Clearing hurdles: Mill's harm principle and noncommunicable diseases

Mill's harm principle, a cornerstone of liberal democratic and libertarian thinking, states that "the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.” In other words, the state either possesses or lacks a mandate to restrict an individual's actions, depending on whether those actions do or do not harm others. For cases of serious communicable disease, the harm principle justifies restrictions on liberty such as quarantine, mandatory vaccinations for school entry, or air travel restrictions. However, for noncommunicable diseases, the harm principle acts as a hurdle for public health action. What I choose to eat or do behind closed doors, so the argument goes, is nobody's business but my own. The example of tobacco will be used to illustrate how the harm principle functioned first as a hurdle and then, after discovery of the dangers of secondary smoke, a justification for tobacco prevention policies. We will consider the extent to which the tobacco example can serve as a model for other noncommunicable diseases, in particular in regard to transforming social norms. We will also explore other rationales that might be adopted to justify policies and interventions that address noncommunicable diseases such as indirect harm or protection of vulnerable populations. Examining these various rationales will allow for a strategic examination of factors that can influence the scope of government's role in intervening.