Freedoms, functionings and the ethics of health promotion

Background. The intent of this dissertation is to advance the scholarship of the capability approach. The manuscripts contained in this volume offer empirical and theoretical investigations of health-related capability, and try to grapple with some of the inherent tensions contained within the capability approach itself. These tensions---between the role of choice and freedom and the achievement of individual- and population-level health outcomes---are fundamental to the ethical assessment of public health programs and policies.;Methods. This dissertation consists of: (1) an ethical analysis of how the capability approach can inform the design of public health interventions generally, and health promotion interventions in particular; (2) a discrete choice experiment examining how laypersons trade off various features of public health interventions; and (3) a methodological paper examining the use of latent constructs (including health-related capabilities) and latent variable modeling in empirical bioethics research.;Results. An account of how the capability approach can used to examine ethical issues in the design of public health and health promotion interventions was developed. Exploring the convergence between the capability approach, behavioral economics and libertarian paternalism sheds light on an alternative way of understanding and balancing considerations of freedom, paternalism and outcomes of public health interventions. In the context of a discrete choice experiment, respondents preferred programs that saved higher numbers of lives, and that reduced health inequalities. Conversely, they disvalued programs that had higher spending levels and those that were mandatory as opposed to opt-in or opt-out programs.;Conclusions. The capability approach, behavioral economics and libertarian paternalism are relatively new areas of scholarship, and their implications for public health policy and program design are just beginning to be explored. As public and private agencies consider implementing public health policies and programs that draw on behavioral economics and libertarian paternalism, attention must to be paid to the ethical dimensions of such efforts. The capability approach can illuminate and inform these ethical assessments.