Public health is an interesting area of research and political activism. Especially since the growth of industrial cities, inefficient disposal of human excreta has been known to favor epidemics of certain diseases. In the 19th century, it was also noticed than sewer workers were, quite understandably, more affected by these diseases. The scope of public health was extended to occupational health.
This suggests a series of questions and considerations that public health activists seem to ignore (as they generally continue to ignore economics): Why sacrifice the health of sewer workers to an improvement of the general population’s health? Do we need a cost-benefit analysis to count the corpses? No, because sewage workers—contrary to, say, the slaves who built the Egyptian pyramids—chose their jobs freely. The same could be said of the typesetters who were victims of lead poisoning: nobody forced them to work in that business and we cannot say that they were sacrificial lambs on the altar of free speech.
It is true that the sewer workers or typesetters of previous ages lacked information about the risks of their occupations. The problem was thus an information problem, which was bound to be automatically solved as medical sciences identified it. Once the information was known, we must assume that adult workers were the most able to make the choices and trade-offs adapted to their own circumstances. Adults are adults, and no less so because they don’t work for the government. Economic research has shown that hazardous jobs carry a wage premium to attract voluntary workers.
Until the Industrial Revolution bore its fruits, the trade-offs available to the poorest individuals were much less attractive. But one must distinguish the impact of poverty from the consequences of economic freedom. Indeed, it is only through a large measure of economic freedom that poverty could be overcome. Until then, the sewer worker was certainly better off (in his own opinion) than in other occupations: this is why, among the alternatives available to him, he chose that one.
Other things (including wealth and poverty) being equal, every walk of life carries its own costs, including often health risks. Some public health reformers, when they became concerned about problems of occupational health, noticed that even intellectual life had its own health risks.
One of them was Dr. George Hayward. In his Lecture on Some of the Diseases of a Literary Life (Boston: Carter, Hendee and Co., 1833), Hayward argued that literary men lack exercise, “confine themselves too long in hot and perhaps ill-ventilated apartments,” eat too much, and “indulge themselves not unfrequently both in smoking and chewing tobacco.” One must beware of “great mental efforts, made without proper attention to bodily exercise.” Even “great public interest and excitement” can increase “the passions of the mind” and lead to the diseases of intellectual life of the kind that occurred “among the distinguished actors in the French Revolution.”
An anonymous book also published in Boston at roughly the same time, Remarks on the Disorders of Literary Men, or An Inquiry into the Means of Preventing the Evils Usually Incident to Sedentary and Studious Habits (Boston: Cummins, Hilliard, and Co., 1825), which Rosen also presents as a public health precursor, gave similar advice with a few addenda—for example, that literary men should eat slowly and not take more than one bath a week.
Medical historian George Rosen (A History of Public Health, John Hopkins University Press, 1958, 1993) tells us that both works were influenced by public health thinking in Europe. According to public-health historian Elizabeth Fee, Rosen, at different times in his life, “might have characterized himself as a democratic socialist or left liberal,” which is far from unusual for people in the field of public health.
Interestingly, 19th-century public-health experts did not argue for laws limiting the working time of literary men like they did regarding other adult workers. They did not propose to forbid them from smoking in their preferred pubs, saloons, or bistrots. (Before the war on smoking, the use of tobacco was especially prevalent among artists, “literary men,” and other creative types.) The authors of the Lecture and the Disorders of Literary Men were content to recommend to literary men voluntary ways of prevention through “temperance and exercise.”
Unexpectedly (did Rosen notice?), the anonymous author of the Lecture has a lesson for today’s public-health warriors. In the last few lines of his book, he wrote:
Besides, as Rochefaucault observes, it is paying too great a tax even for health, when its preservation is made the business of our life.
READER COMMENTS
nobody.really
Nov 25 2019 at 2:12pm
Tangential to Lemieux’s main theme: The premise that the pyramids were built by slaves is contested.
(I swear I get blamed for EVERYTHING….)
1: Once the information was known to whom? People who work in especially unhealthy occupations may also be people least likely to keep abreast of the latest scientific developments.
Here is one more advantage of unions: They act as an institutional repository of information about the risks of various occupations. This isn’t just about poisons. Plenty of physical jobs (construction, sports) can be readily performed by young men well beyond recommended limits. It is only when these young men become older that they will learn about the consequences that exceeding certain limits will have on their bodies. This knowledge does not arise from controlled sample studies, but from long experience—the kind of experience that new job entrants will lack.
2: The premise that people will alter their patterns of behavior to incorporate new, relevant, information is contested. As Nobel Laureate Daniel Kahneman noted, the rate at which people donate organs is overwhelmingly driven by whether the default assumption is that people will donate organs upon their death, or the opposite. The premise of Nudge is that people can retain all the discretion they previously had, yet alter their behavior, based on a change in default social policies.
This fact may not justify prohibiting certain conduct, but it may well justify adopting default policies against certain conduct. For example, most states in the US have adopted some version of the Uniform Commercial Code that imposes certain default assumptions on commercial transactions; parties retain the discretion to waive these assumptions, but must do so expressly. I see little reason why similar policies could not apply to employment relationships.
3: Finally, the premise of Lemieux’s post is that occupational regulations exist for the benefit of people in (or considering) a given occupation. This also is a contested premise. Perhaps the regulations exist because the public wishes to avoid seeing people harmed in certain ways—even if the workers in question have different values.
The inconvenient truth is that humans are social animals: my utility function incorporates some amount of empathy for you, and yours reflects some amount of empathy for me. But empathy tends to extend only to what we can observe. If you suffer an observable harm with an observable cause, I will want to limit that cause. If I cannot observe the harm you suffer, or cannot observe the cause of the harm, empathy may have less influence on my policy judgments.
Essays such as Lemieux’s (and Frederic Bastiat’s) illustrate a weakness of relying on empathy as a guide for public policy. But they do not alter the fact that people do rely on it.
Jon Murphy
Nov 25 2019 at 10:43pm
That’s not empathy, though. That’s antipathy. Bastiat, Pierre, Smith, others who want to limit the “man of the system” do so because the “man of the system” is antipathic. It is empathetic to allow people to make their own choices.
Also, regarding your points 1 & 2, they may be true (as you say, the evidence is contested), but that’s an incredibly strong argument against regulation. After all, if people learn at different rates, there’s no reason to assume the regulators have more information. In other words, who nudges the nudgers?
nobody.really
Nov 26 2019 at 9:34am
1: Would you say that if people learn at different rates, there’s not reason to assume that physicians have more information about the treatment of medical conditions? Or would you acknowledge that specialization in fact DOES give us reason to suspect that people can gain knowledge that the average person lacks?
2: Moreover, who cares? If the nudgers get things wrong, then presumably people will simply exercise their options to return to whatever outcome they prefer.
Now, perhaps it’s not that simple. Perhaps people are busy or otherwise face barriers to exercising their options. But in you acknowledge that possibility, then you’ve rejected the premise that the initial status quo reflected their preferences in the first place. Thus, perhaps the nudgers get things wrong–but there’s no reason to think that the status quo got things right, so there’s nothing lost.
Jon Murphy
Nov 26 2019 at 10:27am
Incorrect assumption. Regulators are specialization in legislation, not in science.
The funny thing about behavioral econ models is that the more people deviate from their models, the more it “proves” the models right, which encourages more nudging.
One of the key assumptions your making is that regulators are not human.
Jon Murphy
Nov 26 2019 at 10:32am
No rejection of the initial premise at all, but rather a confirmation of it (information costs exceed information benefits).
Except personal initiative and individuality, the resources used to implement and enforce the nudging, the resources used to circumvent the nudging, etc etc.
Jon Murphy
Nov 26 2019 at 11:32am
The point I am making, albeit inelegantly, is that due to the subjective nature of economics, and of costs and benefits in particular, one cannot say ex ante that a particular choice (or choices) are right or wrong. The “nudger” does not have the correct knowledge to judge whether or not a nudge is necessary.
Inherently, any nudge is a subjective judgment on the part of the nudger. Sure, he may have mathematics or other scientific analysis to back him up, but he is still making a judgment. Therefore, from the perspective of the “nudger,” any deviation from his plan can be used to justify further nudging. In theory, there are no bounds on where the nudger should stop nudging.
nobody.really
Nov 26 2019 at 3:18pm
I hear you. Some people will agree with you; some won’t. Let’s explore both options.
If I agree with you, then I would also agree that one cannot say ex ante that the status quo was right or wrong. Ergo, we cannot say that there is any harm in tampering with it.
And if I disagree with you, then I have cause to suspect that there WILL be a benefit from tampering with the status quo, because nudgers don’t just nudge at random.
Thus, I find no cause to expect a down-side, and every cause to expect an up-side. Sure, nudgers can make mistakes. But what reason do I have to believe that the consequences of a nudger’s mistake would be worse than the status quo?
The only reason to prefer the status quo seems to be an endowment effect, a well-known cognitive bias.
Pierre Lemieux
Nov 26 2019 at 10:57pm
As constitutional political economists would say, we start from the status quo because there is no other place to start from. Therefore, the question is whether the status quo can be improved or not. If we have no serious argument that it can be improved by going in a certain direction, then it should not be interfered with, or be interfered with in another direction. (In certain cases, such serious arguments exist–say, replacing prohibitions by information or nudges.)
nobody.really
Nov 27 2019 at 4:06am
Not sure what that means.
1: Imagine a man is caught on video robbing a bank. He is charged with robbing the bank–but has not yet been convicted. The status quo is that at the moment of his arrest is that he the cash in his possession and has not yet been convicted. Do you conclude that he is entitled to spend all the money he got from the heist until he’s actually convicted? Or can you envisions some different “place to start from” than the status quo?
2: As a positive (non-normative) statement, I acknowledge that we must apply public policy to the status quo. I do not acknowledge that the status quo has any special moral significance. I rather prefer living in a part of the world in which the status quo levels of infectious diseases has been sharply curtailed.
Perhaps constitutional political economists have different preferences.
I prefer living in a part of the world where the status quo level of lawlessness is curtailed by a police force. The police force does not rely on mere distribution of information or nudges.
Perhaps constitutional political economists have different preferences.
Pierre Lemieux
Nov 26 2019 at 11:08pm
“Improved” must mean “improved according to the individual preferences of everybody involved (except the preferences of those who want to violate others’ preferences)”–at least in such a way that an individual’s constraints result for the consequences of all other individuals exercising the same liberty, instead of resulting from one individual’s coercive actions. I admit that this looks like a more constructivist than evolutionary approach.
Phil H
Nov 27 2019 at 2:10am
Jon – “one cannot say ex ante that a particular choice (or choices) are right or wrong.”
That’s a nicely explicit statement of a certain view. It gives me a good hook to hang some disagreement on.
Even within libertarian theory, there is plenty of space to reject that view: If I make a choice now that restricts the freedom of others 20 years down the road, that can be seen as bad, even within the strictest of libertarian doctrines.
And most people certainly don’t hold to the strictest of libertarian doctrines. I think we can easily list a few general goods that so few people would reject, it is simply not worth thinking about. Life over death; good health over bad health; economic growth over recession; peace over war. It would be reasonable to say, ex ante, that a choice which leads to (or makes more likely) war and death is a worse choice than one which leads to peace and growth.
I get the value of a highly restricted set of principles; but Jon’s statement seems to go too far.
Comments are closed.