The Politics of Public Health in the United States
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《新英格兰医药杂志》
There is something for everyone interested in public health in The Politics of Public Health in the United States. Students will benefit from the history of public health; the chronology of the more important laws and events in public health policy is helpful, as are the list of acronyms and end-of-chapter study questions. Those who favor greater federal involvement in public health and in health services generally will find reasons and arguments to support it. Those concerned that government programs inevitably bring controls, regulation, and loss of personal freedoms, often with marginal benefits, will want to read this book as well. All readers should note the authors' considerable support of big federal government. Their working hypothesis is that the public health sector should control, manage, and provide all health services for populations and individuals.
"Vested interests" are excoriated for opposing government programs and regulation, which the authors believe can only be beneficial. For example, the defeat of the Clinton health plan is attributed to lobbying by clever opponents, with no mention of the concern among many Americans about so intrusive and massive a government program.
The book also reflects the authors' assertions that only "science" can drive policy decisions — this, despite so much evidence of its shortcomings. The highly criticized estimates from the National Institutes of Health of deaths resulting from the obesity "epidemic" are a recent example (Flegal et al. JAMA 2005;293:1861-7, and Greenberg. JAMA 2005;294:552). Furthermore, descriptions of clashes between science and politics (reflecting an opposing view), which assume that "science" is value-free, seem to be naive and to ignore scientific correctness. Even if science were value-free, funding sources are not. Imagine trying to fund research to measure the psychological and physical risks associated with abortion, or the social utility of firearms in the hands of law-abiding citizens, or to determine the costs and benefits of federally mandated safety features in automobiles.
Patel and Rushefsky cite numerous examples of economic interests as the virtually exclusive motivation of opposition to government programs. Economic interests cannot be ignored, but no mention is made of liberty rights and freedom from government control as a principle underpinning opposition. The authors consider states' differences in solving public health problems to be negative — thus the desirability of centralized federal control. No value is attached to these differences as naturally occurring experiments in policy decision and implementation, some of which achieve desired results and many of which do not.
The book is heavily referenced — to the point of distraction. Even simple, obvious concepts have a citation. Extensive referencing can assist other scholars, however. The generally high quality of the writing suffers from several editorial lapses.
That this book was written by political scientists speaks volumes about the field of public health and supports one of Patel and Rushefsky's premises — that public health practitioners are too uninvolved in the politics of their field. Whether greater involvement in the political process by public health practitioners will improve the public's health is unclear, however. In addition, the authors fail to recognize that the political process is a two-way street and any further politicization may ultimately have negative ramifications for public health.
The traditional work and successes of public health practice have affected the safety of food and water, sanitation, and communicable diseases. Largely contemporary diseases are linked to lifestyle choices and the chronic conditions associated with aging. Affecting them will be far more difficult than chlorinating water. The degree of behavior modification that is necessary to affect lifestyle means government-driven indoctrination, regulation, and controls. This is the challenge of public health in the third millennium. Government intrusiveness is the challenge for civil libertarians and those whose first concern is liberty.
Kurt Darr, J.D., Sc.D.
George Washington University
Washington, DC 20037(By Kant Patel and Mark E.)
"Vested interests" are excoriated for opposing government programs and regulation, which the authors believe can only be beneficial. For example, the defeat of the Clinton health plan is attributed to lobbying by clever opponents, with no mention of the concern among many Americans about so intrusive and massive a government program.
The book also reflects the authors' assertions that only "science" can drive policy decisions — this, despite so much evidence of its shortcomings. The highly criticized estimates from the National Institutes of Health of deaths resulting from the obesity "epidemic" are a recent example (Flegal et al. JAMA 2005;293:1861-7, and Greenberg. JAMA 2005;294:552). Furthermore, descriptions of clashes between science and politics (reflecting an opposing view), which assume that "science" is value-free, seem to be naive and to ignore scientific correctness. Even if science were value-free, funding sources are not. Imagine trying to fund research to measure the psychological and physical risks associated with abortion, or the social utility of firearms in the hands of law-abiding citizens, or to determine the costs and benefits of federally mandated safety features in automobiles.
Patel and Rushefsky cite numerous examples of economic interests as the virtually exclusive motivation of opposition to government programs. Economic interests cannot be ignored, but no mention is made of liberty rights and freedom from government control as a principle underpinning opposition. The authors consider states' differences in solving public health problems to be negative — thus the desirability of centralized federal control. No value is attached to these differences as naturally occurring experiments in policy decision and implementation, some of which achieve desired results and many of which do not.
The book is heavily referenced — to the point of distraction. Even simple, obvious concepts have a citation. Extensive referencing can assist other scholars, however. The generally high quality of the writing suffers from several editorial lapses.
That this book was written by political scientists speaks volumes about the field of public health and supports one of Patel and Rushefsky's premises — that public health practitioners are too uninvolved in the politics of their field. Whether greater involvement in the political process by public health practitioners will improve the public's health is unclear, however. In addition, the authors fail to recognize that the political process is a two-way street and any further politicization may ultimately have negative ramifications for public health.
The traditional work and successes of public health practice have affected the safety of food and water, sanitation, and communicable diseases. Largely contemporary diseases are linked to lifestyle choices and the chronic conditions associated with aging. Affecting them will be far more difficult than chlorinating water. The degree of behavior modification that is necessary to affect lifestyle means government-driven indoctrination, regulation, and controls. This is the challenge of public health in the third millennium. Government intrusiveness is the challenge for civil libertarians and those whose first concern is liberty.
Kurt Darr, J.D., Sc.D.
George Washington University
Washington, DC 20037(By Kant Patel and Mark E.)