The Complications of Federalism for Public Health (2024)

States of Health: The Ethics and Consequences of Policy Variation in a Federal System

Leslie P. Francis andJohn G. Francis

Published:

2024

Online ISBN:

9780197538685

Print ISBN:

9780197538654

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States of Health: The Ethics and Consequences of Policy Variation in a Federal System

Leslie P. Francis andJohn G. Francis

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Leslie P. Francis

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John G. Francis

John G. Francis

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Pages

84–121

  • Published:

    May 2024

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Francis, Leslie P., and John G. Francis, 'The Complications of Federalism for Public Health', States of Health: The Ethics and Consequences of Policy Variation in a Federal System (2024; online edn, Oxford Academic, 23 May 2024), https://doi.org/10.1093/oso/9780197538654.003.0004, accessed 11 June 2024.

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Abstract

Pandemics know no political borders, so they present serious challenges for federalism. Public health over the centuries has served intertwined goals of national security and the health of the people. In the United States today, the federal government has exclusive responsibilities for immigration and shares responsibilities with the states for the regulation of commerce. Within the nation’s borders, advantages of the federal government include resources, comprehensive data collection, and coordination of policies and information. Advantages of the states include knowledge of local conditions and greater likelihood of acceptance of policies that may prove unpopular. This chapter explores the ethical issues that arise as the U.S. federal system grapples with the spread of pandemic diseases such as the Great Influenza of 1918–1920, polio, HIV/AIDS, and COVID-19. Pandemic interventions can be viewed as natural experiments subject to ethical evaluation. This chapter compares these efforts to national approaches to noncontagious conditions that have been brought within the scope of public health, using the example of obesity. It concludes that the federal government’s greatest success has been in encouraging or financing vaccine development but that it has not done what it could to create common strategies and messages about serious contagious diseases.

Keywords: Great Influenza, polio, HIV/AIDS, COVID-19, surveillance, Slaughterhouse Cases, Jacobson v. Massachusetts, obesity

Subject

Moral Philosophy

Collection: Oxford Scholarship Online

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