A sweeping claim that ‘health is a public matter’ is as unhelpful as its counter; that ‘health is a private matter’. Health, and welfare more widely, touch on many issues – physical, behavioural, environmental – some of which can be argued to fall into the public sphere, others of which can not. There are many points of controversy, and it is not always clear which answers are definitively right. The role for analysts in public health law and ethics, and for policy-makers concerned about health issues, is to establish which things are public, to what extent, in what regard, and how and why this is so. We have seen repeated a point that can be missed when political paradigms present a ‘presumption of liberty’, suggesting that State inaction is ostensibly benign: States are accountable for their omissions as well as their acts. On one hand this means that States can not shirk responsibility for their failures. On the other, it means that every social determinant of health is under the State’s view, yet each is not ultimately the business of the State. It is for this reason that political analysis is essential: it is this that establishes which matters are of political concern, and the legitimate sources of political obligation.

Beyond the political arguments, any number of moral arguments may be made to individuals, advocating distinct practices in the name of health. There may be strongly felt moral imperatives about what people should do with, to, and for their minds and bodies. But where health is public, we go beyond moral argumentation, and seek to establish the role of the State in assuring or encouraging compliance with health-related imperatives, and the means it would use to do so. In one instance, compulsion may be recommended in response to a problem, in another no governmental action may be required whatsoever. In most cases, the regulatory structures will ‘nudge’ and persuade, rather than coercively direct.