While ethics has been a central consideration of medical research and healthcare delivery, the application of ethics to public health policy and practice is less well developed. There is, however, an increasing interest in public health ethics, reflecting a renewed international policy emphasis on public health, debates about the effectiveness of public health interventions and discussions at a global level about public health risks and action. Public health ethics is now part of mainstream public health training in the US and there is interest in developing ethical frameworks for public health policy and practice in the UK. For example, the Nuffield Council on Bioethics has recently concluded a consultation on public health ethics and published a report that has focused wider UK attention on ethical issues in public health, although the report tends to address broad issues such as obesity and infectious diseases rather than the application of ethics in public health practice. However, it does contain some guidance for local policy makers on how to approach ethical issues. In addition, concern has been expressed that the Council's approach is influenced too much by traditional bioethics and not by more recent ethical and philosophical debate about public health.

With developing technology (such as new vaccines) and new potential public health threats (for example, swine flu and resistant strains of TB), ethical issues in public health are going to be even more central than they are now. Increased mobility nationally and internationally has also changed the way countries have to think about public health issues. This also includes more ways to monitor people, the use of genetic testing, and more public awareness of threats to public health and an awareness that there are ethical and possibly legal (for example, enforced quarantine) difficulties with the distribution of harms and benefits. Balancing the rights and responsibilities of individuals and wider populations is becoming more complex. There is clearly a need to develop this debate and we hope that this book will play a key role in opening out a discussion of public health ethics into the public health practice arena, as well as provide insights into the complexities of making public health decisions in practice.