The Challenge for Public Health

This book aims to address a very specific issue that has wide-ranging implications for the practice of public health. That issue concerns the role of reasoning in public health deliberations. It is important to be clear from the outset on the extent of those deliberations. We make decisions and judgements relating to public health on a daily basis. We need to decide if it is safe to vaccinate our children against certain infectious diseases, if prescription drugs pose risks to our health, if a food product can be safely consumed, and if our health is at risk of damage by exposure to environmental toxins. From assessing food and drug safety to managing the risks of infectious diseases and lifestyle choices, all these decisions are at all possible because of the human capacity to make reasoned judgements. The exercise of reason in each of these areas is at once awe-inspiring and deeply perplexing. When one considers the diverse bodies of knowledge subsumed by the issues just mentioned, it is truly amazing that human beings are somehow able to arrive at judgement about each of them, however flawed that judgement may eventually turn out to be. But the exercise of reason is also deeply perplexing, as two millennia of philosophical reflection clearly demonstrate. In that time, our achievements in terms of understanding reasoning have certainly been substantial. But they are still largely limited to certain sub-components of reasoning (e.g. deduction), with a wider explication of the concept still some way beyond our grasp. An aspect of reasoning that is still relatively poorly understood is its use in the deliberations and judgement-making of daily life. It is one such aspect, namely, reasoning about public health issues, which will be the focus of this volume. So reasoning still holds considerable mystery for those who investigate it. While a little mystery may make reasoning interesting as a concept to explore, it is altogether less helpful in a domain like public health where certain practical exigencies dominate. These exigencies are nowhere more clearly demonstrated than in the definition of public health by the Faculty of Public Health in the UK. The Faculty defines public health as ‘the science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society’. The prevention of ill health and the prolongation of life are not activities that can be pursued at a leisurely pace. And it is the very real sense of urgency that attends these public health activities that confers prominence on a cognitive resource like reasoning. When confronted with a public health problem, howeve