The continuing tensions between individual rights and public health. Talking Point on public health versus civil liberties.

Abstract

To what extent can a state legitimately restrict the liberties of its citizens in order to serve the common good? Furthermore, to what extent has the protection of the public's welfare been a pretext for governments to curtail or erode fundamental rights? These questions have formed the foundation of controversies and long‐running debates about public health in the USA; conflicts that have been animated by a deep‐rooted mistrust of overreaching authorities, concerns about arbitrary exercises of power, and by the anti‐authoritarian ethos that is a historically prominent feature of US politics and civic culture. The first tensions over the scope of public health and the acceptability of its measures arose during the fight against infectious disease in the nineteenth and early twentieth centuries. They resurfaced in the last decades of the twentieth century in the wake of efforts to address chronic conditions that began to inform the pattern of morbidity and mortality in industrial societies. They reveal an enduring tension between public health and individual rights—a tension that we ignore at our own peril. Scientific advances in Europe during the nineteenth century, notably in the laboratories of Louis Pasteur (1822–1895) and Robert Koch (1843–1910), identified the causative agents of many infectious diseases. This ‘bacteriological revolution’ transformed our understanding of how disease spreads and laid the foundations for a new public health ethos (Baldwin, 1999). In this regard, it is worth noting that the discoveries of infectious bacteria by Pasteur and Koch provoked sharp resistance in those nations that were concerned about whether and how the imposition of quarantines would interrupt the free movement of goods and people (Ackerknect, 1948). Early advocates of public health in the USA, such as Mitchell Prudden (1849–1924) and Hermann Biggs (1859–1923), who was general medical officer of the city of New York's (NY, USA) …