Morality, Politics, and Health Policy

Significant debates about health policy are often highly moralistic and ideological and unrelated to the preponderance of evidence. They inevitably involve questions of personal versus collective responsibility, government versus self-help, individual fault versus social causation, and a broader framing of populations as worthy and unworthy. For example, some debates entail obviously religious perspectives, as with abortion, use of substances, and sexually related diseases. But as James Morone illustrates in his introductory chapter, these same debates encompass broader issues of public responsibility for providing health care, enforcing morality in contrast to reducing social harm (as in providing clean needles to drug users), bringing health care and sex education into schools rather than leaving it to parents, and of social versus individual interventions to combat obesity.

Major policy discussions rarely get very far from notions of good and evil and the worthy and unworthy. Morone shows how moral ideologies and disputes—and the resulting politics—shape our notions of health and appropriate health policy. Using schoolbased health clinics and current interest in the epidemic of obesity as examples, he explores the clash between the Puritan ethic and the social gospel and the dangers of demonization.