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Free to Be Foolish

Free to Be Foolish: Politics and Health Promotion in the United States and Great Britain

Howard M. Leichter
Copyright Date: 1991
Pages: 300
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  • Book Info
    Free to Be Foolish
    Book Description:

    Each of us is, to a certain extent, dangerous to his or her own health, but how far do we want the government to curb our freedom to be "foolish"? In a look at such highly charged health issues as smoking, alcohol, road safety, and AIDS, Howard Leichter analyzes the efforts of the United States and Great Britain to confront the seemingly constant tension involved with this question. Leichter contends that both governments are now paying less attention to providing access to health care and more to forcing or encouraging people to change their behavior. The result has been a transformation of health politics from a largely consensual to a largely conflictual enterprise: health promotion policies often provoke debate on issues filled with scientific uncertainties, while taking on the quality of a disagreeable moral crusade. A primary concern of this book is to account for the differences, as well as the similarities, between the two countries in their public health policies. Leichter examines, for example, why seat belt regulation flourished in the American states even when federal action was blocked while, in Britain's more concentrated political structure, similar regulation faced a tortuous political path through the Lords and Commons. Finding that the United States is more apt to use formal regulation and that Britain tends toward voluntary agreement, Leichter compares the two approaches. Neither government avoids conflict, he maintains, but regulation, despite its problems, is more effective.

    Originally published in 1991.

    ThePrinceton Legacy Libraryuses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

    eISBN: 978-1-4008-6199-6
    Subjects: History of Science & Technology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. List of Figures
    (pp. ix-x)
  4. List of Tables
    (pp. xi-xii)
  5. Preface
    (pp. xiii-xvi)
  6. List of Abbreviations
    (pp. xvii-2)
  7. One Foolishness and Politics
    (pp. 3-31)

    In 1808 a controversial but highly respected Scottish physician and professor of medicine at Edinburgh University, Dr. James Gregory, became involved in a debate over a parliamentary bill “To Prevent the Spreading of the Infection of the Small Pox.” The bill would have prohibited vaccination within three miles of any city or town and required compulsory removal, isolation, and reporting of smallpox cases. The proposal met with considerable opposition, especially because of its compulsory provisions. Dr. Gregory, one of the bill’s most vocal opponents, argued that “England is a free country and the freedom which every freeborn Englishman chiefly values...

  8. Two The Health of Nations: The First Public Health Revolution
    (pp. 32-67)

    Rarely in history has public health policy had as its sole purpose the promotion of good health or the prevention of disease. As often as not, it has sought to secure other critical social and political values, including moral renewal, reduction of poverty, improved economic efficiency, and strengthening of national defense. Many of these concerns were especially evident in the nineteenth century, when nations such as the United States and Great Britain were forced to respond to the social and political traumas associated with industrialization and urbanization. The result was the first public health revolution, during which industrializing nations took...

  9. Three A New Perspective on Health: The Second Public Health Revolution
    (pp. 68-96)

    The first public health revolution occurred in capitalist societies as a result of the changes wrought by the industrial revolution. The second public health revolution is a response to similarly dramatic changes. Some scholars use the term “postindustrial” to describe societies that have undergone or are undergoing these changes. Some academics disagree over whether or not recent social and economic changes constitute a distinct phase in capitalist development, but this particular debate need not detain us.¹ For the purpose of this book it is simply necessary to acknowledge the structural changes in British and American society since World War II,...

  10. Four Smoking and Health Policy: A New Prohibition?
    (pp. 97-142)

    In February 1987 U.S. physicians in an organization called “Doctors Ought to Care” followed the lead of some of their British colleagues and began to send black-bordered death notices to members of Congress. The notices informed the legislators that one of their constituents had died of a smoking-related disease. The form included the name of the constituent, the specific disease, and an appeal to the legislator to oppose any bills aiding the tobacco industry. The death notice, which was characterized by a representative of the tobacco industry as “grotesque,” reflects the emotional intensity generated by the issue of smoking and...

  11. Five Alcohol Control Policy: Who Should Drink, When, Where, and How Much?
    (pp. 143-180)

    As an issue of public policy concern, the use or misuse of alcohol has a much longer history than that of cigarettes. In Britain, problems associated with alcohol abuse first appeared in the late fifteenth and early sixteenth centuries. Acts that sought to deal with public disorder in alehouses were adopted in 1495, 1504, and 1552. The 1552 act enforced licensing of alehouses because “the intolerable hurts and troubles to the Commonwealth of this Realm doth daily grow and increase through such abuses and disorders as are had and used in common ale-houses and other houses called ‘tippling houses.’ ”¹...

  12. Six Road Safety Policy: Blaming The Car Or The Driver?
    (pp. 181-209)

    Since the first recorded traffic death in 1899, nearly 2.5 million Americans have died in road accidents, more than twice the number killed in all the wars in our history. In Britain the story is much the same. In a 1979 parliamentary debate on mandatory seat-belt legislation, one member of Parliament pointed out that in the previous five year period (1974–1979) there had been over three times as many casualties on British roads as British troops suffered during the five years of World War II.¹

    In recent years policymakers in both the United States and Britain increasingly have concerned...

  13. Seven Dealing with AIDS: Just Desserts?
    (pp. 210-248)

    In the fall of 1980 the United States Department of Health and Human Services publishedPromoting Health/Preventing Disease: Objectives for the Nation,which, as noted in Chapter 3, set national goals to reduce a wide variety of diseases by 1990. The objectives in the section on sexually transmitted diseases included reducing the incidence of gonorrhea, syphilis, herpes, and chlamydia; acquired immune deficiency or AIDS was not mentioned in the study. Within five years, AIDS was being described as “a major peril to our entire species,” “one of the gravest public health threats of this century,” and “the century’s most virulent...

  14. Eight Promoting Health and Protecting Freedom: American And British Experiences
    (pp. 249-262)

    No one wants to die of AIDS, lung cancer, cirrhosis of the liver, or injuries sustained in an automobile accident. The public policy debate is not over the desirability of avoiding illness, injury, or premature death, but over the individual and collective sacrifices we are willing to make to maximize our chances of living long and healthy lives. If those sacrifices were simply of a material nature, the personal and social dilemmas that life-style modification issues raise would be less intractable. The choice, however, is rarely limited to spending more or less money; it invariably involves allowing more or less...

  15. Bibliography
    (pp. 263-272)
  16. Index
    (pp. 273-281)