Coercion in public health: a scoping review of definitions

It is common for certain public health measures to be characterised as 'coercive', which often carries negative moral connotations that can fuel opposition to their use. Yet, coercion admits of myriad definitions and justifications. This lack of conceptual clarity not only risks the inconsistent implementation and evaluation of policy but can also undermine public trust and weaken the legitimacy of public health governance.

A scoping review of the public health literature was conducted to understand (1) how coercion is defined in the public health literature and (2) which justificatory conditions, if any, are identified to support the use of coercion for public health purposes. The search strategy covered five databases. Results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline.

56 publications were included. Definitions appeared most within the contexts of infectious disease (n=30) and public health ethics (n=34). While definitions lacked consistency and often conceptual precision, several publications (n=16) drew on established philosophical accounts of coercion (eg, Wertheimer, Nozick, Feinberg). We identified five elements central to how coercion is commonly understood and invoked in public health: limiting alternative options; influencing voluntariness; inducing fear of consequences; using state powers to enforce a rule; leaving someone worse off if they do not comply.

This review reveals an important gap in the public health literature. Despite the ubiquity of the term 'coercion' in public health, it remains poorly and inconsistently defined. This ambiguity risks the imprecise and at times inappropriate categorisation and evaluation of public health interventions as coercive, potentially compromising both policy effectiveness and public co-operation. Future research could aim to synthesise a definition of coercion agreeable to most public health stakeholders.