Public health, well-being and reciprocity

Public-health measures are very effective and efficient means of improving health, yet public health is either neglected by the literature or fraught with unease, mainly due to the combination of the aggregate-distributive tension with the element of compulsion. I argue that this unease can be decreased by 1) a pluralist-holistic view of health, situating the normative value of health in its effect on well-being, incorporating both the objective and subjective source of the value of health; and 2) by a rich concept of reciprocity. This article supports Martha Nussbaum's critique of social-contract thinking for placing too much weight on the scale of normal functioning and productive reciprocity, as well as Sen's distinction between well-being and agency freedom. To reach an adequate understanding of the value and goal of public health within the general setting of health care, a pluralist conception of health, well-being and reciprocity is necessary.