A new book by University of Auckland professor Martin Wilkinson challenges the common assumption that public health interventions always benefit individuals and society.

In The Ethics of Public Health Paternalism (Oxford University Press, 2025), Wilkinson examines government measures designed to encourage healthier choices, such as taxes on unhealthy foods, bans on sales and marketing, warning labels, and age restrictions.

He argues that many of these policies infringe on personal autonomy and may not provide enough compensating benefits.

The book categorises public health interventions based on how they influence behaviour—whether by making unhealthy choices harder, healthier options easier, influencing beliefs, or subtly nudging individuals toward preferred actions.

Wilkinson explores historical examples, including the US alcohol prohibition (1920–1933) and Denmark’s brief fat tax (2011–2012), assessing their impact and ethical implications.

“Trying to stop people harming themselves sounds paternalistic,” Wilkinson states.

“Paternalism in public health raises two main questions: Why do we think that getting people to make healthier choices would make them better off? And should people not be free to choose for themselves?”

While the book broadly critiques public health interventions, Wilkinson makes an exception for smoking, citing strong evidence supporting efforts to reduce tobacco use.

However, he questions many other measures and argues that health is not the sole or ultimate value in people’s lives.

Wilkinson clarifies that his stance is not rooted in free-market ideology or libertarianism.

He does not oppose all government intervention but insists that public health policies must be justified with stronger evidence.

“A persistent theme of the book is that we often don’t have very good, or in fact competing, evidence on these issues,” he says.

“Because the absence of evidence is not evidence of absence, I don’t conclude that public health interventions are unjustifiable, only that they have not been justified.”

The book is freely available online with print copies released on 6 February 2025.

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