From steward to Stuart: some problems in deciding for others

The purpose of this paper is to explore the concepts of state stewardship and international super-stewardship in public health from a philosophical point of view. The paper falls in 3 sections. The first section explores the origins of stewardship discourse in general and how the concept of stewardship entered discussions about public health. The second section outlines two particular conceptions of stewardship one put forward by the Nuffield Council on Bioethics in its report on “Public Health – Ethical issues� and one put forward by Roger Brownsword who was a member of the group drafting the Nuffield Report . It then discusses some problems in state stewardship in public health focusing on whether stewardship can be differentiated from paternalism and whether a state role as steward of the publics’ health can be justified. The third and final section extends this critical analysis to international super-stewardship in the public health area.