Appendix Three: Nuffield Council on Bioethics - The Stewardship Model

Core characteristics of public health programmes carried out by a stewardship-guided state can be summarised as follows:

Concerning goals, public health programmes should:

■ aim to reduce the risks of ill health that people might impose on each other;

■ aim to reduce causes of ill health by regulations that ensure environmental conditions that sustain good health, such as the provision of clean air and water, safe food and appropriate housing;

■ pay special attention to the health of children and other vulnerable people;

■ promote health not only by providing information and advice, but also by programmes to help people overcome addictions and other unhealthy behaviours;

■ aim to ensure that it is easy for people to lead a healthy life, for example by providing convenient and safe opportunities for exercise;

■ ensure that people have appropriate access to medical services; and

■ aim to reduce health inequalities.

In terms of constraints, such programmes should:

■ not attempt to coerce adults to lead healthy lives;

■ minimise interventions that are introduced without the individual consent of those affected, or without procedural justice arrangements (such as democratic decision-making procedures) which provide adequate mandate;

■ seek to minimise interventions that are perceived as unduly intrusive and in conflict with important personal values.

Note that the positive goals and negative constraints are not listed in any hierarchical order. The implementation of these principles may, in theory, lead to conflicting policies. However, in each particular case, it should be possible to resolve these conflicts by applying those policies or strategies that, in the circumstances, enable the desired social goals to be achieved while minimising significant limitations on individual freedom.