This working paper examines different concepts and models of public health.
It was drafted before the coronavirus SARS-CoV-2 became a worldwide threat, however, it’s very relevant to a new epidemic threat like Covid-19, which is not well understood, does not have proven treatments, and cannot be avoided by a vaccine or other simple prevention measures. To see this relevance, and although the paper already discussed quarantines, mentions of the current crisis have been added as well as a short section on quarantines and social distancing.
There are many different concepts of public health, ranging from protection against epidemics of contagious diseases up to social justice. Based on different methodologies and different theories of the social world, the various meanings of public health lead to very different prescriptions for government intervention and public policy.
In the public-good model, public health corresponds to some common good that every individual deems to be in his own interest. This model focuses on protection against contagious diseases. In the government health care model, public health is viewed as health care in general, which must be financed if not supplied by the government. In the total government care model, health becomes an all-encompassing concept, and the health-care role of government becomes a role of total care.
The opposite model of public health—voluntary cooperation—focuses on individual and economic freedom to produce public health. It is very different from the two previous models and can be seen as either an alternative or a complement to the public-goods model. As a means of limiting coercion, this model is preferable. Even if the public-good components of public health can be subsidized if necessary, the focus of the model remains voluntary cooperation. Coercion reaches its limits at some point. The goal of the voluntary cooperation model can be conceived as the minimization of coercion in society. The ideal to keep in mind is that individuals should be equally allowed to take care of their own interests and health according to their own preferences.
The policy implications are numerous. Their common denominator is that government interventions should be based on individual preferences and individual consent, not on what a coercive elite—like the current public health movement—believes everybody else should think and want. These broad orientations of public health policies should be as follows:
- Orientation 1: Focus on public health as a public good in the economic sense, not as something that a portion of society can coercively impose on others.
- Orientation 2: When government intervention is necessary, favor non-coercive measures as opposed to injunctions and bans.
- Orientation 3: Distinguish between problems of poverty and issues of individual choice.
- Orientation 4: Treat children as children and adults as adults.
- Orientation 5: More generally, favor voluntary cooperation whenever possible.