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See, for example, Illich, Ivan, Medical Nemesis: The Expropriation of Health (New York: Pantheon Books, 1976); Dubos, Rene, The Mirage of Health: Utopias, Progress, and Biological Change (New Brunswick: Rutgers University Press, 1987) (a somewhat friendlier critique); and see also, for example, Callahan, Daniel, The Troubled Dream of Life: Living with Mortality (New York: Simon & Schuster, 1993), pp. 40-48, 120-24 (criticizing overreliance on medical technology in current conceptualization of death and dying).Google Scholar

In talking about a “choice between” these two views, I am speaking metaphorically. I do not mean to suggest that either view provides a complete and sufficient account of health or how people experience it. It is not even necessary to my argument to claim that people may actually hold either of these views in the belief that it provides a complete explanation of health. These archetypal views suggest tendencies in talking about health that prefigure as well as they express understandings of the concept. One of the interesting things about the medicalized discourse of health is that many people who talk this way are quite aware that it is a radically incomplete account of health. The problem is not that looking at health through a medical lens is somehow inherently bad (as, for example, Illich seems to argue), but rather that medicalized thinking has an unwonted dominance in our thinking. The definitive account of medicine's triumph as an idea is Starr, supra note 5.Google Scholar

See, for example, Blackstone, William T., “On Health Care as a Legal Right: An Exploration of Legal and Moral Grounds,” Ga. L. Rev., 10 (1976): 391–418.Google Scholar

Ethicists have struggled with this problem. For example, Brennan, Troy, in his Just Doctoring (Berkeley: University of California Press, 1991), offers a vision of the doctor as a mediator between the patient's and the society's interests. As full as the book is of insight and practical wisdom, however, it cannot so easily resolve the conflict. Emanuel's, Ezekiel J. rejection of liberal neutrality, in The Ends of Human Life: Medical Ethics in a Liberal Polity (Cambridge: Harvard University Press, 1991), although attacking what is perhaps a straw version of liberalism, powerfully exposes this problem.Google Scholar

As Starr has shown, much of the edifice of medical regulation has been constructed to protect, or at least not threaten, the autonomy of doctors (see supra note 5). See Beauchamp, Dan E., The Health of the Republic: Epidemics, Medicine, and Moralism as Challenges to Democracy (Philadelphia: Temple University Press, 1988), ch. 2.Google Scholar

An interesting recent attempt to conceptualize a right to medical care is Chapman, Audrey R., Exploring a Human Rights Approach to Health Care Reform (Washington, D.C.: AAAS, 1993).Google Scholar

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See Miller, C. Arden et al., “Statutory Authorization for the Work of Local Health Departments,” AJPH, 67 (1977): 945. Even with respect to these functions, most statutes are outdated, not at all reflecting legal developments in due process and privacy. See Gostin, Larry, “The Future of Public Health Law,” Am. J. L. & Med., XII, nos. 3-4 (1986): 461-90.Google Scholar

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See, for example, Turnock, Bernard J., Kelly, Chester J., “Mandatory Premarital Testing for Human Immunodeficiency Virus: The Illinois Experience,” JAMA, 361 (1989): 3415–18; Bayer, Ronald, Fairchild-Carrino, Amy, “AIDS and the Limits of Control: Public Health Orders, Quarantine, and Recalcitrant Behavior,” Am. J. Pub. Health, 83 (1993): 1471–76; cf. Gellert, George A. et al., “Managing the Non-Compliant HIV-infected Individual: Experiences from a Local Health Department,” AIDS & Pub. Policy J., 8, no. 1 (1993): 20-26 (isolation used primarily for public relations reasons, and applied only to individuals suffering serious mental health problems); and Hamburg, Margaret A., “Rebuilding the Public Health Infrastructure: The Challenge of Tuberculosis Control in New York City,” JLME, 21, nos. 3-4 (1993): 352-59 (detention of tuberculosis patients is a very limited, last resort for individuals with a history of noncompliance with treatment).CrossRefGoogle Scholar

The implications of the decline of infectious diseases was much discussed in the 1940s and 1950s (see Fee, , Krieger, , supra note 28, pp. 335–36), and have been a source of rich thinking about public policy ever since (see, e.g., Lalonde, Marc, A New Perspective on the Health of Canadians: A Working Document (Ottawa: Information Canada, 1974); Department of Health and Human Services/Public Health Service, Healthy People 2000: National Health Promotion and Disease Prevention Objectives (Washington, D.C.: DHHS Publication No. (PHS) 91-50212, 1991)). For a discussion of this “second revolution in public health,” see generally Leichter, Howard M., Free to be Foolish: Politics and Health Promotion in the United States and Great Britain (Princeton: Princeton University Press, 1991).Google Scholar

The issue of obedience to authority and the impact of various kinds of interventions have generated a rich literature within and without public health. See, for example, Jeffery, , supra note 26; Hinds, M. Ward, “Impact of a Local Ordinance Banning Tobacco Sales to Minors,” U.S. Department of Health and Human Services/Public Health Reports, 107 (1992): 355–58; Finn, Peter, “Decriminalization of Public Drunkenness: Response of the Health Care System,” J. of Studies on Alcohol, 46, no. 1 (1985): 7-23; and Tyler, Tom R., Why People Obey the Law (New Haven: Yale University Press, 1990).Google Scholar

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The division of tasks between health agencies and others has often been a matter of political dispute. See, for example, Rosner, David, Markowitz, Gerald, “Research or Advocacy: Federal Occupational Safety and Health Policies During the New Deal,” J. of Social History, 8, no. 3 (1985): 365–81.Google Scholar

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See, for example, Blum, Alan, “Strategies to Reduce Cigarette Sales: Excise Taxes and Beyond,” JAMA, 255 (1986): 1049–50.CrossRefGoogle Scholar

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See, for example, CDC, “Public Health Focus: Physical Activity and the Prevention of Coronary Heart Disease,” MMWR, 42, no. 35 (1993): 669–72; Centerwall, Brandon S., “Television and Violence; The Scale of the Problem and Where to Go From Here,” JAMA, 267 (1992): 3059-63; Safriet, Barbara J., “Health Care Dollars and Regulatory Sense; The Role of Advanced Practice Nursing,” Yale J. Reg., 9, no. 2 (1992): 417-88; Thompson, Robert S. et al., “Cost-Effectiveness Analysis of Bicycle Helmet Subsidies in a Defined Population,” Pediatrics, 91 (1993): 902-07; CDC, “Mandatory Bicycle Helmet Use—Victoria, Australia,” MMWR, 42, no. 18 (1993): 359–63; and Jeffery, , supra note 26.Google Scholar

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