Public health has been defined as “the science and art of preventing disease,” prolonging life and improving quality of life through organized efforts and informed choices of society, organizations (public and private), communities and individuals. Analyzing the determinants of health of a population and the threats it faces is the basis for public health.
President Kennedy was interested in the public health and well-being. His administration developed the US Physical Fitness Program as Kennedy aimed to increase the nation’s strength. In recent years, as the advent of computers and video games have resulted in a more sedentary lifestyle, childhood obesity has become a national problem.
I smoked cigarettes for 45 years – from the time I was 16 years old until I was 61. In 1964, the Surgeon General of the United States had put out a warning of the dangers of smoking, linking cigarette smoking to lung cancer and heart disease. This was the beginning of the decline of smoking in this country.
By the 1970s, a serious push to reduce smoking was made by Jimmy Carter’s administration under the stewardship of Joseph Califano, then Secretary of Health, Education, and Welfare. He put the Department through the most complete reorganization in its 25-year history; mounted major health promotion and disease prevention programs, including childhood immunization, the first national anti-smoking campaign, an alcoholism initiative, and issuance of Healthy People, the first Surgeon General’s Report on Health Promotion and Disease Prevention, which for the first time set health goals for the American people.
The government gets pushback from certain segments of the public. There are anti-vaxxers, people who refuse to allow themselves or their children be vaccinated due to religious or other reasons. Distrust of pharmaceutical companies, eradication of diseases like smallpox and tuberculosis, and concern about side effects are some reasons that anti-vaxxers point to in opposition.
In 1984, New York State became the first state to mandate wearing seatbelts. Although on its face, the measure would seem to protect only the wearers of seatbelts, a secondary benefit to the community at large was the reduction in calamitous and gruesome injuries suffered by those not wearing safety harnesses. Insurance premiums reflected the reduction in fatal and life-threatening injuries due to accidents.
When Mayor Bloomberg tried to limit the size of soda servings, he was ridiculed by me and others for his “government as nanny” approach. But, in his defense, looking at it as purely a dollars and cents matter, if the incidence of diabetes was reduced by less sugar being consumed, wouldn’t the expense of treatment be lessened as well? And wouldn’t our tax dollars and insurance premiums be reduced as well?
“But you’re taking away my freedoms,” the Libertarians say. And they may be right, except when it effects other people. When the reality of the dangers of second-hand smoke started to take hold and restaurants were forced to limit and later eliminate smoking in their restaurants, they did so because of the impact on their non-smoking customers and employees who’d complain about their clothes and skin smelling like smoke at the end of a shift. I even had to give up smoking in elevators because I heard that people didn’t like it.
Beyond public health, there are other things we do to protect the community at large. In New York State and other states, we are required as motor vehicle owners to obtain liability insurance as a condition for registering and driving a car.
So then, why is it that some people refuse to wear a mask to protect other people? Is it the same distrust of government, like the anti-vaxxers? Is it the Libertarian refrain of losing their freedoms? Is it for religious reasons, that God shall provide?
There have been several instances where maskless people spit on others in a show of defiance, while others have made near violent scenes inside of stores with rules about wearing masks. New Yorkers have done an excellent job of complying with the law requiring masks – it is the least we can do to reduce the spread of this pandemic. Although I wear a mask for the 15 minutes I spend in a store, I don’t like it. I have sympathy for those in retail or taxi drivers, where it is an eight-plus-hour requirement.
The fact is, I’d rather wear a mask than a ventilator. American founding father Patrick Henry famously said, “Give me liberty or give me death.” When it comes to a pandemic, I believe that’s a false choice. There is no such thing as absolute liberty unless you live in solitary confinement. But, there is such a thing as death, and it is absolutely absolute.