Trustworthiness, Non-Manipulation, and Public Health Guidance for Individuals

Authors

  • Stephanie Harvard Division of Respiratory Medicine, University of British Columbia, Vancouver, Canada; Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, Canada https://orcid.org/0000-0002-9008-2163
  • Eric Winsberg Department of History and Philosophy of Science, University of Cambridge, Cambridge, United Kingdom; Department of Philosophy, University of South Florida, Tampa, United States https://orcid.org/0000-0002-8764-0072

DOI:

https://doi.org/10.5195/pom.2026.340

Keywords:

Public health, Evidence-based medicine

Abstract

Public health guidance for individuals addresses private members of the public but is delivered through mass communications. We argue that “improving” public health guidance for individuals involves ensuring that it is trustworthy. This points to the need to clarify whose goals or interests such guidance should serve, because to be trustworthy is for a trustee to act in the interests of their truster. Public health guidance for individuals should serve the interests of the members of its target audience, aligning it with clinical medicine. We consider how guidance developers can be responsive to the interests of a heterogeneous public, maintaining trustworthiness by upholding a principle of non-manipulation.

References

Alonso-Coello, Pablo, Holger J. Schünemann, Jenny Moberg, et al. 2016. “GRADE Evidence to Decision (EtD) Frameworks: A Systematic and Transparent Approach to Making Well Informed Healthcare Choices. 1. Introduction.” BMJ 353, i2016. https://doi.org/10.1136/bmj.i2016.

American Thoracic Society. 2026. “Wildfires Disaster Guidance: Tips for Staying Healthy During Wildfires.” Accessed July 20, 2026. https://site.thoracic.org/advocacy-patients/patient-resources/wildfires-disaster-guidance-tips-for-staying-healthy-during-wildfires.

Blumenthal-Barby, J. S. 2012. “Between Reason and Coercion: Ethically Permissible Influence in Health Care and Health Policy Contexts.” Kennedy Institute of Ethics Journal 22, no. 4: 345–366. https://doi.org/10.1353/ken.2012.0027.

British Columbia Centre for Disease Control. 2024. “How to Prepare for Wildfire Smoke Season.” https://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Health-Environment/BCCDC_WildFire_FactSheet_HowToPrepare.pdf.

Casey, Joan A., Yuqian M. Gu, Lara Schwarz, et al. 2025. “The 2025 Los Angeles Wildfires and Outpatient Acute Health Care Utilization.” JAMA Health Forum 6, no. 11, e254632. https://doi.org/10.1001/jamahealthforum.2025.4632.

Charles, Cathy, Amiram Gafni, and Tim Whelan. 1997. “Shared Decision-Making in the Medical Encounter: What Does It Mean? (Or It Takes at Least Two to Tango).” Social Science & Medicine 44, no. 5: 681–692. https://doi.org/10.1016/S0277-9536(96)00221-3.

Chin-Yee, Benjamin. 2023. “Generalizations in Clinical Trials—Do Generics Help or Harm?” Kennedy Institute of Ethics Journal 33, no. 4: 359–400. https://doi.org/10.1353/ken.2023.a931051.

Christman, John. 1991. “Autonomy and Personal History.” Canadian Journal of Philosophy 21, no. 1: 1–24. https://doi.org/10.1080/00455091.1991.10717234.

Clarke, Angus. 1992. “Is Non-Directive Genetic Counselling Possible?” Obstetrical & Gynecological Survey 47, no. 5: 304–305.

Coker, Eric S., Susan Lyon Stone, Erin McTigue, et al. 2024. “Climate Change and Health: Rethinking Public Health Messaging for Wildfire Smoke and Extreme Heat Co-Exposures.” Frontiers in Public Health 12, 1324662. https://doi.org/10.3389/fpubh.2024.1324662.

Douglas, Heather. 2009. Science, Policy, and the Value-Free Ideal. University of Pittsburgh Press.

Dworkin, Gerald. 1988. The Theory and Practice of Autonomy. Cambridge University Press.

Elwyn, Glyn, Dominick Frosch, Richard Thomson, et al. 2012. “Shared Decision Making: A Model for Clinical Practice.” Journal of General Internal Medicine 27, no. 10: 1361–1367. https://doi.org/10.1007/s11606-012-2077-6.

Harvard, Stephanie, Rachel Carter, Sian Hoe Cheong, et al. 2025. “The ‘Values in Modelling’ Framework for Patient and Public Involvement in Health Economics Modelling: Development and Application in the LEAP Model Project.” PharmacoEconomics 44: 115–139. https://doi.org/10.1007/s40273-025-01561-5.

Harvard, Stephanie, and Eric Winsberg. 2021. “Causal Inference, Moral Intuition, and Modeling in a Pandemic.” Philosophy of Medicine 2, no. 2: 1–10. https://doi.org/10.5195/pom.2021.70.

———. 2022. “The Epistemic Risk in Representation.” Kennedy Institute of Ethics Journal 32, no. 1: 1–31. https://doi.org/10.1353/ken.2022.0001.

Harvard, Stephanie, Eric Winsberg, John Symons, and Amin Adibi. 2021. “Value Judgments in a COVID-19 Vaccination Model: A Case Study in the Need for Public Involvement in Health-Oriented Modelling.” Social Science & Medicine 286, 114323. https://doi.org/10.1016/j.socscimed.2021.114323.

Hills, Alison. 2023. “Trustworthiness, Responsibility and Virtue.” The Philosophical Quarterly 73, no. 3: 743–761. https://doi.org/10.1093/pq/pqad036.

Kukla, Quill (writing as Rebecca). 2014. “Medicalization, ‘Normal Function,’ and the Definition of Health.” In The Routledge Companion to Bioethics, edited by John D. Arras, Elizabeth Fenton, and Rebecca Kukla. New York: Routledge. https://doi.org/10.4324/9780203804971.

John, Stephen. 2015. “Inductive Risk and the Contexts of Communication.” Synthese 192, no. 1: 79–96. https://www.jstor.org/stable/24704488.

Ludewigs, Sophie, Jonas Narchi, Lukas Kiefer, and Eva C. Winkler. 2025. “Ethics of the Fiduciary Relationship Between Patient and Physician: The Case of Informed Consent.” Journal of Medical Ethics 51, no. 1: 59–66. https://doi.org/10.1136/jme-2022-108539.

McLeod, Carolyn. 2023. “Trust.” In The Stanford Encyclopedia of Philosophy, Fall 2023 edition, edited by Edward N. Zalta and Uri Nodelman. https://plato.stanford.edu/archives/fall2023/entries/trust/.

McLeod, Carolyn, and Emma Ryman. 2019. “Trust, Autonomy and the Fiduciary Relationship.” In Fiduciary Obligations in Theory and Practice, edited by Paul B. Miller and Andrew S. Gold. Cambridge University Press.

NCCEH (National Collaborating Centre for Environmental Health). 2025a. “Indoor Air Filtration During Wildfires: Impacts on Air Quality and Health.” June 5. Accessed February 23, 2026. https://ncceh.ca/resources/evidence-reviews/indoor-air-filtration-during-wildfires-impacts-air-quality-and-health.

———. 2025b. “Rapid Review: Evaluating the Effectiveness of Masks and Respirators Against Wildfire Smoke.” July 23. Accessed February 23, 2026. https://ncceh.ca/resources/evidence-reviews/rapid-review-evaluating-effectiveness-masks-and-respirators-against.

———. 2026. “Wildfire Smoke: What Is the Relationship Between Outdoor and Indoor Air Pollutants?” February 11. Accessed February 23, 2026. https://ncceh.ca/resources/evidence-reviews/wildfire-smoke-what-relationship-between-outdoor-and-indoor-air.

Noggle, Robert. 2018. “Manipulation, Salience, and Nudges.” Bioethics 32, no. 3: 164–170. https://doi.org/10.1111/bioe.12421.

Public Health Agency of Canada. 2001. “Implementing the Population Health Approach.” Policies, November 25. Accessed February 23, 2026. https://www.canada.ca/en/public-health/services/health-promotion/population-health/implementing-population-health-approach/implementing-population-health-approach.html.

Rasmussen, Sonja A., Richard A. Goodman, and Wendy E. Parmet. 2023. “Addressing the Need for Accountability in Public Health.” American Journal of Public Health 113, no. 6: 620–622. https://doi.org/10.2105/ajph.2023.307290.

Robinson, Sally. 2022. Principles and Practice of Health Promotion and Public Health. Routledge. https://doi.org/10.4324/9780367823696.

Stacey, Dawn, France Légaré, Laura Boland, et al. 2020. “20th Anniversary Ottawa Decision Support Framework: Part 3 Overview of Systematic Reviews and Updated Framework.” Medical Decision Making 40, no. 3: 379–398. https://doi.org/10.1177/0272989X20911870.

Winsberg, Eric. 2024. “Managing Values in Science: A Return to Decision Theory.” Kennedy Institute of Ethics Journal 34, no. 4: 389–418. https://doi.org/10.1353/ken.2024.a965814.

Winsberg, Eric, and Stephanie Harvard. 2024. Scientific Models and Decision Making. Cambridge University Press. https://doi.org/10.1017/9781009029346.

Zhang, Qiang, Yuexuanzi Wang, Qingyang Xiao, et al. 2025. “Long-Range PM2.5 Pollution and Health Impacts from the 2023 Canadian Wildfires.” Nature 645, no. 8081: 672–678. https://doi.org/10.1038/s41586-025-09482-1.

Downloads

Published

2026-08-17

How to Cite

Harvard, S., & Winsberg, E. (2026). Trustworthiness, Non-Manipulation, and Public Health Guidance for Individuals. Philosophy of Medicine, 7(1). https://doi.org/10.5195/pom.2026.340

Issue

Vol. 7 No. 1 (2026)

Section

Perspectives

License

Copyright (c) 2026 Stephanie Harvard, Eric Winsberg

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

  1. The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
  2. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
  3. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
    1. Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
    with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
  4. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
  5. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
  6. Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
  7. The Author represents and warrants that:
    1. the Work is the Author’s original work;
    2. the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
    3. the Work is not pending review or under consideration by another publisher;
    4. the Work has not previously been published;
    5. the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
    6. the Work contains no libel, invasion of privacy, or other unlawful matter.
  8. The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
  9. The Author agrees to digitally sign the Publisher’s final formatted PDF version of the Work.