PHS 2101 - Chapter 2

• economic status:

  people with higher incomes tend to be healthier for a variety of reasons

  access to better medical services

  *old adage- ‘you get what you pay for.’
• Public Health’s goal is to:

  ‘fulfill society’s interest in assuring conditions in which people can be healthy.’
• The early history of Public Health in the United States was closely tied to social reform movements (19th century):

  sanitary science and public hygiene

  improved housing

  workers rights

  abolition of child labor

  maternal and children’s health
• Dan E. Beauchamp, (Public Health philosopher), writes (~50 years after Winslow):

  ‘public health should be a way of doing justice, a way of asserting the value and priority of all human life.”
• Beauchamp challenges ‘Market Justice.’

  *emphasis on individual responsibility,

  *minimal obligation to the common good, and

  *fundamental freedom of all individuals to be ‘left alone.’
• On the other hand, Social Justice suggests that:

  minimal levels of income,

  basic housing,

  employment,

  education and

  health care

  Beauchamp writes,

  “the historic dream of public health that- preventable death and disability ought to be minimized-is a dream of social justice.”
• In the 1930s and 1940s

  *Limited federal health funding

  *Health Departments were focused on:

  *providing services for child health

  *venereal disease control

  *tuberculosis

  *dental health
• Concerns about health threats from environmental pollutants that arose in the 1960s

  not considered by the govt to be within the realm of Public Health and separate agencies were established to deal with such problems
• Social problems

  homelessness, drug abuse and violence were also NOT thought of as Public Health issues.

  In 1988, the Institute of Medicine re-affirmed the views of Winslow and Beauchamp.
• Three issues always surface at debates concerning Public Health actions or activities:

  *economic - who will pay?  Is it worth the money?

  *libertarian - is this infringing on my civil liberties?

  *moral - is the govt imposing some kind of morality?
• Most public health measures cost money.

  some segment of the population or some industry will have to pay
• New Public Health proposals = likely to be opposed.

  *may lead to lost jobs

  *may result in an increased price of the product

  *may require tax increases

  *might reduce the company’s profits
• Industries Resist Change

  *milk producers resisted pasteurization

  *landlords resisted building codes

  *car manufactures resisted safety design changes
• There are several reasons why these conflicts are particularly difficult to resolve:

  *controversy arises b/c those who pay for a public health measure are not always the ones who benefit

  *in times of economic difficulty, people are often unwilling to pay short-term costs to obtain a benefit in the long term.

  *the costs of public health measures are usually much easier to calculate than the benefits
• those who pay are not always the ones who benefit environmental regulations such as restrictions on timber harvesting in the Pacific Northwest are being disputed

  
  

  will probably cost jobs in the lumber industry although they may preserve jobs in the fishing and tourist industries and contribute in the long term to a more stable climate

  
  

  
  

  regulations that protect the health and safety of workers may require expensive protective equipment, thus driving up costs to consumers
• Major factors that contribute to the ‘general welfare’ include:

  health and safety

  economic well-being
• But the gov’t does not guarantee health and safety for each individual,

  provide for maximum health and safety for the community as a whole.
• *restricting an individual’s freedom from acting in ways that cause direct harm to others:

  laws against assault and murder date back to the Babylonian Code of Hammurabi (1800 BC)

  
  

  
  

  But when harm is less direct, the issues become more controversial.

  
  

  
  

  more controversy arises when the government places restrictions on people’s individual freedom to harm themselves (seat belts, smoking, etc..)
• In today’s industrialized world…. The ‘pasture’ is:

  air, water and other elements of the of the environment that people share

  gov’t action is required to protect these “commons”

  The general principle of protecting the ‘commons’ is accepted by most citizens

  much controversy exists in defining:

  *what resources

  *the extent of the protective measures
• Restrictions on individual behavior is often criticized as ‘paternalism.’

  form of paternalism that is generally accepted is: that children and young people can be restricted in their behavior because they are not yet mature enough to make judgments in their own best interests.
• •LIBERTARIANS.

  those who believe in free will and individual freedom in the words of John Stuart Mill,

  •“the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others… in the behavior which merely concerns himself, his independence is… absolute.”
• Restrictions on individual liberty are justified on the basis that the purpose of the law is the protection of other members of the community.
• Most Public Health advocates believe in restrictions on individual behavior for the sake of the public.

  Beauchamp argues that restrictive laws are needed most for behaviors that are common and carry small risks
• Beauchamp’s argument in favor of limiting individual liberty for the common good

  “social justice.”

  death and disability are collective problems…and collective action, he argues, is needed to  promote the common welfare.
• Alexis de Tocqueville,

  believed that the U.S. tradition of supporting private liberty is wrong, because it, ‘disposes citizens not to think of their fellows and turns indifference into a sort of public virtue.’
• Public Health can lead to controversy on moral grounds especially with respect to sexual and reproductive issues

  *AIDS

  *other STDs

  *teenage pregnancy

  *low birthweight babies

  major problems in the U.S.

  The Public Health approach:

  sex education and the provision of contraceptive

  services, especially condoms.
• AIDS has been an especially divisive issue

  many of its victims contracted the disease through behavior that is widely regarded as immoral–

  *homosexual acts and i.v. drug use.

  AIDS-related political policies are charged.

  *moral revulsion to the disease and its victims

  *it’s commonly believed, while not supported by the evidence, that education on how to protect oneself against contracting the virus may encourage homosexuality.
• Regulation for the common good is valid, trying to legislate morality is difficult:

  ineffective

  self-defeating

  threat to liberty
• This leads to potential problems:

  *free speech is repressed

  *victims are demonized

  *practitioners of the behavior go “underground” and AIDS, drug abuse, or  teenage pregnancy

  *the epidemic– spreads more easily.
• Public Health is controversial because

  *challenge people’s values

  *demands sacrifices.
• The expansive view of public health asks people to give up a degree of personal liberty for the common good.
• In its most idealistic philosophy, Public Health is a

  broad social movement,

  a campaign to maximize health for everyone in the population through distributing benefits and responsibilities in an equitable way.
• Public Health:

  *Medical endeavor

  *Political endeavor

  Many Public Health measures have a

  negative economic impact on some segment of the population or some industry.

  This often leads to conflict and controversy
• Some measures necessary to protect the public health may restrict the freedom of some individuals or industries to behave as they wish.

  This is another source of conflict and controversy.
• Moral and religious controversy is often generated when public health tries to address sexual and reproductive issues

  Sometimes the most effective public health messages offend moralists.