As everyone who has been conscious for the last few months knows, the world is in the middle or early stages of a pandemic.
Whatever you think of the responses to it, this is a major public health challenge. It is though far from being the first, nor will it be the last. What it has done, for various reasons, is highlight the continuing uneasy relationship between individualism and both the idea and practice of public health. Public health is both an idea and an institutionalised practice. It is a central feature of the modern state (and of some earlier ones) and it raises all kinds of challenges for individualist liberals.
The activities that we collectively term public health have been provided by governments at several points in history, particularly when those governments ruled over large towns and cities, because the challenges that public health addresses are much more severe in urban environments. The usual activities include things like provision of potable water, supply of drains and sanitation, paving of streets, all of which count as infrastructure. However, there are others that require activity and inspection or supervision on the part of state servants, such as controlling pollution and noise, limiting fire risks, and taking steps to prevent or mitigate epidemics – the last of course being centre stage right now.
Most people see these as core functions of government, on a par with things such as defence or the provision of law. The case for governments doing these things is actually stronger than that for them providing either law or defence but despite that there have been many cases where they were not provided at all or on a very limited basis. In the Ancient world large imperial states such as Han China or Rome did provide them, extensively, but for much of the Middle Ages in many parts of the world they were not.
The big shift in thinking about public health in Europe happened during the Baroque era, from the mid-seventeenth century to the early nineteenth. At this point states began to try to provide public health services and to emulate both the Romans and their Chinese contemporaries. What also appeared was a worked-out theory of public health as a function of a well-ordered government, produced by theorists of Baroque absolutism such as the German Kameralists. This made public health a central part of the so-called police power of government, which was concerned with policies and activities that promoted the general welfare of society – notice the collective nature of the good described by this term. This thinking was an influence on the American Founders as can be seen by the explicit use of the concept of the police power in the Constitution and in the political discussions and policy at State level at the time.
The concept and practice of public health has been problematic for individualist liberals from that time onwards. The idea itself causes at least uneasiness, the practice even more so. For many small state radicals of the eighteenth century such as Jefferson, this was yet another reason to favour agrarianism and to be sceptical of large commercial cities (large cities made public health measures a necessity but these were seen as dubious, so this was another strike against the big city).
The first source of uneasiness is the very idea of public health. The concept has an inherently collectivist quality, because it is more than the aggregation of the health of individuals. It is something that affects individuals and is influenced and produced by individual action but it derives from the network aspect of those actions, the relations between people that are not determined by particular people and for which no particular person or persons are responsible. For a social conception of individualism this is not a difficulty but it does raise the question of how responsibility is to be assigned and exercised.
The second challenge is more serious. This is that public health as an activity has a necessary coercive aspect, that cannot be avoided, even if it can be minimised. There are two reasons for this. The first is the need for very high levels of compliance with and observation of rules and norms, if they are going to be effective. This is a case where unless an overwhelming majority comply with a rule, it will not be effective. The second reason is the existence of collective action problems and what we may call ‘litter effects.’ Let us take the case of refuse collection and disposal. If this is not done effectively then there will be a serious health problem, for various reasons. If it was left entirely to the responsibility of individuals, the temptation is for each person acting on their own to think that if everyone else is going to observe the rules, he can get away with flouting them.
The problem of course is that even if only a minority do this, if the number is large enough the effects will be severe. Moreover, some people, seeing the rubbish left by others, will start to think “Why should I bother?” and also stop doing it, so the problem will have a tendency to escalate – it is not self-limiting. The solution is to make the activity or measure compulsory, with penalties for noncompliance, so coercion is an inevitable part of the phenomenon of public health (regardless of how it is financed, so that does not come into it).
Stephen Davies – American Institute for Economic Research – July 19, 2020.
