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CHAPTER 2

Why Is Public Health Controversial?

Social Justice Versus Market Justice

Differences:

Social justice: The common good

Market justice: Individual responsibility

Questions about the scope of public health

Importance of economic factors for health

Politically controversial

Sources of Controversy

Economic impact

Individual liberty

Moral and religious opposition

Political interference with science

Economic Impact

Most public health measures have a negative economic impact on some segment.

Businesses often resist public health measures because they affect profits.

Those who must pay may not be the ones who benefit.

Costs may be short-term, while benefits may be long-term.

Costs are easier to calculate than benefits.

Tragedy of the Commons

Is exemplified in many environmental laws

Freedom of individuals should be restricted for the well-being of the population.

Do laws overly restrict “freedom” to pollute?

What should be included among protected resources?

When Can Government Restrict Individual Freedom?

Restrictions to prevent harm to others is generally acceptable.

Paternalism is only acceptable for laws concerning children.

For protecting individuals from their own actions? (Libertarians are opposed.)

Libertarian view has a strong tradition in the U.S.

Argument for restrictions for the “common good” leaves lots of room for controversy.

Moral and Religious Opposition

Concerns:

Sex and reproduction

AIDS, STDs, teenage pregnancy, and low birth-weight babies are major U.S. public health concerns.

Public health solutions are often viewed as promoting immoral behavior.

Alcohol and drugs

Such opposition may discourage scientists and funding agencies from conducting research on many important health problems.

Politics Versus Science

There is always the possibility of tension.

Conservative control of federal government intensifies the conflict.

Under Bush administration, EPA changed a section of a major report.

Obama administration made efforts to inform policy decisions based on honest science.

Under Trump administration, EPA director proposal would bring politics into initial review and synthesis of research step.

Discussion Question 1

Do you agree that the philosophy of social justice is preferable to the philosophy of market justice?

Which is likely to lead to greater improvements in public health?

Discussion Question 2

Give an example of a measure that would benefit public health but that might be expensive to implement.

Who would benefit?

Who would pay the cost?

Discussion Question 3

Give an example of a measure that would improve public health but that might limit some people’s freedom.

Who would benefit?

Whose freedom would be limited?

Discussion Question 4

How far do you believe government should go in advocating and/or enforcing moral behavior?