Health promotion is the “science and art of preventing disease, prolonging life and promoting health through the organised efforts of society.” The philosophical questions concerning Health Promotion fall into three categories. A) Philosophy of Science Identifying causation in public health is difficult. Standard empiricist approaches prioritizing prioritize randomized trials may not work. Scientific inquiry using a realist approach and modeling may be better. B) Ethics Hidden harms: There are concerns about the quality of evidence behind Health Promotion and that potential harmful effects are ignored in its evaluation. Treating populations: Ethical concerns arise when treatment is based more on the health of the population than of an individual person, such as in vaccination and mass medication. C) Political Philosophy Personal autonomy. Libertarians object to State attempts to alter the behavior of the population; they often invoke Mill’s liberty principle, that the State should only protect individuals from harming others, not themselves. By contrast, communitarians believe community efforts that limit autonomy to improve community health can be justified. Inequality. Health promotion can be at odds with another political goal, health equality; measures that improve average population health might also and unacceptably increase health inequality. Precautionary principle. This states roughly that the possibility of severe public health harm permits major State intervention. It was used to justify highly restrictive measures during the Covid pandemic. Its formulation and scope are controversial, however.