Privatization of Public Health

Public health is a quintessential government function. Governments have the responsibility to consider the interests of the entire community and make efforts to protect these interests. State and local governments use their police powers to effectuate good public health outcomes. Private entities, by contrast, typically lack the incentives or the power to achieve population health goals. Yet, private entities are increasingly involved in public health practice.

This presentation explores the implications of increased privatization on the theory and practice of public health. Central to this discussion is the example of the Detroit Department of Health and Wellness Promotion, which underwent a radical experiment of contracting out most of its operations to a non-profit institute in 2012. The Detroit privatization experiment raises challenging questions about the scope of public health powers and the extent to which legal authority for public health can be delegated outside governmental entities. Privatization of public services is not inherently problematic, but privatization raises concerns about continuity of services that do not generate revenue and about serving the mission of public health. Furthermore, privatization of population health services may undermine some of the structural and legal protections afforded by public entities, and may render public health priorities more susceptible to market forces and political dynamics.