Public health policymaking, like medical practice, has a substantive impact on people’s lives: their wellbeing, life-expectancy, and even liberty. There is thus an extensive ethical dimension to public health policymaking. Policies that enhance the health of one person or group might do so at the expense of others. The reality of health economics ensures this is almost always the case. Furthermore, policies can either respect the autonomy of those affected, or entirely ignore it. They might increase or reduce health inequalities. In this chapter, I consider a variety of existing approaches to public health ethics, from welfarist approaches to contemporary principlist frameworks. I highlight my concerns with each of these, setting the stage for the capacities approach to public health ethics I present and defend in chapter 6.