Modesty of scale as a public health value

Public health adopted its first official code of ethics in 2002. Problematically, the new code is modeled on the clinical health professions and only weakly interleaves larger, environmental concerns. Here, I introduce several environmental principles that should be included in public health ethics. I then explore the connections between public health and environmental ethics with more specific reference to a scale-related subset of environmental values, such as ‘balance' ‘limits' ‘adequacy', and in particular, ‘modesty'. I discuss some of the problems of these scaling concepts as they relate to popular culture and images of these concepts. Recent discussion of the public health code of ethics properly tends to move to consequentialist approaches to ethics. The above scale-related concepts tend to introduce ‘balance' and ‘environmental efficiency' to this conceptual infrastructure of consequentialism. I consider how these scaling concerns modify, but leave unscathed, the essential maximizing course of consequentialism in our perceptions of public health ethics. These concepts challenge some aspects of current health-related mores and language. But, additional and more fundamentally transformational concepts may well be needed. For public health practitioners to adapt to environmental change, we need to include a commitment to environmental concerns amply among our professional values and our public statements regarding these values.