The Role of Government in Public Health
This debate will be front and center in the incoming administration
With the nomination of RFK, Jr. and others of the same ilk, it is clear that the Trump Administration is seeking the opportunity to redefine the role of government in moderating the public’s health. This is not a new debate.
The renewed conversation about government's role in public health reflects a fundamental tension in modern democracy: where does individual responsibility end and collective action begin? As new health challenges continue and emerge, this question becomes increasingly relevant for policymakers and citizens alike.
There is so much desire among Americans to improve the performance of the U.S. health system, to reduce per capita costs, and to make life better for our sickest and most vulnerable neighbors. In entrepreneurial pursuits over the last ten years, we have witnessed an explosion of innovation, passion, and technology seeking these outcomes. In many cases, due to the interconnectedness of government policy and commercial health markets, it is the government that first funds and creates the environment for health innovations that can transform care delivery and quality of life.
In the post-Covid-19 era, fears about government infringement on on liberty and individual freedoms are rampant. We should acknowledge that this is a quintessential American trait and comes from a well-intentioned and ingrained belief that is core to the American experiment. However, it is equally critical to balance this belief with logic and scientific evidence. In this brief article, I will reflect on the critical role of government in promoting public health. History is a guide in this pursuit.
The Historical Imperative
History provides compelling evidence for government intervention in public health. The eradication of devastating diseases like smallpox and polio stands as a testament to coordinated government action. A striking example is London's 1854 cholera outbreak, where Dr. John Snow's investigation into the cause (infected drinking water from the Broad Street water pump) of the outbreak led to the removal of the Broad Street pump handle, demonstrating how government intervention in water infrastructure could prevent disease spread.
Similarly, New York City's successful battle against tuberculosis (TB) in the early 1900s through mandatory reporting, isolation policies, and public health education reduced TB deaths by over 75% in just two decades. Allow me to make something very clear (this will be graphic), if you are unaware of of the horrors of tuberculosis disease, I suggest you look into it via this video. After watching the video, which explains the disease in a very matter-of-fact manner, I will now share that the disease was called “The Red Death” because entire families used die out (dying from coughing up blood for quite some time before succumbing from sepsis) from the condition because it is so contagious.
Outside of infectious disease, The Pure Food and Drug Act of 1906 exemplifies another crucial government intervention, sparked by Upton Sinclair's exposé "The Jungle," which revealed horrific conditions in meat-packing facilities. This legislation laid the groundwork for the FDA and modern food safety regulations. Additionally, the successful elimination of lead from gasoline in the 1970s by the EPA demonstrates how government action can protect public health against industrial interests - this intervention led to a 90% reduction in blood lead levels in American children between 1976 and 1995. In case this is too abstract, lead in children is very bad for their health.
Without systematic vaccination programs, quarantine measures, government regulation, and disease surveillance, these pathogens and toxins would still claim millions of lives annually. The cholera epidemics of the 19th century were only conquered through government-mandated sanitation infrastructure and water treatment systems.
We do not worry about these problems today because of the government institutions that have prevented these issues from entering our modern world. You do not worry about your entire family dying from TB because of public health interventions and good scientific research.
Herein lies the paradox of the modern era. Because we do not see the problems in our daily lives due to effective prevention, some people think the government programs are obsolete. Why do we need measles vaccines when there are no children I know dying from measles? Why do we need the FDA when our pork is safe to eat1? Why do we need the EPA when our children do not have lead exposure? Why do we need the CDC for infectious disease when our biggest problems are chronic diseases like hypertension, diabetes, obesity, and heart disease (we ALSO need to focus on chronic disease)?
Once again, it is because of these agencies and their regulations that we live our lives without fear of these consequences. But, infectious disease and toxins are not the only reasons why the promotion of public health is critical American prosperity and quality of life.
Economic Benefits of Population Health
A healthy population forms the backbone of a robust economy. Healthy workers are more productive, take fewer sick days, and remain in the workforce longer. The CDC's National Diabetes Prevention Program demonstrates this economic impact: participating employers reported saving an average of $2,650 per employee annually in medical costs and reduced absenteeism, with returns ranging from $3 to $7 for every dollar invested in the program. Healthcare costs for preventable conditions drain both public and private resources. When governments invest in preventive health measures, they create a positive feedback loop: healthier citizens contribute more to the economy, generating resources for further health improvements.
National Security Implications
Military readiness depends directly on population health. During World War II, the U.S. military found that many potential recruits were unfit for service due to preventable health conditions, but has worsened since. This trend continues: in 2022, the Army fell 25% short of its recruitment goals, with military leaders citing that only 23% of American youth meet eligibility requirements, largely due to obesity, mental health issues, and other preventable health conditions. The Marines faced similar challenges, finding that 70% of potential recruits in certain regions were ineligible due to health-related issues. Today, obesity and poor physical fitness continue to limit the pool of eligible military candidates. A country's defense capabilities rely not just on technology and training, but on having a healthy population from which to draw defenders.
The Hidden Infrastructure of Public Health
Much of public health work operates invisibly in the background of daily life. While vaccine mandates, lockdowns, mask mandates, and other infectious disease measures came to the forefront during Covid-19, government health interventions operate in ways and places you will never see. Government agencies ensure:
Safe drinking water through treatment and testing
Food safety through inspection and regulation
Waste management and sanitation services
Vector (e.g., rats, animals, mosquitos, ticks) control to prevent disease spread
Environmental monitoring for toxins and pollutants
Building codes that prevent health hazards (do you know how many people died in building fires in the 1800s and early 1900s?)
These systems protect public health so effectively that many take them for granted, forgetting the dangers they prevent.
Education and Individual Choice
While individuals ultimately make their own health decisions, government plays a crucial role in health education. Public health campaigns about smoking risks, nutrition guidelines, and exercise benefits provide citizens with information needed to make informed choices. Schools teach basic health literacy and physical education, establishing foundations for lifelong health behaviors. We cannot expect individuals to take personal responsibility without educating them.
Market Forces and Public Protection
History shows that unregulated markets can create serious health hazards. The Pure Food and Drug Act arose from widespread food contamination in the early 1900s. The Environmental Protection Agency was established to address rampant pollution. Tobacco companies suppressed evidence of smoking risks for decades. These examples demonstrate why government oversight remains necessary – market incentives don't always align with public health interests.
The Federal Food, Drugs, and Cosmetics Act of 1938 allowed the FDA to prevent mis-labeling and mis-marketing of foods, drugs, medical devices, and cosmetics. Imagine purchasing a medication that is labeled as treating your ear infection that turns out to just be a sugar pill. These things happened and the FDA Act was a direct response to the harms that they caused.
Finding the Balance
The debate isn't truly about whether government should play a role in public health, but rather about its scope and methods. Effective public health policy recognizes both individual autonomy and collective needs. It maintains essential protections while respecting personal choice. As new health challenges emerge, from pandemics to environmental threats, finding this balance becomes increasingly crucial.
The most successful public health initiatives combine government coordination with community engagement and individual participation. This collaborative approach acknowledges that while personal responsibility matters, many health challenges require collective action to address effectively.
As we face evolving health challenges, the question isn't whether government should be involved in public health, but how to optimize that involvement to protect and promote population health while respecting individual liberty.
The next administration will shake things up in the U.S. government’s approach to public health and medical care delivery. It is critical to take an objective approach to solve problems in health. Change can be good, but it must be measured and carefully monitored to avoid worsening the health of the public.
To RFK Jr.’s credit, we critically need more regulations on the ingredients in food to prevent disease. This is a core function of public health and both the FDA and USDA should do more to prevent cancer-causing, endocrine disrupting, and obesity-contributing ingredients. We know from history and research that public health interventions targeting food are important. This is a “Yes, And” moment.