Promoting Health and Preventing Disease: Ethical Demands and Social Challenges

This article argues that a critical impasse has been reached in American health promotion and disease prevention and examines the three factors that must be confronted and addressed if we are to move forward. These factors are: 1) the cultural and political contexts of health promotion, including the continuing tension between individualism and a common good/public health perspective, 2) the increasing power of narrow, biomedical conceptualizations of disease and illness, and 3) the variety of ethical options available to governments, employers and HMO's concerned with changing unhealthy behaviors. A public interest perspective on health promotion then is presented, with attention to both the obstacles it faces and the advantages it may hold as we pursue the goal of a healthy society at the turn of the century.