Public Health and Social
Justice
Edward P. Richards
http://biotech.law.lsu.edu
April 2, 2001
The Impact of Public Health
Increased Life Expectancy
More than Doubled between 1850 and
1950
Biggest Impact on Children
Reduced Acute and Chronic Morbidity
Cholera, Yellow Fever
TB, Malaria, Syphilis
Changing Public Perceptions
Communicable Disease Once Paralyzed
Government and Community Life
No More Visible Public Health Crises
Quarantine for TB and Other Diseases
Closing of Public Facilities and Limiting Travel for
Polio
Magic Bullet Mentality
Vaccines
Antibiotics
Lowered Public Support
No Crisis – No Political Support
Reduced Funding
Politization of Agencies
Resistance to Interventions
Loss of Academic Support
Research Money Shifts to Social Science and
Biotech
Public Health Training Loses Focus
“No There, There” Problem
Public Health as Oppression
Tuskegee Syphilis Experiment
Typhoid Mary
TB as a Housing Problem
STD Control as Sexual Discrimination
Fluoridation Foes
Anti-Vaccination Movement
Environmental Justice
Public Health as Suspect Activity
Shift from Societal Protection to
Personal Protection
Shift from Police Power to Parens Patria
Increased Due Process
Increased Agency Cost
Shift from Expert Decisionmakers
Civil Rights Mentality
Lawyers and Law Professors
Prefer Civil Rights
Helping the Downtrodden
Empowering the Individual
Distrust of the State
Lots of Money in Suing for Individuals
Not Much Money in Representing the
State
No Money or Private Practice in Public
Health Law
Was Public Health Oppression?
Was Public Health More or Less
Discriminatory than Society As a Whole?
Generally Much More Progressive
The Burden of Disease Always Falls Hardest on the
Poor and Disenfranchised
Greatest Benefits to the Worst Off
Separate Out Medical Care
Public Health Was the Most Egalitarian Service
Public Health Elitism
AIDS Think
Driven by White Affluent Gay Men
Privacy and Autonomy is More Important than
Disease Control
Ignores Casual Contact Diseases
Self-Empowerment Model
Driven by Political Power in Urban Centers
Aggressive Involvement in Medical Care
Even Private Importation of Drugs
Impact of Public Health Elitism
AIDS and Poor and Minority Women
Denied Access to Medical Care
Left Out of Clinical Trials
No Protection from Sexual Contacts
Environmental Justice
East Fix
Really About the Environment
Just Results in Gentrification
Public Health Justice
Reject Elitism
Empowerment only Benefits the Affluent and
Powerful
Is Privacy More Important than Life and Health?
Real Oppression
Underfunded Public Health Services
Incompetent Public Health Professionals
Ignoring the Most Significant Risks to Health and
Community