Critical literatures, and public discourses, on public health policies and practices often present fixated concerns with paternalism. In this paper, rather than focus on the question of whether and why intended instances of paternalistic policy might be justified, we look to the wider, real-world socio-political contexts against which normative evaluations of public health must take place. We explain how evaluative critiques of public health policy and practice must be sensitive to the nuance and complexity of policy contexts. This includes sensitivity (...) to the ‘imperfect’ reach and application of policy, leading to collateral effects including collateral paternalism. We argue that theoretical critiques must temper their demandingness to real-world applicability, allowing for the detail of social and policy contexts, including harm reduction: apparent knock-down objections of paternalism cannot hold if they are limited to an abstract or artificially-isolated evaluation of the reach of a public health intervention. (shrink)

This brief comment responds to some of the issues raised by Daniel Weinstock’s paper on the application of the republican ideal to public health. It considers the application outside of that specific context of both the problem Weinstock identifies and the solution he proposes. It queries, with reference to the different sorts of relationships of domination which exist, whether a republican approach to public health might not be better to seek to begin from private relationships of domination and to define (...) its scope with reference to such relationships. (shrink)