HM 101 Lecture Notes - Lecture 2: Smallpox Vaccine, Health Policy, Infection

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26 Feb 2020
influence of health policy, law, and ethics on public health and focus on the following
key topics:
legal principles that underlie public health and healthcare law in the U.S.,
including types of laws
Health policy
Social justice vs. market justice
Principles of bioethics
What do we mean by social justice and why is it important to public health?
Social justice is based on the notion that every person has a right to fair and equitable
treatment, and a just share of the benefits society has to offer. This includes good
health and access to good health care. However, we know that not everyone is treated
the same. For centuries, inequalities in wealth and power have been linked to health. A
blatant example today would be higher levels of morbidity and mortality that exist in less
developed countries as compared to developed countries. Even within developed
countries like the U.S., there are inequalities in health. The highest levels of morbidity
and mortality occur in areas with high population density (cities) and high levels of
poverty. The distribution of health follows the distribution of wealth. Social and cultural
factors, such as racism and other types of discrimination, compound problems caused
by poverty and income inequality, and only serve to increase the risk of poor health
outcomes for the most vulnerable populations.
Police Power
One of the most important dilemmas public health faces is balancing the rights of the
individual with the best interests of the public. Police power - the most important legal
tool in public health practice -- is the constitutional right of the state to take coercive
action (to do something against a person's will) against an individual to protect the
health and safety of the public. To what extent does government have the right to
prevent an individual from exposing the general population to a communicable disease -
like TB or SARS? Is it right that government imposes restrictions of the rights of
individuals to smoke in public places? Our country has decided - based on the Supreme
Court’s interpretation of the Constitution - that yes, under certain circumstances,
government has the right to limit or restrict certain individual behaviors to protect the
health of the general public.
The most famous case - that established the basis for police power - is Jacobsen v.
Massachusetts 197 U.S. 11 (1905). In 1905 the Board of Health of Cambridge,
Massachusetts mandated that everyone be vaccinated against smallpox. Mr. Jacobsen
didn’t want to be vaccinated - he didn't believe it would protect him against smallpox and
thought the vaccination would, in fact, harm him. Mr. Jacobsen believed his rights were
being violated and that forcing him to be vaccinated against his will was 1) against the
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