Dangerous Perspectives: The Perils of Individualizing Public Health Problems
38 Pages Posted: 25 Mar 2009 Last revised: 30 Jan 2012
Date Written: January 2009
In the spring of 2007, the U.S. Centers for Disease Control and Prevention (CDC) announced that it had issued its first quarantine order on an individual in over 40 years. The subject of the order, Atlanta attorney Andrew Speaker, had traveled to Europe after being diagnosed with multi-drug resistant tuberculosis and had returned to the U.S. after CDC had asked him to remain in Italy based on the erroneous belief that he had extensively drug-resistant tuberculosis. During the ensuing uproar and media circus lawmakers compared Speaker to a terrorist and demanded that the government take tough actions to protect the public against such cases in the future.
This paper uses the Speaker case to examine both the causes and consequences of what I term "the dangerous person perspective." This perspective identifies both the risk of and responsibility for disease with particular individuals (such as Speaker or Typhoid Mary) and presupposes that public health can be protected only if action is taken against those individuals. The paper uses several social science theories, especially social amplification theory and behavioral economics, to explain the tendency to identify diseases with particular individuals and treat them as if they were morally culpable for their illness, as well as the reasons why we tend to ignore broader social determinants of health. The paper then discusses the implications of this identification for both public health policy and public health law. For public health, the dangerous person perspective is problematic because it offers the false promise that health can be protected by acting against particular individuals while distracting policymakers from undertaking more effective interventions. In addition, the dangerous person perspective encourages policies that are highly coercive and very stigmatizing. Such policies are apt to be ineffective and even counterproductive, as they undermine the relationship between affected populations and public health officials. For public health law, the dangerous person perspective leads to an over-emphasis on emergency powers and an exaggeration of the conflict between individual rights and public health. Perhaps most disturbing, like fears of terrorism, the dangerous person perspective encourages undue deference to the extraordinary powers of executive officials. In short, the fear aroused by the dangerous person perspective can threaten the role of the rule of law in public health.
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