The ethics of public health practice: balancing private and public interest within tobacco policy.

INTRODUCTION: Public health practice is characterized by measuring population health, assessing needs for health care and the provision (directly or indirectly) of services to protect and promote the public's health. It is increasingly explicitly concerned with issues of equity. SOURCES OF DATA: Publications discussing ethical issues in public health. AREAS OF AGREEMENT: Unlike the duties of clinicians, professional standards for public health practice are not well defined. An ethics framework would help the development and implementation of public health policy. AREAS OF CONTROVERSY: Public health strategies have been criticized for being paternalistic and restrictive of personal choice behaviours or for being too pragmatic, and appearing to endorse illegal activities. GROWING POINTS: Historically public health programmes have been delivered at a population level for large groups of people with varying capacity to benefit. Within more autonomy, consumer-orientated political environment, strategy must be more targeted to facilitate healthy choices as defined by the individual. AREAS TIMELY FOR DEVELOPING RESEARCH: Debate is needed on the aims of public health, rights and responsibilities of professionals and citizens and mechanisms for developing and implementing policy.