Disease and Personal Liberty

Society and the Responsibility of PH

• Gov’t dicey with aid

• Ind. contribution can inspire the greater community

• Communities sometimes will pit against each other to blame one another for PH crises

• Social determinants are the true players to create and reinforce structures of power and affluence

• Social norms/Conventions influence health behavior → Social purity movement against Christian evils such as prostitution and abortion

Individual Rights superseding common good examples

Reproductive choice, human centered research protection

Common Good prevailing over individual rights examples

Infectious disease control, vax mandates

What is the “common good”?

• Social Contract Theory: Sacrificing liberty to gain protection, but the idea of popular sovereignty supporting the people to prevent there from being an overstep

• What is considered the common good is incredibly subjective

Apply the common good to public health

• Examine interpersonal & societal duties that govern the common good

• Assumption gov’t is there to protect and serve the people without stakes in private interests

• With the assumption in place, police power for public health is valid with checks and balances to prevent unreasonable oppression with the enforcement of laws

Significance of Boston Smallpox ‘01

• ~1600 cases, ~300 deaths → Vaccines are available but the immunization debate arises

• Antivax - Comp. Vax. slaughters innocent children and is illegal

• Media classified the vax. debate as intelligence v. ignorance

• Brit. Parli. ex. → Conscience Clause for parents with medically fragile children to argue to the court why their children should be exempt from vaccination

Compulsory Vax and the Courts

• MA Comp. Vax Laws → Courts on side of PH and support police power for comp. vax. mandate

• Only valid med. exemptions

• Regulated by will of the people → Consequences include fines, denial of admission to schools, quarantines

Jacobson Case

• Henning Jacobson refused smallpox vax, refused to pay the fine - MA court rejects argument of sickness post childhood vax as Jacobson was not currently medically delicate

• Anti-Comp. MA Group supports → Goes to SCOTUS → 7/2 favor of MA as they approve of fines/imprisonment due to Jacobson has the option to not be vaxed

• Decided comp. vax was cruel and unusual for medically delicate people

Impact of Jacobson Case

• Present day → Less infectious disease, more chronic disease

• Comp. vax. overtaken by PH edu. to contribute to social benefit → Relies on persuasion to support individual liberties sans gov’t restraint

  • Still used for school children/quarantine for serious disease

Limitation of PH Persuasion

• Populations in need of resources/edu not receiving them due to social determinant based factors

• Duration of campaigns too short

• Recidivism post achievement of behavioral change

• Lack of motive to chance

Nushawn Williams - 1996

• Tested positive for HIV in ‘96, throughout the following year a significant amount of people in Chautauqua County test positive for HIV with Williams as the common denominator

• Flyers with WIlliams’ image are used with a message to get tested

• 28 known Chautaugua partners, 13 positive, 6 infected after known HIV test

• 6 testify against him on counts of reckless endangerment and statutory rape (13 yr old)

  • 2 of his children born infected

  • 12 yrs prison

  • Cuomo placed him on civil confinement as a sex offender after sentence

  • Claims he didn’t believe results

Motorcycle Helmet Usage

• ‘67 Helmet Laws mandated for high way funding → by the ‘70s almost all states have universal helmet laws

• ‘76 - States lobby congress to stop DoT from assessing penalties on state without helmet laws

• Simon v. Sargent ‘72 → Idea that the consequences of injury and survival post injury