Public Health and Social Justice

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					Public Health and Social
Edward P. Richards
April 2, 2001
The Impact of Public Health
   Increased Life Expectancy
     More than Doubled between 1850 and
     Biggest Impact on Children
   Reduced Acute and Chronic Morbidity
     Cholera, Yellow Fever
     TB, Malaria, Syphilis
Changing Public Perceptions
   Communicable Disease Once Paralyzed
   Government and Community Life
   No More Visible Public Health Crises
     Quarantine for TB and Other Diseases
     Closing of Public Facilities and Limiting Travel for
   Magic Bullet Mentality
Lowered Public Support
   No Crisis – No Political Support
     Reduced Funding
     Politization of Agencies
     Resistance to Interventions
   Loss of Academic Support
     Research Money Shifts to Social Science and
     Public Health Training Loses Focus
     “No There, There” Problem
Public Health as Oppression
   Tuskegee Syphilis Experiment
   Typhoid Mary
   TB as a Housing Problem
   STD Control as Sexual Discrimination
   Fluoridation Foes
   Anti-Vaccination Movement
   Environmental Justice
Public Health as Suspect Activity
   Shift from Societal Protection to
   Personal Protection
   Shift from Police Power to Parens Patria
   Increased Due Process
     Increased Agency Cost
     Shift from Expert Decisionmakers
   Civil Rights Mentality
Lawyers and Law Professors
Prefer Civil Rights
   Helping the Downtrodden
   Empowering the Individual
   Distrust of the State
   Lots of Money in Suing for Individuals
   Not Much Money in Representing the
   No Money or Private Practice in Public
   Health Law
Was Public Health Oppression?
   Was Public Health More or Less
   Discriminatory than Society As a Whole?
     Generally Much More Progressive
     The Burden of Disease Always Falls Hardest on
     the Poor and Disenfranchised
   Greatest Benefits to the Worst Off
     Separate Out Medical Care
     Public Health Was the Most Egalitarian Service
Public Health Elitism
   AIDS Think
     Driven by White Affluent Gay Men
     Privacy and Autonomy is More Important than
     Disease Control
     Ignores Casual Contact Diseases
   Self-Empowerment Model
     Driven by Political Power in Urban Centers
     Aggressive Involvement in Medical Care
     Even Private Importation of Drugs
Impact of Public Health Elitism
   AIDS and Poor and Minority Women
     Denied Access to Medical Care
     Left Out of Clinical Trials
     No Protection from Sexual Contacts
   Environmental Justice
     East Fix
     Really About the Environment
     Just Results in Gentrification
Public Health Justice
   Reject Elitism
     Empowerment only Benefits the Affluent and
     Is Privacy More Important than Life and Health?
   Real Oppression
     Underfunded Public Health Services
     Incompetent Public Health Professionals
     Ignoring the Most Significant Risks to Health and

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