The readings in this chapter and the next examine the fields of public health and public health ethics. The first chapter contains classic readings that illuminate the core values of public health: prevention and the population-based perspective, the role of community and civic participation, the significance of social justice, and modern perspectives on the “public health system.” Chapter 2 then turns to contemporary explanations of public health ethics, examining how ethical principles and values can inform society about the justifiability of actions taken to safeguard the public’s health and safety. The readings on public health ethics analyze the inevitable trade-offs...

The field of public health ethics applies principles and values to evaluate the justifiability of public health actions. A central question posed is, “What are the appropriate limits on the state’s power when its exercise to safeguard the public’s health and safety interferes with individual interests?” In answering this question, ethicists take account of the personal and economic interests of individuals, as well as the collective benefits to the population of improved health and safety. This ethical analysis of public health interventions does not dictate policy choices; rather, it enables public health ethicists to identify a range of ethically appropriate...

The United States Constitution provides the framework for the distribution of governmental power. It divides power between the federal government and the states, separates power among the three branches of government, and limits governmental power over individuals to protect a sphere of liberty (see figure 4). Federal and state public health agencies carry out public health functions within these constitutional boundaries. Governmental actors must use their power to protect and promote the public’s health according to this constitutional design and within the scope of legislative mandates. When disputes regarding governmental powers arise, courts often determine the lawfulness of particular public...

Government has a long tradition of regulating for the community’s welfare. Regulations target individuals (e.g., setting forth infectious disease powers), professionals and institutions (e.g., requiring licenses), and businesses (e.g., mandating inspections and safety standards). The previous chapter emphasized the broadpowers and dutiesof government to safeguard the public’s health. This chapter considers therestraintson government power that protect individual interests in autonomy, privacy, liberty, and property.

The cases and commentary in this chapter trace the evolution in judicial thought on the balance between public health power and protection of individual rights. Public health jurisprudence is neither static nor...

The first two chapters in this part of theReaderexplored the scope and limits of the government’s public health powers. In this chapter, we examine how these powers are exercised. To achieve communal health and safety, governments have formed specialized agencies, usually in the executive branch. Local and federal agencies issue and enforce regulations to ensure occupational health and safety; prevent environmental degradation; and protect consumers from unsafe products, impure food and water, and ineffective or dangerous pharmaceuticals and medical devices. They license professionals, businesses, and institutions to ensure adequate qualifications and standards, and inspect premises and commercial establishments...

The levers of public health regulation are often viewed as being in the hands of legislatures and executive agencies. However, attorneys general and private citizens possess a powerful means of indirect regulation through the tort system. Tort litigation can be an effective method for reducing the burden of injury and disease. The courts help redress harms caused by pollution, toxic substances, unsafe pharmaceuticals or vaccines, and defective or hazardous consumer products. Figure 8 provides an image of how tort law serves as a tool for reducing a variety of harms to the population’s health.

The goals of tort law, though...

Scholars view public health law primarily as a domestic field of study. And constitutional, statutory, administrative, and tort law affecting the public’s health undoubtedly is found mainly at the federal, state, and local levels. But neither the legal system nor the health system operates in isolation. The forces of globalization heavily influence both, propelling pathogens, and even behaviors and lifestyles, across national frontiers. No state, acting alone, can ensure the conditions that will guarantee the health of its population. This has always been true, but never as obviously as in today’s world. Travel and migration, dense settlements in urban areas,...

To achieve collective benefits, public health officials systematically collect, store, use, and disseminate vast amounts of personal information, commonly in electronic form. Public health officials monitor health status to identify health problems, diagnose and investigate health hazards, conduct research to understand health problems and find innovative solutions, and disseminate information intended to inform, educate, and empower people in matters related to their health. The data that they collect provide the basic infrastructure necessary to effect many of the common goods of community health. These data are also often personally identifiable and sensitive. Data may reveal information about a person’s lifestyle...

Public health authorities recognize behavior as an important determinant of health in the community. This idea is reflected mostly in modern discourse about the roles of smoking, diet, and sedentary lifestyle in the development of chronic disease, but the influence of behavior in transmitting infection (e.g., sexual or needle-sharing behavior) or causing injury (e.g., use of automobiles and firearms) is also well recognized. Researchers seek to identify effective techniques for changing people’s behavior to achieve reductions in chronic and infectious diseases, as well as in injuries. Public health assessments and interventions occur at the point of human contact, whether at...

This chapter and the next examine the most ancient and enduring threats to health in the population—infectious diseases. The effects of epidemics on society are as destructive as those of war. For example, the estimated 50 to 100 million deaths from the Spanish influenza pandemic of 1918–20 exceed the number of combatants killed in World War I, World War II, Korea, and Vietnam combined (Johnson and Mueller 2002). And HIV/AIDS has claimed approximately 25 million lives since 1981 (UNAIDS 2008). Not surprisingly, the United States has classified HIV/AIDS as a national security priority, reasoning that it may result...

Measures to control communicable diseases are not limited to biological approaches. Societies can also cope with communicable disease epidemics by separating contagious persons from the rest of the population. Public health authorities possess three overlapping powers of detention to help prevent the spread of disease: isolation of known infectious persons, quarantine of healthy persons exposed to disease, and civil commitment (compulsory hospitalization) for care and treatment. (For descriptions of these three forms of detention, see pages 428–36 and table 19 in chapter 11 of the companion text.)

We like to think that the employment of these measures is thoughtful...

Previous chapters have focused on the limits on government power to protect personal freedoms: autonomy, privacy, bodily integrity, and liberty. Individuals, however, value not only personal freedom but also economic liberty. They claim the liberty to own and use private property, run businesses, enter into contracts, and pursue trades, livelihoods, or professions.

Market Capitalism and the profit incentive are widely valued in modern America. Citizens sometimes see government as an obstacle to achieving their financial dreams. They assert a right to freedom from government bureaucracy, taxation, and burdensome regulation. Some economists believe that regulation, if desirable at all, should redress...

The field of public health vastly helped improve the health and well-being of populations during the twentieth century, leading to substantial increases in life expectancy, improved sanitation and living conditions, and reductions in infectious diseases. Nevertheless, major problems, as well as remarkable opportunities, confront the field in a new century.

This chapter offers case studies on three of the most complex and important public health challenges: bioterrorism and biosecurity, public health genomics, and obesity. Each of these challenges raises core questions regarding the proper scope of and ethic for public health, highlights the interconnectedness of domestic and global health, and...