ABSTRACT As bioethics emerged in the 1960s and 1970s and began to have enormous impacts on the practice of medicine and research – fuelled, by broad socio‐political changes that gave rise to the struggle of women, African Americans, gay men and lesbians, and the antiauthoritarian impulse that characterised the New Left in democratic capitalist societies – little attention was given to the question of the ethics of public health. This was all the more striking since the core values and practices (...) of public health, often entailing the subordination of the individual for the common good, seemed opposed to the ideological impulses of bioethics. Of what relevance is autonomy‐focused bioethics for public health, with its mix of justifications including those that are either implicitly or explicitly paternalistic or that seek to impose strictures on individuals and communities in the name of collective welfare? To examine the deep divide between the central commitments of bioethics and the values that animate the practice of public health, we focus on a series of controversies implicating the concepts of privacy, liberty, and paternalism. Recognising the role of moral values in decision‐making was a signal contribution of bioethics in its formative period. Over the past three decades a broad array of perspectives emerged under the rubric of bioethics but individualism remains central. As we commence the process of shaping an ethics of public health, it is clear that bioethics is the wrong place to start when thinking about the balances required in defence of the public's health. (shrink)

Although unprecedented in scope and beyond all our life experiences, sweeping social distancing measures are not without historical precedent. Historically, racism, stigma, and discrimination resul...

In 2012, New York City Mayor Michael Bloomberg proposed capping the size of sugary beverages that could be sold in the city’s restaurants, sporting and entertainment facilities and food carts. After a lawsuit and multiple appeals, the proposal died in June 2014, deemed an unconstitutional overreach. In dissecting the saga of the proposed soda cap, we highlight both the political perils of certain anti-obesity efforts and, more broadly, the challenges to public health when issues of consumer choice and the threat (...) of paternalism are involved. (shrink)

Alice considered [the idea of un-birthday presents] a little. “I llke birthday presents best,” she said at last.“You don’t know what you’re talking about!” cried Humpty Dumpty. … “[There are three hundred and sixty-four days when you might get un-birthday presents… And only one for birthday presents, you know. There’s a ‘glory’ for you!”“I don’t know what you mean by ‘glory,’” Alice said.Humpty Dumpty smiled contemptuously. “Of course you don’t—till I tell you. I meant ‘there’s a nice knock-down argument for (...) you!’”“But ‘glory’ doesn’t mean ‘a nice knock-down argument,’” Alice objected.“When I use a word,” Humpty Dumpty said in a rather scornful tone, “it means just what I choose it to mean—neither more nor less.”. (shrink)

Alice considered [the idea of un-birthday presents] a little. “I llke birthday presents best,” she said at last.“You don’t know what you’re talking about!” cried Humpty Dumpty. … “[There are three hundred and sixty-four days when you might get un-birthday presents… And only one for birthday presents, you know. There’s a ‘glory’ for you!”“I don’t know what you mean by ‘glory,’” Alice said.Humpty Dumpty smiled contemptuously. “Of course you don’t—till I tell you. I meant ‘there’s a nice knock-down argument for (...) you!’”“But ‘glory’ doesn’t mean ‘a nice knock-down argument,’” Alice objected.“When I use a word,” Humpty Dumpty said in a rather scornful tone, “it means just what I choose it to mean—neither more nor less.”. (shrink)

Fairchild, Center for the History and Ethics of Public Health in the Department of Sociomedical Sciences at Columbia University's Mailman School of Public Health Abstract Surveillance is a cornerstone of public health. It permits us to recognize disease outbreaks, to track the incidence and prevalence of threats to public health, and to monitor the effectiveness of our interventions. But surveillance also challenges our understandings of the significance and role of privacy in a liberal democracy. In this paper we trace the (...) century-long history of public health surveillance in the United States situating that history in the context of the broad social, political, and ideological forces that have shaped our conceptions of privacy. Although we focus here on the United States, the debates over privacy that unfolded in the 1960s were repeated in many European nations. The themes we explore here, then, provide a framework for examining the relationship between privacy and public health in other contexts. CiteULike Connotea Del.icio.us What's this? (shrink)

What justified the Center for Disease Control's1999 determination to require HIV casereporting? Why were names necessary? Why didopponents view the reporting of names with suchalarm? This paper retells the history of theencounters over HIV reporting that had occurredsince the mid 1980s. In placing HIV reportingwithin a larger context, however, we understandthe clash between privacy and public healthnecessity as a complex issue, both inhistorical and contemporary practice. Byunderscoring the similarities and differenceswith the histories of surveillance for otherinfectious diseases, vaccination, occupationaldiseases, cancer, (...) and birth defects, and HIVreporting internationally, we can betterunderstand the implications of the HIV debatefor an ethics of surveillance more generally. (shrink)

Surveillance serves as the eyes of public health. It has provided the foundation for planning, intervention, and disease prevention and has been critical for epidemiology research into patterns of morbidity and mortality for a wide variety of disease and conditions. Registries have been essential for tracking individuals and their conditions over time. Surveillance has also served to trigger the imposition of public health control measures, such as contact tracing, mandatory treatment, and quarantine. The threat of such intervention and long-term monitoring (...) has provoked alarm and rendered surveillance suspect for those concerned about the unwarranted exercise of state authority in the name of public health. Thus the history of surveillance has been bounded by promise of disease control and a specter of intrusion. In this article we address the tension between the public's need for knowledge as a foundation for rational policy-making and the centrality of norms of privacy for democratic societies. (shrink)

Surveillance serves as the eyes of public health. It has provided the foundation for planning, intervention, and disease prevention and has been critical for epidemiology research into patterns of morbidity and mortality for a wide variety of disease and conditions. Registries have been essential for tracking individuals and their conditions over time. Surveillance has also served to trigger the imposition of public health control measures, such as contact tracing, mandatory treatment, and quarantine. The threat of such intervention and long-term monitoring (...) has provoked alarm and rendered surveillance suspect for those concerned about the unwarranted exercise of state authority in the name of public health. Thus the history of surveillance has been bounded by promise of disease control and a specter of intrusion. In this article we address the tension between the public's need for knowledge as a foundation for rational policy-making and the centrality of norms of privacy for democratic societies. (shrink)

As therapeutic advances in the treatment of AIDS began to emerge in the late 1980s and public health began to have more to offer than just the threat, or the perceived threat, of quarantine or partner notification, fissures began to appear in the alliance against named HIV reporting that had emerged a few years earlier. In 1989, New York City’s Health Commissioner stated that the prospects of early clinical intervention warranted “a shift toward a disease-control approach to HIV infection along (...) the lines of classic tuberculosis practices,” including the “reporting of seropositives.”Although his proposal met with fierce and effective resistance, it is now clear that his call represented part of a national trend. The CDC continued to press for cases of HIV to he reported by name to health departments, an effort that assumed the dimensions of a campaign. It was supported by a growing number of public health officials. (shrink)

As therapeutic advances in the treatment of AIDS began to emerge in the late 1980s and public health began to have more to offer than just the threat, or the perceived threat, of quarantine or partner notification, fissures began to appear in the alliance against named HIV reporting that had emerged a few years earlier. In 1989, New York City’s Health Commissioner stated that the prospects of early clinical intervention warranted “a shift toward a disease-control approach to HIV infection along (...) the lines of classic tuberculosis practices,” including the “reporting of seropositives.”Although his proposal met with fierce and effective resistance, it is now clear that his call represented part of a national trend. The CDC continued to press for cases of HIV to he reported by name to health departments, an effort that assumed the dimensions of a campaign. It was supported by a growing number of public health officials. (shrink)

ArgumentIn this paper I examine the mass medical inspections of immigrants to the United States from the 1890s through the 1920s. I show how, framed as it was not only by nativism and eugenics but also by national industrial imperatives and priorities, scientific medicine served dual purposes. On the one hand, the medical exam was a tool for managing cultural and biological threats to the nation. There were regional variations in medical inspections that reflected the politics of race. On the (...) other hand, the medical exam played an important role in the process of building an unskilled, highly mobile labor force. The industrial demands of the nation provided a rationale for drawing and absorbing millions of European immigrants into the labor force. It was thus a distinct product of the political economy of immigration. It was this second function that characterized the exam for the majority of immigrants entering the nation. (shrink)

In target articles for this special issue, Fox et al. report that ethics consultation (EC) practices have not improved significantly since 2000, and question whether the status quo affords patients...