Tag: typhoid

The ‘Public Health’ Confusion Again

The National Transportation Safety Board is calling on states to require motorcycle riders to wear federally approved helmets.

“Too many lives are lost in motorcycle accidents,” Christopher A. Hart, NTSB vice chairman, said in announcing that helmets had been added to the board’s annual “most-wanted list” of safety improvements. “It’s a public health issue.”

No, it’s not. Motorcycle deaths are not a public health problem. If motorcyclist A doesn’t wear a helmet, that has no impact on cyclist B. Riding a motorcycle without a helmet may be a bad idea, but it is an individual and non-contagious problem.

The meaning of “public health” has sprawled out lazily over the decades. Once, it referred to the project of securing health benefits that were public: clean water, improved sanitation, and the control of epidemics through treatment, quarantine, and immunization. Public health officials worked to drain swamps that might breed mosquitoes and thus spread malaria. They strove to ensure that water supplies were not contaminated with cholera, typhoid, or other diseases. The U.S. Public Health Service began as the Marine Hospital Service, and one of its primary functions was ensuring that sailors didn’t expose domestic populations to new and virulent illnesses from overseas.

Those were legitimate public health issues because they involved consumption of a collective good (air or water) and/or the communication of disease to parties who had not consented to put themselves at risk. It is difficult for individuals to protect themselves against illnesses found in air, water, or food. A breeding ground for disease-carrying insects poses a risk to entire communities.

The concern back in 2007 over a tuberculosis patient on an airplane raised public-health issues. You might unknowingly find yourself in an enclosed space with a TB carrier. But nobody accidentally rides a motorcycle without a helmet. And your helmetless ride doesn’t threaten me. That’s why riding a motorcycle without a helmet is not a public health issue, even though it may be a bad choice for an individual. As I wrote before,

Language matters. Calling something a “public health problem” suggests that it is different from a personal health problem in ways that demand collective action. And while it doesn’t strictly follow, either in principle or historically, that “collective action” must be state action, that distinction is easily elided in the face of a “public health crisis.” If smoking and obesity are called public health problems, then it seems that we need a public health bureaucracy to solve them — and the Public Health Service and all its sister agencies don’t get to close up shop with the satisfaction of a job well done. So let’s start using honest language: Smoking and obesity are health problems. In fact, they are widespread health problems. But they are not public health problems.

UPDATE: An astute reader asks: But what about the costs to the taxpayer if an uninsured, helmetless motorcyclist is injured? That’s still not a public health problem, and it’s not the claim NTSB is making. It might be a public finance problem, but libertarians have generally argued that a free market in health insurance is a better response to that problem than a smothering nanny state that bans all dangerous behavior on the grounds of socialized medical costs.