The Politics of Public Health: A Response to Epstein

Conservatives are taking aim at the field of public health, targeting its efforts to understand and control environmental and social causes of disease. Richard Epstein and others contend that these efforts in fact undermine people's health and well-being by eroding people's incentives to c...

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Bibliographic Details
Published in:Perspectives in biology and medicine 2003, Vol.46 (3), p.S160-S175
Main Authors: Gostin, Larry O. (Larry Ogalthorpe), Bloche, Maxwell Gregg
Format: Article
Language:English
Subjects:
Bioethics
Coercion
Delivery of Health Care - standards
Delivery of Health Care - trends
Disease control
Disease spread
Disease transmission
Economics
Forecasting
Freedom
Government Regulation
Health care policy
Health Education - organization & administration
Health policy
Humans
Infectious diseases
Intervention
Morals
Politics
Public health
Public Health - economics
Public Health - standards
Public Health - trends
Public Policy
Social Responsibility
Socioeconomic Factors
United States
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Summary:Conservatives are taking aim at the field of public health, targeting its efforts to understand and control environmental and social causes of disease. Richard Epstein and others contend that these efforts in fact undermine people's health and well-being by eroding people's incentives to create economic value. Public health, they argue, should stick to its traditional task--the struggle against infectious diseases. Because markets are not up to the task of controlling the transmission of infectious disease, Epstein says, coercive government action is required. But market incentives, not state action, he asserts, represent our best hope for controlling the chronic illnesses that are the main causes of death in industrialized nations. In this article, we assess Epstein's case. We consider his claims about the market's capabilities and limits, the roles of personal choice and social influences in spreading disease, andthe relationship between health and economic inequality. We argue that Epstein's critique of public health over-reaches, oversimplifies, and veils his political and moral preferences behind seemingly objective claims about the economics of disease control and the determinants of disease spread. Public health policy requires political and moral choices, but these choices should be transparent.
ISSN:0031-5982
1529-8795
1529-8795
DOI:10.1353/pbm.2003.0053