Public Health Is Not What Many Think It Is
By Pierre Lemieux
Many people seem to think that that “public health” is a scientific white knight. For sure, many medical experts in the public health movement do have real scientific knowledge, but the science stops there. The rest is essentially a political movement.
The Reason Foundation just published my primer on public health: “Public Health Models and Related Government Interventions: A Primer.” A few excerpts:
“In many respects,” says a major textbook of public health, “it is more reasonable to view public health as a movement than as a profession.”
With its wide definition, ideology, and scope, public health is as much as, or more of, a political movement than a field of scientific inquiry. Elizabeth Fee agrees with “the idea that public health is not just a set of disciplines, information, and techniques but is, above all, a shared social vision.” This hared social vision is not founded on the respect of the preferences of all individuals and an attempt to find social institutions that can best reconcile them, but on the idea that some experts, or perhaps a democratic majority that agrees with them, should impose their values and trade-offs on other individuals in society. The progress of public health appears closely tied to the collectivist ideologies that developed in the 19th century. At the beginning of the 20th century, medical educator Harvey Jordan of the University of Virginia predicted that in light of eugenics and “the general change from individualism to collectivism,” medicine would be transformed into public health, and that physicians would upgrade from “doctors of private diseases” to “guardian of the public health.”
One factor in the drift of public health toward total government care has been a non-scientific conception of society.
The ideological content of the public health movement is visible there: a priori, they believe the issue is a matter of collective choice, that is, of imposing a politically determined opinion and behavior on those who don’t agree, instead of leaving it to individual choices. There is no recognition of the existence of two distinct facets of human activity: it is one thing for science to determine (at least provisionally) what are the health consequences of different actions; it is another thing to impose one course of action on those individuals who would make different trade-offs. In the perspective of this paper, truth is a matter of scientific inquiry; choice is a matter of individual preferences (with some exceptions).
Few economists should fail to see how anti-scientific this ideological movement is in matters relating to society, politics, and economics.