There is no doubt that the modern field of public health has led to many positive reforms, especially in public sanitation infrastructure, industrial pollution controls, and the banning of especially harmful drugs and food additives.

At the same time, the field has expanded over the years to encompass every aspect of human life, along with mandating behavior, versus banning things that are dangerous. K-12 vaccines and COVID-19 vaccine and mask mandates are examples where public health has collided head-on with our cultural notions of personal autonomy and rights. Being opposed to mandates does not mean you oppose the freedom to choose to use interventions like vaccines. Perhaps public education, versus mandates, offers a better balance of public good and personal freedom.

Jacobson v. Massachusetts

Since the 1905 case of Jacobson v. Massachusetts, the legal paradigm has supported the idea of mandates for the public good, as well as unbridled deference to the purported expertise of health boards. In that case the Supreme Court upheld the state’s smallpox vaccine mandate, and it has been used since then for the proposition that mandates do not violate our basic right to bodily autonomy. There are many reasons why this case should be overturned; a main one is that it was decided in an era when the high court was still using a low standard called “rational basis” to justify personal freedom infringements. 

After Jacobson was decided it was used to approve many other intrusions on personal choice, such as forced sterilization of people deemed unfit to reproduce.  However constitutional law has evolved as our country and protection of personal freedom has become paramount to our understandings of freedoms. Forced sterilization and cases involving bodily autonomy have been overturned over the years, as the Court identified a stricter standard to apply to potential infringements on persons freedoms called the “strict scrutiny standard.”

Government control for the common good

Today’s public health field has defined anything that is in the “common interest” as part of its mission. So socio-political issues like racism, and personal issues such as what medicines people choose to use for their health, often are seen to come under its purview. At the same time, it has come to encompass the idea that “populations” in the abstract need constant management of their behavior and choices by public entities. As an example, we have California’s Department of Public Health definition itself as follows:

“What is Public Health?

Public health shapes our communities by addressing the root causes of health issues and promoting overall well-being. Through proactive efforts like policy development, education and prevention, public health seeks to create healthier, safer, and more equitable environments for everyone.” 

And giving hints of its arguably overreaching nature, this California Department notes that:

“Our programs and services, in collaboration with local health departments, state, federal and private partners, touch the lives of every Californian and visitor, 24 hours a day, 7 days a week.” (Emphasis added.)

How did we get to this point, where “24/7” government management of our health is considered normal?

Modern public health

Modern public health developed from the 17th century on, and its history offers clues as to how we got to our current situation. Originally this concept meant keeping track of the health of the public, especially with modern developments like statistics. In the 18th century this morphed into the idea of governance over the health of the public. In German states, there were new medizinische Polizei (“medical police”), which came from the idea that the government has a right and duty to regulate the bodies and health of entire populations. And then the 19th Century saw expert management take over from prior ideas of moralistic governance.

Merger of medicine with social science

In the 20th Century the identification of public health with a permanent institutional complex, as represented by health ministries, the WHO, the CDC, and the National Institute of Health in the US, has taken place. These entities aimed, at the population level, to manage risks, policies, and behaviors. Here a key development was the merging of hard science with soft science, e.g. combining epidemiology with social science in efforts to control things like gun violence, cigarette smoking, people’s body weight, and even mental health. 

Public health today

In our time, public health has come to mean any policy that might be justified by a population-level good, such as seatbelt laws, taxes on soda pop, and efforts to fight global warming. We see a fusion of science, morality, and authority in which public health implies both scientific correctness and moral legitimacy. “Follow the science”? This now means that democratic debate is to be replaced with management by experts. And “emergency” became a buzzword granting extraordinary powers to government bodies. Once inherently temporary concepts, “crisis” and “emergency,” have become justifications for permanent control. Can public health be scrutinized and reigned in from being all-encompassing  in order to protect personal autonomy according to our constitution and our laws?

What can you do?

Become involved in the governance process, whether local in your community, or nationally.  We have county and state health boards and, along with federal agencies like the CDC, tasked to promote the health of the public. While they are often opaque, we all can get to know more about these public bodies and use avenues such as correspondence, going to official meetings and forums, and providing public comment as appropriate.

Engaged citizens are needed to ensure that personal liberties are not limited by public health efforts. We encourage everyone to get involved in the sometimes-contentious political processes in which public health, and the limits of that paradigm, are molded.