s “upstream” causes in social life, embracing a professional commitment to studying and ameliorating the staggering health inequities in and between populations; and reforming scientific practices to foster humility and respect among the many scientists and non- scientists who must work collaboratively to promote health. -/- Featuring illustrative case studies from around the globe at the end of all main chapters, this radical monograph is written to be accessible to all scholars and advanced students who have an interest in health—from public health students to professional philosophers. (shrink)

The contribution of food and diet to health is much disputed in the background culture in the US. Many commercial or ideological advocates make claims, sometimes with health as a primary goal, but often accompanied by commercial or ideological interests. These compete culturally with authoritative recommendations made by publicly funded groups. For public policy concerning diet and health to be legitimate, not only should it not be inconsistent with the scientific evidence, but also it should not be inconsistent with the (...) political environment. Healthy Eating Policy and Political Philosophy (HEPPP), by Barnhill and Bonotti (2022), addresses how policy in this complex area might be justified. In the present essay I highlight some important strengths of their work and also make some points about how it might be clarified or enlarged in scope. The great strength of HEPPP is that it emphasizes the role of a political philosophy in evaluating the legitimacy of public policy. They presume a well-off liberal democratic state, and specifically they draw on Rawls’ political liberalism, as developed in Political Liberalism (PL). One of several interlocking technical concepts developed in this book, public reason speaks to the boundaries of what should be acceptable in public deliberation about constitutional essentials and basic justice. HEPPP explores the application of an extension of public reason to the justification of policies related to “healthy eating.“ Public reason has two components, both of which pertain to a common understanding among citizens: (1) a common understanding of the principles and ideals that are the foundation of the political society, and (2) a common understanding of the standards that govern reason and evidence, including common sense. HEPPP argues that even though for diet and health the complexity of the scientific evidence goes far beyond anything like common sense for a typical citizen, the technical idea of “accessibility” of the scientific evidence justifies reliance on it within the concept of public reason. I question this accessibility argument about scientific evidence and public reason because the nature of the population-level epidemiological evidence about diet and health is that it often includes judgments that are based on arguable interpretations, framing incidence in terms of risk and prevention; thus the issue is more than one of potential accessibility of scientific evidence. Nevertheless, evaluation and consideration of the scientific evidence is of obvious practical importance in policy deliberation concerning policy related to what Rawls call “ordinary legislation.“ Even though public reason applied to healthy eating policy may not be as pertinent as it is for constitutional essentials and basic justice, and even though it is unlikely to result in a “correct outcome,“ invoking reasons based on political values and principles held in common has important value even in these deliberations about more ordinary questions. That value applies not to the specifics of the particular issue, but to the larger context for the particular policy being deliberated, as a potential contribution to an overlapping consensus that is stable for the right reasons. If this vision of political liberalism were achieved, then contentious debate about health eating policy and its scientific basis could occur within that context and be resolved within the basic political structure. Because public health and political liberalism have a common concern for a good at the population level, they have an underlying affinity. Healthy eating policies could be evaluated in two not-unrelated ways: based on their instrumental contribution to the good of the public body of citizens as population-level health, and according to their stabilizing contribution to an overlapping consensus among citizens. In this latter way a policy would contribute to a conditional integral common good a la Sulmasy, one that has the prospect of conditioning a political system, and by doing so create the conditions of the possibility of a constitutive integral common good that is constituted on the right reasons for allegiance to an overlapping consensus. To conclude with reference to HEPPP, public reason may play an important function with respect to the political common good, even as debates about the weight and meaning of scientific evidence from epidemiology play out in deliberation of ordinary legislation concerning healthy eating. (shrink)