Too much public health.

• Author: Sullum, Jacob
• Position: Follow-Up - Controlling behavior that affects health of others

A couple of decades ago, while researching a book about the anti-smoking movement, I was struck by the way that the concept of "public health" had expanded during the 20th century. Originally focused on communicable disease and other external threats, the field grew to encompass a wide range of voluntarily assumed risks, including those associated with inhaling tobacco combustion products.

"Americans no longer live in terror of smallpox or cholera," I wrote in the January 1996 issue of reason ("What the Doctor Orders"). "For the most part, Americans die of things you can't catch: cancer, heart disease, trauma. Accordingly, the public health establishment is focusing on those causes and the factors underlying them. Having vanquished most true epidemics, it has turned its attention to metaphorical 'epidemics' such as smoking, obesity, and suicide." I cited the evolution of the U.S. Centers for Disease Control and Prevention (CDC), which began as an anti-malaria project of the Public Health Service during World Warn, as a prime example of the ever-expanding public health agenda.

"Treating behavior as if it were a communicable disease is problematic," I noted, since "behavior cannot be transmitted to other people against their will ... People do not choose to be sick, but they do choose to engage in risky behavior. The choice implies that...