In most developed countries the epidemiological disease profile has changed from infectious to
degenerative causing major alterations in epidemiological thinking and public health policies.
Less developed nations have to deal with a more complex situation because social disparities
create highly unequal health conditions the affluent being afflicted by degenerative
conditions whereas the poorer social segments continue to suffer infectious diseases but also
begin to feel the effects of chronic illness. At the turn of the 21st century equity in health
care is not being served and social justice has lost credibility as a conceptual driving force
of public health policies. Rampant injustice confirms that theories reality and suggested
practices of just social orders are flawed leaving the needy without help or hope in a world
of flagrant ethical inadequacy. And yet mainstream bioethics loses meaning and relevance as it
clings to the principle of justice and hails such concepts as global justice and universal
health-care equity misleadingly focusing on justice as a desideratum. This book pleads for an
urgent turn towards directly addressing injustice as a reality that requires pressingly needed
arguments and proposals to inspire realistic public health policies and programs based on an
ethics of protection. Ever since Hobbes all shades of political philosophy accept that the
basic obligation of the ruling power is to protect its subjects. The ethics of protection
emphasizes aiding the needy and the disempowered in obtaining access to basic goods and
services related to health-care. Public health is called upon to fulfill protective obligations
to guarantee disease prevention and medical services to the population taking special care to
safeguard those unable to cover their health-care needs in market-oriented medical services and
institutions. The bioethics of protection developed in this text presents specific and explicit
guide-lines to assure that protective public health actions be efficacious (problem-solving)
efficient (sustainable cost benefit relation) and ethically sound (respecting human rights and
the common weal). These guide-lines are designed to give ethical support and justification to
public health policies even when they require some unavoidable limitations of individual
autonomy to promote social health benefits.
