Community: The Neglected Tradition of Public Health

1. Community: The NeglectedTradition of Public Health Dan E. Beauchamp

2. What is a Community? • A community is NOT just a group of people living in proximity. • A community is a group of people who share and have something substantial in common, such as a history, values, religion, language, customs, traditions, culture, etc. • It is this common interests and purpose that creates and forges a community.

3. A Community’s Interest • A community has common interests: safety and security are among the most fundamental. • The flourishing, safety and security of a community requires education, laws, enforcement, economic system, and health care. • The public’s health, therefore, is a fundamental element of any political community. • The public’s health improves the community’s quality of life and protects its members from diseases and illnesses.

4. Individual versus Community • The well being and interests of the community do not always coincide with the well being and interests of the of individuals in the community. • Sometimes the public’s good, or the “common good,” will conflict with an individual’s rights, privacy or property rights. • Beauchamp argues that our republic has a legal tradition and history that has protected the common good and the public’s interest over and against the individual’s privacy and property rights.

5. Emphasis on Individual: John Stuart Mill • “The only purpose for which power can be rightfully exercised over a member of a civilized community, against his will, is to prevent harms to others.” • The Harm Principle • The common good, therefore, is that which maximizes the individual’s private rights and freedoms.

6. Paternalism • Paternalism is the interference of government in the “private” lives of individuals. • Governments do this by passing legislation (laws and regulations) or through common law (court interpretations). • Paternalism is justified (so it is argued) in cases when leaving it up to the choice of individuals is too costly for the individuals and/or for society and/or when it is believed that the individuals are not completely free.

7. Paternalism and The harm Principle • Individual freedom can create risks not only for the individual making the choice but also for other individuals. • Therefore, paternalism can be justified, in some cases, by the harm principle.

8. Paternalism and Voluntarism • Paternalism might also challenge the notion of voluntary actions, that is the claim that individuals within a community are truly acting freely. • For instance, you might believe that your decision to smoke a cigarette is freely chosen, however, the fact of the matter is that there are a number of invisible social factors that have strongly influenced your decision. Therefore, you are NOT really choosing freely.

9. Individual versus Community • The state serves the welfare of the individuals (as individuals) and the welfare of the community (individuals as a group). • The Community: the common shared interest of a group of individuals. • Private Property vs. Community • The Market vs. Community • Individual and institutional rights vs. Community

10. 1850 Report to Legislature • “The condition of perfect public health requires such laws and regulations, as will secure to man associated in society, the same sanitary enjoyments that he would have as an isolated individual…”

11. Gibbon v. Ogden 1824 • In this case Chief Justice John Marshall was the first to coin the term “Police Power” in reference to the states power to regulate public health care. • This case gave power to the state to protect the the health of the common good. • Inspection laws, quarantine laws, etc.

12. Commonwealth v. Algers1851 • A decision by Chief Justice Shaw of Massachusetts Supreme Court provided the first broad definition of “Police Power” and the classic definition. • “The power we allude to is…the police power, the power vested in the legislature by the constitution, to make, ordain and establish all manner of wholesome and reasonable laws, statues and ordinances, either with penalties or without, not repugnant to the constitution, as they judge to be for the good and welfare of the commonwealth, and of the subjects of the same.”

13. Muglerv. Kansas 1887Relevance of the Community • The plaintiff argued that he had the right to make beer in his own home, even if beer was illegal in the state of Kansas. The Kansas constitutional amendment that outlawed beer was an infringement on his basic rights as a US citizen. • The Supreme Court held that “There is no justification for holding that the State under the guise of police regulations, is aiming to deprive the citizen of his constitutional rights: for we cannot shut out of view the fact, within the knowledge of all, that the public health, the public morals, and the public safety, may be endangered by the general use of intoxicating drinks.”

14. Contemporary Public Health and safety Problems • There are two pertinent questions with respect to police power of the state: (1) Does the state have police power and how much. (2) On what basis is the state’s police power justified.

15. 2 contemporary examples • Fluoridation: opponents argue that fluoridation is a form of “mass medication” and a violation of private citizens individual autonomy and rights. • However, the courts have not agreed and thus fluoridation remains a strong example of the common good overriding individual’s rights.

16. 2 Contemporary example • Motorcycle Helmets: Opponents of the motorcycle helmet law have argued that the such a law infringes on their individual rights. After all, if a person does NOT want to wear a helmet that is his or her right not to do so. • However, the courts have not agreed and have argued that by not wearing a helmet the individual HARMS others. First, it puts other drivers at risk, and, second, the costs of the serious injuries due to motorcyclists not wearing helmets has to be paid by taxpayers.

17. The Language of Public Health • Political Individualism • Political Community • Body Politics • Shared commitments and promises to one another