Tyranny of the Individual in Public Health: A Plea for the Public

This presentation will discuss the recent, post-1890, acceleration of public health toward the individual. The presentation will first discuss how the Progressive period used a legal and political discourse that emphasized the consumer and the individual. The emphasis on the consumer and the individual shaped the development of the federal administrative state in the United States. This focus and subsequent development of the administrative state occurred after the aborted attempts to establish a national public health authority in the wake of repeated Yellow Fever outbreaks in the South and has influenced the development of public health since that period. This development will be explored by examining the law and public health in the US.

Public health in the United States has adopted an ideology of the individual. This unquestioned background preference has pushed public health law particularly into a focus on public health as a question of liberty, rather than justice. This policy preference makes public health action to address fundamental structural inequities extremely difficult and relegates the public health infrastructure to a facet of the social welfare state and marginalized political movement. Further, current U.S. justifications of public health interventions are yoked to a model of representational governance that makes addressing future and collective public health issues difficult and addressing public health problems globally problematic.

Public health is a zero-sum game and the primary focus of public health should not be the individual vs. the community, as it is now, but rather should be focused on equity. Only by focusing on equity can the public health community allocate its resources and address serious problems that, I argue, cannot be addressed satisfactorily in the current model, e.g. climate change, environmental issues, and structural poverty. Understanding this background assumption will enable public health practitioners to reframe current issues in public health to focus on the public health and welfare. The presentation will examine other public health traditions, particularly East Asian, as well as Western philosophers such as Rawls, Jennings, and Fuller to explore possibilities for a new approach to public health in the United States.