Announcing ‘The Philosophy of Public Health’ by Benjamin Smart

It is a delight to share the publication of The Philosophy of Public Health by CPEMPH co-Director, Professor Benjamin Smart of the University of Johannesburg. This is an important and timely book which exemplifies the best of applied philosophical thinking: it identifies deep conceptual problems that arise in real-world contexts, and uses rigorous philosophical tools to reach conclusions that can guide public health practice.

At its core, the book develops a powerful account of health as a property of complex systems. Rather than treating health as a feature of isolated organs or discrete individuals, Ben argues that health is an emergent, capacities-dependent property instantiated at multiple biological and social levels: cells, organs, organisms, and—crucially—populations. This move allows him to dissolve familiar puzzles about “population health” and to provide a framework that aligns far more closely with what public health professionals actually confront.

A second major contribution concerns the goal of public health. Ben rejects the simplistic idea that public health should merely raise aggregated individual health scores, noting that such metrics neglect inequality, autonomy, and the broader social determinants of health. Instead, he argues that public health should aim to increase the capacities that matter for individuals’ ability to realise the goods of life—capacities that range from access to clean water and functioning healthcare systems, to education, mobility, and the structural conditions required for dignified living.

The book also provides a philosophically grounded defence of Evidence-Based Public Health that is sensitive to context, values, and the limitations of traditional hierarchies of evidence. Ben engages seriously with recent failures in global pandemic response, arguing for a more nuanced and context-aware understanding of what it means to “follow the science”.

In the final chapters, he turns to ethics and the question of decolonising public health, offering a principled but pragmatic framework for navigating public health decision-making across profoundly unequal societies. Throughout, the book is shaped by his decade of experience living and working in South Africa, but its arguments travel far beyond this context.

The result is a work that will influence both philosophers and practitioners. It is a rare example of philosophy that is simultaneously conceptually rigorous, policy-relevant, and deeply humane. I could not be more pleased to see it in print, and I recommend it warmly to anyone working in public health, philosophy of medicine, or the conceptual foundations of health policy.

Congratulations, Ben. 

Methodological Pluralism in Epidemiology: Lessons from Covid-19

We are pleased to share a commentary published in Global Epidemiology by CPEMPH members Pieter Streicher and Alex Broadbent, with co-author Joel Hellewell (EMBL-EBI), titled The need for methodological pluralism in epidemiological modelling.”

This paper examines two high-profile failures in Covid-19 forecasting by the UK’s Scientific Advisory Group for Emergencies (SAGE), during the Delta and Omicron waves of 2021. In both instances, projections proved not only inaccurate but too vague to be practically useful—hospitalisations were overestimated by an order of magnitude, and deaths by even more.

The authors argue that a key contributor to these failures was SAGE’s reliance on a single modelling approach: mechanistic simulation. By contrast, the South African Covid-19 Modelling Consortium adopted a pluralistic strategy—combining mechanistic and descriptive methods, learning iteratively from outcomes, and achieving far greater predictive accuracy despite far fewer resources.

The commentary makes a strong case for adopting methodological pluralism in epidemic modelling, highlighting the value of multiple, complementary perspectives when dealing with uncertainty in high-stakes contexts. The paper calls for diverse methodological inputs, critical evaluation of past performance, and more open-minded engagement with data from a variety of global contexts.

📄 Read the full article here

Workshop: Thinking About Drinking – Philosophical Contributions to Human-Alcohol Interaction

11 April 2025, 9am-5pm | Register Interest

We are delighted to be hosting this workshop on Thinking About Drinking on 11 April 2025. This is not a series of stand-and-deliver talks, but a world café inspired approach to developing interdisciplinary projects on philosophical aspects of drink, drinking, and alcohol use, misuse, and harms, arising in health, social, personal, and commercial contexts. Despite recent work in other disciplines on alcohol, we believe that philosophical work in this area remains underdeveloped. At the same time, conceptual frameworks in public health, psychology, and other areas are sometimes underdeveloped or partial. An opportunity exists to connect philosophical approaches to these conceptual needs for a project that is at once intellectually novel and impactful, and this workshop supports the development of such a project. Participants are drawn from academia (including philosophy, psychology, sociology, and pharmacology), public health, clinical practice, and industry in the UK, continental Europe, and sub-Sarahan Africa.

Background

Ever since humans began to consume alcohol, they have had a difficult relationship with it. Alcohol is a colorless liquid that has, in itself, no material, cultural, or moral value. But like many other commodities, it has been ascribed complicated and often contradictory sets of values that have varied over time and place, and that are interwoven with the complexities of power, gender, class, ethnicity, and age in the societies in which it is consumed. (Phillips 2014, 1)

So Rod Phillips begins his history of alcohol. Drinking is a well-established subject of study in the social sciences. Yet philosophical literature on alcohol and alcohol use is remarkably sparse across the spectrum of traditions. A small number of books have been written about alcohol and philosophy, often with jocular titles like “The Unexamined Beer is Not Worth Drinking” (Hales 2007) or “I Drink Therefore I Am” (Scruton 2009). There is a notable vein of work on the aesthetics of wine. Elsewhere, medical and public health ethicists have discussed issues related to, for instance, liver transplants for alcohol dependent individuals or justification of alcohol policies (e.g., Gavanagh 2009; John 2018). Addiction has been a topic for philosophers of science (e.g., Burdman 2021); yet the relationship between alcohol and the – relatively recent – concept of addiction may itself be scrutinised. Philosophical interest in drinking remains niche, and there is no defined philosophical literature on alcohol, drinking, or drink.

Yet philosophical questions about alcohol are central to contemporary developments in thinking about alcohol, although commonly left implicit. Here is a selection of such questions.:

  • Is alcoholism a disease? What does/would this mean?
  • Is “alcohol” the right or only conceptual framework within which to think about drinking, given the variety of alcoholic drinks, and their different functions for individuals and in different drinking cultures, past and present?
  • Is “Alcohol Use Disorder” a medically valid category? Is it a spectrum? Is it value-laden? If so, with what values? How does it relate to alcoholism – a replacement, or a different concept?
  • Is all alcohol consumption harmful (“no safe limit”)? In what sense – health, socially, morally?
  • How should alcohol-related “harm” be conceptualized?
  • What is an acceptable limit for alcohol consumption? What does “acceptable” mean – health, social consequences, morality? Or something else?
  • How, if at all, should the longstanding spiritual significance of alcohol be accommodated in contemporary understanding? (Alcoholics Anonymous, the largest recovery programme, is a spiritual programme; alcohol has been regarded as connected to the divine, to truth, to the Devil; etc.)
  • What are the connections between humour and alcohol? Why is it so common to joke about drinking, and behaviour related to drinking? What function does humour perform and what function does alcohol perform in provoking a humorous response even in its absence?

Sometimes, these questions are explicitly discussed, as in the psychology and self-help debate about whether alcoholism is a disease. At other times, answers are assumed, for instance in leaflets by the UK’s National Health Service stating “Like tobacco, alcohol is harmful” and urging everyone to drink less.

Questions such as the nature of health and disease, the role of values in concepts of health and in medicine, the significance and proper extent of medicalisation, the scope of mental health, and the conceptual implications and foundations of measurement in medical contexts are topics of lively philosophical discussion in philosophy of medicine, epidemiology, and public health.

Workshop Rationale

With a view to discussing the possibilities for collaboration on a funded project, the purpose of this workshop is to identify philosophical issues around drinking, by bringing together those thinking about drinking in academic, professional, health, and commercial contexts.

We hope the conversation will enrich all parties, and is the beginning of a lively, fruitful, and impactful philosophical tradition that combines academic and practical interests.

Organisers

The event will be hosted by the Centre for Philosophy of Epidemiology, Medicine, and Public Health (CPEMPH), part of the Institute for Medical Humanities (IMH).

Alex Broadbent      Director of CPEMPH, and Professor of Philosophy of Science at Durham University

Saana Jukola          Assistant Professor of Philosophy at University of Twente, Netherlands

Interested?

Register your interest in attending or following the outcomes of the workshop

Philosophy of Medicine Roundtable 9-10 May 2024

Registration is free but required. Register here

Going online for the first time, the latest instalment of the Roundtable brings together over fifty speakers from six continents to present the latest philosophical thinking on topics including:

  • Medicine and artificial intelligence
  • Ageing
  • Nature of health
  • Classification of disease
  • Disability and neurodiversity studies
  • Epistemic injustice in medicine
  • Medical research
  • Epidemiology
  • Population health
  • Social justice in medicine

…and many more.

Keynote speakers

  • Sandro Galea, Robert A. Knox professor and dean at the Boston University School of Public Health
  • Maël Lemoine, Professor of Philosophy and leader of the ImmunoConcept project at Bordeaux University
  • Jerome Wakefield, Professor at NYU Silver as well as an NYU University Professor with multidisciplinary appointments
  • Sarah Wieten, Assistant Professor of Philosophy at Durham University

Programme

Abstracts

Publications

Selected papers from the conference will be published in a special section of Philosophy of Medicine.

Hosts

The event is hosted by the Centre for Philosophy of Epidemiology, Medicine, and Public Health, a joint enterprise between Durham University’s Institute for Medical Humanities and the University of Johannesburg’s Faculty of Humanities.

About the Roundtable

The International Philosophy of Medicine Roundtable is an open group of philosophers, clinicians, epidemiologists, social scientists, statisticians, bioethicists, and anyone else with an interest in epistemological and ontological issues connected with medicine.

Registration for this conference is free but required. Register here

Lancet letter: ‘Lockdown is not egalitarian: the costs fall on the global poor.’ #epitwitter

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31422-7/fulltext

We wrote this letter a couple of months ago in response to an editorial in the Lancet suggesting that opposing lockdowns was neoliberal. I continue to be surprised by how the world hasn’t noticed that, in fact, extreme measures to combat COVID-19 shift the burden from the wealthy to the poor, who suffer more from the measures than from the disease. It’s a disease that primarily affects the old, and thus primarily the wealthy. This is true even if people who are of the same age fare worse if they are lower down the socioeconomic scale. That is unsurprising, extremely so; what is surprising, and what outweighs that effect massively, is that this disease is so much more dangerous for demographics that are dominated by the wealthy of the world. I still feel that has not been grasped in the global north. So, I’m very pleased to have this letter out. Maybe it will change the perspective just a little towards a more global one.

This Thursday at 11:30am (via Zoom) the @CHESS_DurhamUni reading group will be discussing our recent report from the IFK, ‘A Framework for Decisions in a Post-COVID World’ by @AlexBroadbent

This Thursday at 11:30am (via Zoom) the @CHESS_DurhamUni reading group will be discussing ‘A Framework for Decisions in a Post-COVID World‘ by @AlexBroadbent . . . please contact admin.chess@durham.ac.uk for the paper and joining instructions #COVID19 #socialpolicy #policymakers

Thinking rationally about Coronavirus

I have written an op ed which can be found here:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/country-readiness

There is also a very good (in my opinion) peace in the Lancet which emphasizes the importance of rate of spread and anticipates public health measures as an inevitability, better embraced sooner than later.

https://doi.org/10.1016/ S0140-6736(20)30567-5

Events like this really make me feel that epidemiology must be much more widely understood in the contemporary world. Debates about red meat do the same, but less dramatically. This is such a stark case. Epidemiological expertise must guide us and basic comprehension of epidemiology – even as basic as just knowing that there is such a thing and that there are Experts in it, and that they are not necessarily doctors – would help so much. Politicians aren’t better educated than the rest of the educated public. I’m not critiquing any particular decision – so far, things have mostly been sensible, I think – but the sense of not knowing could be greatly alleviated. How about just a short module on epidemiology as part of high school biology?…

Health as a secondary property – print version finally out

https://academic.oup.com/bjps/article/70/2/609/4102132

Health as a Secondary Property 

The British Journal for the Philosophy of Science, Volume 70, Issue 2, June 2019, Pages 609–627, https://doi.org/10.1093/bjps/axx014

In the literature on health, naturalism and normativism are typically characterized as espousing and rejecting, respectively, the view that health is objective and value-free. This article points out that there are two distinct dimensions of disagreement, regarding objectivity and value-ladenness, and thus arranges naturalism and normativism as diagonal opposites on a two-by-two matrix of possible positions. One of the remaining quadrants is occupied by value-dependent realism, holding that health facts are value-laden and objective. The remaining quadrant, which holds that they are non-objective but value-free, is unexplored. The article endorses a view in the latter quadrant, namely, the view that health is a secondary property. The article argues that a secondary property framework provides the resources to respond to the deepest objections to a broadly Boorsean account of natural function, and so preserves the spirit, though not the letter, of that account. Treating health as a secondary property permits a naturalistic explanation—specifically, an evolutionary explanation—of the health concept, in terms of the assistance such a concept might have provided to the survival and reproduction of those organisms that had it. (This approach is completely distinct from evolutionary and aetiological accounts of natural functions.) This provides the explanation, missing from Boorse’s account, for the fact that function is determined with reference to the contribution to the goals of survival and reproduction, relative to the age of the sex of the species, rather than some other equally natural goals or reference classes.

  • 1 Introduction
  • 2 Two Ways to Disagree about Health
  • 3 Secondary Properties
  • 4 Health as a Secondary Property
  • 5 Conclusion

Book: B Smart, “Concepts and Causes in the Philosophy of Disease”

Recently published with Palgrave Macmillan: Concepts and Causes in the Philosophy of Disease, by Benjamin Smart. A very interesting short book that aims to summarise and progress some of the central recent work in the philosophy of medicine, concerning the nature of health and disease, causality in medicine, the classification of diseases and the relation between medicine and public health.

On Amazon: http://www.amazon.co.uk/gp/search?index=books&linkCode=qs&keywords=9781137552938

On the Palgrave site: http://www.palgrave.com/page/detail/?k=9781137552914