Public health ethics has grown out of the medical ethics movement and has remained in individualistic biomedical models. However, as public health is a different enterprise than medicine dealing with communities rather than individuals. The author develops public health principlism based on the idea of common citizenship in the community. When the four principles of public health ethics—solidarity, efficacy, integrity, and dignity—are in balance, a state of justice exists. The goal is to have programs that are the least destructive to communities and the least restrictive to people. These principles provide guidance in ethical reasoning when analyzing programs and interventions such as mandatory helmet laws, water fluoridation, and smallpox vaccination to improve the aggregate health of a community.



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