2.13: Public Health Involves Making Public Policy for the Public Good

When we think and talk about improving health these days, it often comes down to discussions of our personal behaviors. Are you eating a vegan diet? A "Paleo" diet? Do you make it to the gym regularly? How many servings of alcohol do to you consume in a week (if any)? Do you smoke tobacco (or anything else)?

These are important health questions! And certainly, there is a large amount of public health efforts that go into influencing individual behaviors. You have probably seen ads like the ones below (optional viewing):

 

 

As much as public health might spend on advertising campaigns like "5 a day" (eat 5+ vegetables or fruits a day) or the old "kick the habit" (quit tobacco) campaigns, the industries that sell junk food, tobacco, alcohol, and so on are always going to spend more on their marketing campaigns. It is very hard to change human behavior! Just having health knowledge (as important as that is) is seldom enough to make a large-scale change in health behaviors across a population.

And in public health, we focus on populations.

So how do we best improve the health of populations?

If we can change something in the environment that reduces the risk for lots of people (like, put speed bumps on that road where people drive too fast) or create a policy that removes a danger (like, laws that reduce asbestos use) or makes the healthier choice the easier choice (like, rules that require schools to offer water instead of juice or soda), then we are likely to affect a lot more people's health.

Public Health is a Public Good

A "public good" is something that is created by our collective or governmental efforts, rather than through a private business, that benefits everyone, and that is (at least theoretically) available to everyone in a non-competitive way. For example, if you are healthy, it doesn't mean there is less health available for me -- I can be healthy too. And what makes us healthy includes things that it would be very hard or impossible to obtain individually -- like, functioning sewer systems and clean water and clean air. So it is clearly a public responsibility to work for the public good, including public health. In the United States, there is a strong ethic or belief in neighborliness, in stepping up to a challenge together, in patriotism, and in a sense of collective or mutual responsibility. Public health is closely connected to these values.

Sometimes this clashes with another strong ethic or belief in the United States, that of individualism and individual choice. When a law goes into effect that shapes a health behavior -- for example, the "click it or ticket" seat belt law -- there will be people who resist it, saying, "It's my own darn business if I choose to wear a seatbelt or not!" Sure, that's true. But if a person is badly injured because of not wearing a seat belt, the cost of their hospitalization will be partly paid by all of us -- either through public insurance programs like Medicare or Medicaid, or through rising premiums on private health insurance. The doctors attending that person aren't available to attend other patients. Indirectly, there are costs to the larger society. This is part of why public health workers often support laws that may place the public good ahead of individual choices.

The process of making public policy involves balancing these competing ideas and values. Often there are tensions, and we don't always see different prevention strategies the same way (even within public health circles).

Can you think of any examples of seeking a balance between the right to individual choice versus the desire to create a safer or healthier community for all?