The Principle of Reciprocity: How Can it Inform Public Health and Healthy Public Policies?

In this paper we will outline the concept of reciprocity as it may be applied in the ethics of public health. The goal of this paper is to present the concept as it has been developed and used in the literature.

Whether considered as a value or formulated as a principle to guide actions, reciprocity is commonly appealed to in public health to help ensure that certain obligations due to others – or to be expected from others – may be taken into account and acted upon by public authorities or by individuals. It is one of the values commonly considered when applying an ethical lens to decisions and actions linked to public health or healthy public policies.

We will consider how it has been used to date in public health ethics and then include some aspects of reciprocity drawn from other sectors and other disciplines. In addition to the various dimensions of reciprocity and its application to public health, one observation that will emerge from this paper is that differences in perspective yield very different notions of what constitutes reciprocal obligations.

We will attempt to detail these differences, both in perspective and in the conception of reciprocity that results, in order to make it easier to identify them and to understand both their significance and their implications. This clarity may make it easier to navigate through ethical issues with others in order to make decisions.

We will conclude by offering some ways to take reciprocity and reciprocal obligations into consideration in practice. The goal is to render the notion of reciprocity accessible so that it can be put to use to inform thinking and influence policies, actions and so on in the real world.

Our discussion will unfold as follows:

• Part 1 – What is reciprocity?
• Part 2 – How has the principle of reciprocity been used in public health?
• Part 3 – The dimensions of reciprocity
• Part 4 – Reciprocity and cooperation, justice, social capital and the moral economy
• Part 5 – Putting ideas about reciprocity into practice: cases, questions, application.