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Public Health—Stealth Health: Part Two

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Burden S. Lundgren
May 6, 2022

In my last column (2/3/22), I recounted the success of public health workers in eradicating smallpox—a success gained by massive global immunization campaigns. This was naked public health, a practice with little regard to any supposed rights to refuse vaccination.

Health care and public health are not the same—not even close. Health care involves individual practitioners treating individual patients—most of whom are already ill. Public health is much broader, and its aim is not the health of individuals, but of populations. Public health is far more multi-disciplinary than the health care professions involving epidemiologists, statisticians, environmental specialists, policy analysts, sociologists and many others.

Public health is oriented to prevention rather than cures. C-E.A. Winslow, Founding Dean of the Yale School of Public Health, defined public health as “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private communities and individuals.” Unfortunately for public understanding, prevention is seldom celebrated. We do not notice what does not happen, making public health generally invisible.   

But invisible or not, public health is ubiquitous. William Henry Welch, Founding Dean of both the Johns Hopkins School of Medicine and the Johns Hopkins School of Hygiene and Public Health, offered this, “There are no social, no industrial, no economic problems which are not related to problems of health.” We have public health laws governing food production and service, water supplies, manufacturing processes, vehicle safety, public accommodations, building codes, child care, professional licensing and an almost endless list of other activities—almost all under the radar.   

Health care and public health do share selected ethical principles: the duty to do no harm, the duty to improve health. But there are some that are not shared. Health care bears the stamp of individualism. Autonomy carries a great deal of weight. Patients can almost always refuse treatment offered by their health care practitioners. Public health is about interconnection and is directed by the principle of utilitarianism. We look to bring the best outcomes for the greatest number of people. I would also argue that public health practitioners are more involved in principles of distributive justice—giving to each person his/her “due” which means greater attention is paid to vulnerable populations. Individual autonomy is severely limited.                                                      

Unlike clinical practice, public health interventions are enshrined in laws rather than in customs, local standards of care or practice guidelines. Like any laws, they are an abridgement of rights. Car-makers must meet safety standards. Farmers cannot spray their fields with contaminated water. Factories must install safety equipment—and on and on. Most of our public health laws do not announce themselves. It is only at times like these that they become controversial. Endorsing the notion that health care and public health are the same gives undue importance to the principle of autonomy thus empowering those who are resisting public health measures that would protect us all.

Being vaccinated against a contagious disease is not a personal choice. This was settled in the 1905 Jacobson v Massachusetts decision and affirmed by the Supreme Court. The Court’s opinion was delivered by Justice Harlan. The crux of his reasoning is below.

“But the liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good…Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, in respect of his person or his property, regardless of the injury that may be done to others. This court has more than once recognized it as a fundamental principle that persons and property are subjected to all kinds of restraints and burdens, in order to secure the general comfort, health, and prosperity of the State…”

States have the right to compel vaccinations, and they do. I have no more right to refuse vaccination for a highly transmissible and lethal disease than I have to drive drunk. The failure to make this clear at the beginning of the pandemic was not only a political failure, but also a failure on the part of the media and often of the health care establishment to recognize the difference between personal clinical decisions and public health requirements. And it freed the public to decide that they were their own vaccine experts. In the absence of the appropriate framework for vaccine enforcement, public health departments struggled and generally failed to reach enough of the population to halt the spread of the virus.

Failure to vaccinate allows more viruses to circulate. More viruses in circulation means more infections, more variants and more preventable deaths. The means were coercive, but smallpox is dead. For COVID vaccinations, the means were permissive, and nearly a million Americans are dead. I have little doubt as to which is the better outcome.

Author: Burden S Lundgren, MPH, PhD, RN practiced as a registered nurse specializing in acute and critical care.  After leaving clinical practice, she worked as an analyst at the Centers for Medicare and Medicaid Services and later taught at Old Dominion University in Norfolk VA.  She has served as a consultant to a number of non-profit groups.  Presently, she divides her time between Virginia and Maryland. She can be reached at [email protected].

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