An obvious tension is between public health and for-profit markets which may not prioritize public health protections."
Paula Lantz
The government has a clear role in promoting and assuring the goals of public health—the prevention of illness and injury, prolonging life, and promoting the collective health of the entire population. Achieving these goals cannot be left to the private sector, or even to collective action and partnerships. An obvious tension is between public health and for-profit markets which may not prioritize public health protections. In addition, determining the best policies for public health requires data, planning, resources, and tailored interventions.
Furthermore, the U.S. has significant racial/ethnic and socioeconomic inequities in most health outcomes that require governmental tracking and policy responses. For example, it has been and remains incumbent upon governmental public health to document, understand, and intervene upon the ways in which the COVID-19 pandemic has had a significantly greater impact on the health of racial/ethnic minority populations.
The U.S. Constitution provides a strong foundation for governmental involvement in public health. In particular, the Constitution grants to state governments powers to protect the “health, safety, morals, and general welfare of their inhabitants.” These powers include the ability to make and enforce policies/regulations that: a) protect people who cannot protect themselves (including children); b) protect people from the action and behaviors of others; and c) sometimes protect competent adults from themselves.
While medical/health care interventions are important, the biggest gains in life expectancy and other population health metrics have historically come from governmental policies and regulations related to worker safety; food safety; auto safety; air and water quality protections; vaccine promotion and subsidization; and age restrictions, excise taxes, and other policies related to tobacco/alcohol products.
The design of effective public health policy, however, is neither simple nor straightforward. Public health policies often intrude upon individual rights/freedoms and infringe upon private markets. As such, in my teaching and research related to public health, I emphasize the constant need to consider and balance the potential effectiveness and health impact of a particular policy approach with its potential drawbacks. These can include the infringements the policy may have on individual freedom and personal choices and the costs of goods, services, and innovation in private markets and to taxpayers. It is this complex balancing of policy benefits and burdens that is the great challenge of public health policy design and evaluation.
By Paula Lantz, James B. Hudak Professor of Health Policy
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