In much of contemporary public health ethics, principlism – derived from biomedical ethics – remains the dominant framework. Its appeal lies in its accessibility and apparent universality, offering a clear set of guiding principles for ethical decision-making. Yet, when applied to public health, this model reveals serious limitations. Its principles lack universality across social and cultural contexts, suffer from internal inconsistencies, and fail to capture the structural and political forces that shape health and illness – such as the rise of authoritarianism, technological disruption, privatisation, and state capitalism. Drawing on my work as vice-chair of the Ethics Committee of the UK Faculty of Public Health, where we are developing educational training for public health professionals, I argue that these limitations stem from a neglect of political philosophy. Ethical reasoning in public health cannot remain confined to individual-level moral principles but must engage with theories of justice, power, and governance. At the same time, political philosophy itself has often failed to take health seriously, remaining overly abstract, Eurocentric, and inattentive to global inequalities. This lecture explores how revitalising public health ethics requires reuniting it with political philosophy – especially under current movements for decolonising knowledge, advancing epistemic justice, and challenging dominant Western perspectives. Only through such a reorientation can public health ethics adequately respond to the profound social transformations shaping global health today.

This talk develops the concept of structural health vulnerability to explain how social inequalities, embedded in structural and epistemic injustices, generate and sustain health disparities. Drawing on Iris M. Young’s theory of structural injustice and feminist analyses of vulnerability, it rejects essentialist views of “the vulnerable” and highlights the political roots of health risks. Building on recent debates in political philosophy, the lecture explores how power, knowledge, and responsibility intersect in healthcare and public health, calling for justice-oriented, participatory approaches to reducing structural health vulnerabilities.