What are governments for? A public health perspective

We often take governments for granted. They get elected, they serve their term, and they ask us to re-elect them. Whether we vote for them or the opposition depends on many factors, but does health ever feature in our choices? This paper goes back to basics, asking what, from a health perspective, is the legitimate goal of government. Governments have always recognized the need to save the lives of their citizens. Sometimes this meant confronting disease, as with quarantine, but more often it meant securing a powerful army to stave of invaders. They have also seen a legitimate role in pursuing economic growth, although often showing less interest in how the benefits are distributed. Both goals raise important issues for public health. First, what value do we place on a life? Is the political response to a death from terrorism the same as that from lack of health insurance? Second, is economic growth really what should be pursued? GNP is simply the sum of monetarised transactions in the economy; it does not necessarily equate to health or happiness. So should the goal of government be to improve health? If so, there are some fundamental philosophical questions about the role of the individual and the state. By means of a number of contemporary and historical examples, ranging from the plague of Athens to Hurricane Katrina, this paper will explore some of the fundamental questions that public health professionals should be asking of those who seek their votes.