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The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.
By Jeffrey Zimmerman
February 24, 2017
What is or should be the government’s role in public health here in the United States? This is a broad and vague question depending on which group, lobbyist(s), advocacy groups, political parties, etc. will provide a different response; this question can also be the foundation for very strong feelings about the role of government in public health.
The question of what should the government’s role be in public health generates discussions and debates on all sides of the topic, such as the government is overstepping their limits by passing the Patient Protection and Affordable Care Act; or comments that the government should be more involved in public health to ensure that we live in the healthiest environment possible. The United States is a democracy and because of our governing nature of a democracy in which we have two major political parties and several other minor parties in our democracy; because of this democracy, it is difficult to come up with the right answer about what the right amount of involvement in the public health system from our government.
The United States government has passed two major pieces of legislation in the past fifty years that showed its involvement in the public health paradigm; the passage of Medicaid and Medicare in 1965 and the passage of the Affordable Care Act in 2010. Both instances of government throwing themselves into the public health arena had many supporters and those who objected these pieces of legislation for myriad reasons. I am certainly not going to argue against the many benefits of both laws, e.g. under Medicaid and Medicare many elderly and poor people could get health insurance or assistance with their health insurance which is a great benefit to society for many reasons. Medicaid, Medicare and the Affordable Care Act are just some examples where the government passed legislation to insert itself into the public health arena. There are many examples where the government doesn’t create legislation to immediately intervene in a public health matter, e.g. assisting with the Ebola and Zika virus epidemics (or perceived epidemics), responding to other public health crises, etc.
The government is involved in public health both directly and indirectly through legislation, advocacy and other programs. One such program was former First Lady Michelle Obama’s work with child obesity during her time in the White House. She worked fervently at times to address the national issue of child obesity. She worked to get the school lunch changed to healthier foods and encouraged children to exercise for at least 60 minutes a day. Many partnerships outside of politics presented this message; one example of this was the National Football League’s (NFL) “Play 60” campaign in which NFL players encouraged kids to play every day for 60 minutes.
The level of involvement in the public health arena varies by level of government; there are local, county, state and federal public health agencies that have different responsibilities and levels of involvement. One example of a federal public health agency is the Centers for Disease Control (CDC), an example of a state public health agency could be a state’s Department of Health and Human Services (or a similarly named agency) and an example at the county or local level could be the City or County Public Health Department (or a similarly name agency). These various governmental public health agencies might have different levels of responsibility but their main objective is public health. They provide their services in the interest of the public and not to make a profit as these agencies are generally funded by taxes and other government appropriations.
A recent example of the government intervening on behalf of public health was sanctioning or regulating the “vape, vaping or e-cigarette” movement that started a few years ago, when vaping or e-cigarettes were first introduced they were done so as a safer alternative to smoking. The Food and Drug Administration (FDA) and CDC subsequently came out with findings that contradicted those assertions and essentially stated vaping had health risks associated with them. The government passed regulations to ensure these e-cigarettes and vaping devices and other associated items were regulated and sold to adults like tobacco. In this example, we can assume that this involvement by the government had both supporters and objectors for a variety of reasons; one reason for supporting this regulation could be promoting healthy lifestyles and that vaping is not a safer alternative to smoking, conversely, an argument for not supporting the government involvement could be that “big brother” is overstepping his boundaries again or that the government just wants the tax revenue from vaping.
As we can see, this debate of government involvement in public health is a complicated discussion for many reasons and presumably this debate that will continue for decades and centuries to come.
Author: Jeffrey R. Zimmerman Ph.D. in Public Policy and Administration from Walden University. I am currently serving as a Social Science/Education Research Associate for the North Carolina Justice Academy and as an adjunct professor in the MPA program with Strayer University. I can be reached via email at [email protected].