Rework of “Paternalism- what a tangled web” post, August 6, 2013
Published in 1859, John Stuart Mill wrote On Liberty. The basic premise of this work made the position that the essence of man is to defend the individual rights to think and act for him or herself without unwarranted intervention. I am not here to bore with the specifics of Mill but that book is well worn and highlighted on my bookshelf. There are a host of reasons why public health should assume the position of grand overseer over the public’s health. But before public health acts upon that privilege, it is paramount to acknowledge that the fear of paternalism is a palpable reaction to loss. But do we not fear loss in public health as well? We hold strong disdain for the loss of health expressed as worsening health outcomes. Public health works feverishly to cultivate and maintain the continual buy-in of the very people that we seek to protect. We all fear loss however divergent they appear on the surface. To the anti-public health set, they fear losing “me” to some “you” out there. For public health, “we” fear losing “you all” to premature disease and health disparity.
What is made quite evident is the warring of the ideals of maintaining personal liberty with the maximization of social rewards. Someone has to give up liberty so others can gain. But who wants to be the loser? If the argument remains as a question of personal liberty, yes, someone will shoot craps. It will sting but there is a salve for that. It is getting over the immediacy of the personal loss of liberty that stings the most. People live by the concreteness of their own experiences. Unfortunately, this is often to the disadvantage of public health to get buy-in of impact that we seek. But it is perhaps the imperfection of human experience that makes the work of public health the noblest profession of all. It is just so darn hard for people to “lose” while “gaining”.