Public Health: When Personal Choice Isn’t Enough

I once thought public health was about free medical services for those who couldn’t afford to pay. As an impoverished student, I was grateful the county clinic gave my baby vaccinations that would otherwise have cost $35 apiece.

Only much later, as I worked closely with public health professionals, did I see that public health is so much more. Even those of us with employer-paid insurance are profoundly affected by community factors beyond individual control. Sanitation doesn’t respect property lines. No vaccine is 100 percent effective. Tracking some threats requires laboratory tools.

​Infectious diseases are the examples I know best. Personal decisions aren’t enough to prevent or control an epidemic. Among recent outbreaks:

• Measles in Samoa, 2019. Samoa was on track to eliminate measles when the success of anti-vaccine activists let the disease return with a vengeance. Within less than four months, thousands of Samoans caught measles and eighty-three of them died.
• Covid in the United States, 2020. The surge of cases in a population with no prior immunity overwhelmed the medical system, leaving hospitals with too little space and staff to provide needed life-saving care.
• Polio in Gaza, 2024. Airstrikes destroyed most water and wastewater infrastructure in war-torn Gaza. Children waded through sewage. The first child paralyzed by polio there in twenty-five years signaled hundreds infected, since most infections are asymptomatic.

There’s legitimate room for debate on where to draw the line between personal freedom and danger to the community. Public health can help keep us all safer than we could be through individual choices alone.

Image: Laboratory scientist holds slide for DNA sequencing. Centers for Disease Control and Prevention.