Logan Spector from the Department of Epidemiology at Emory University takes issue with a previous Samizdata article
I am a libertarian and an epidemiologist, and with these perspectives I must take issue with the statement made by Perry de Havilland that, “Except for communicable diseases, there is no such thing as ‘public health’.” The field of public health is primarily concerned with prevention of disease, so your statement is nonsensical. Of course we can prevent chronic ailments like heart disease or diabetes (though they possibly have infectious etiologies, as is increasingly being suspected for an array of conditions). The question is how- through force or persuasion??
Now, my colleagues in the field are by and large statists who look first to government mandates to improve the public’s health. In fact one of my professors, Godfrey Oakley, is a prominent folic acid researcher and was instrumental in making folate supplementation mandatory. It would give you a pounding headache to hear the list of things he think should be taken care of by government fiat. But just because practitioners of public health have so far relied on coercion for good ends does not mean that non-coercive means are not available or should not be tried.
The first method for improving health, as you imply by your personal use of folic acid, is education. If undertaken by private groups health education is entirely consistent with libertarian principles, no matter how bitterly some segments of libertarianism dislike being told what to do (see www.lewrockwell.com for this perspective). It is, however insufficient to rely solely on individuals’ initiative in improving their health. Folic acid is needed during a critical period very early in pregnancy, before a woman knows she is pregnant. If folate is lacking, neural tube defects (such as spina bifida) can result. Would that every woman with the chance of conceiving were taking folate, but such is not that case.
Well, if it is legitimate to educate, persuade, and cajole individuals to take folate, why would not the same apply to companies as well? U.S. bakeries put up almost no fight to the mandate that they supplement their bread with folate, mainly because the benefit was clear and the cost minimal. Had public health organizations gone directly to bakeries, rather than to the government, they would have had little problem convincing them to supplement. The companies would benefit by touting their altruism (thus negating their altruism but you get the idea), and the public would benefit from improved health. Note that if anyone objected to having folate in their bread, companies would be free to market folate-free bread.
I hope you don’t think that taking this position makes me a totalitarian.
Logan Spector
