The US ranked 30th in the 2005 Health Olympics, a "competition" that ranks countries' health status by life expectancy at birth. (Population Health Forum, 2008). (The Population Health Forum relies on the life expectancy at birth numbers found in the UNDP Human Development Report which in turn uses the life expectancy numbers from World Population Prospects 1950-2050: The 2006 Revision, (Human Development Report 2007/2008), therefore, when discussing life expectancy I use the figures from World Population Prospects 1950-2050: The 2006 Revision.) In 2005 the US life expectancy was 77.9 years. (World Population Prospects 2006). The life expectancy in the US in the years 1950-1955 was 68.9 (World Population Prospects 2006). Based solely on the life expectancy status from 60 years ago, the current US population would be considered healthier.
Another indicator that points to a healthier US population today from 60 years ago is infant mortality. Between 1950-1955 and 2000-2005 the infant mortality rate declined from 27.8 deaths per 1,000 to 6.8 deaths per 1,000. (World Population Prospects 2006). (I should note, however, that even though the US infant mortality rate decreased significantly from 1950 to present, there was an actual increase of infant mortality in 2002. In subsequent years the rate fell back to previous levels).
Not all indicators show a healthier US population. The percentage of overweight and obese Americans increased from 44.8% of the overall population in 1960-1962 to 64.5% by 1999-2000. (Health, United States, 2002). Additionally, the rate of obesity increased from 13.3% to 30.9% during the same time period. (Health, United States, 2002). The indicators therefore show that over the past 60 years the US population's health improved in some regards but declined in others.
Comparing the US of 60 Years Ago to the Top 30 of 60 Years Ago.
Sixty years ago twenty of the 2005 Health Olympics top thirty countries were equal to or below the US life expectancy of 68.9. (World Population Prospects 2006). When compared to the 1950-55 life expectancies of the top thirty countries, the US ranks eleventh out of thirty. Between 1950-55 and 2005 twenty countries either surpassed or equaled the 2005 US life expectancy of 77.9. For example, South Korea's life expectancy during 1950-55, a time of war for that country, was 47.5, yet by 2005 South Korea's life expectancy reached 77.9 (World Population Prospects 2006). Other countries that had a lower life expectancy sixty years ago but now surpass the US include: Chile, 54.7 to 78.3; Costa Rica, 57.2 to 78.5; Austria, 65.7 to 79.4; and Japan, 63.9 to 82.3. (World Population Prospects 2006). Another interesting comparison is with Canada, which had a life expectancy of 69.1 in 1950. Canada's life expectancy was just above the US figure at the time, however, in the intervening years Canada increased its life expectancy to 80.3. The US has also dropped in worldwide infant mortality rankings from 12th in 1960 to 28th in 2003. (Bezruchka 2007).
Role of the Federal Government in Promoting Public Health.
The Constitution divides governmental power between the federal government and the states. This division is known as "federalism" and it is used to distinguish which government (federal or state) has the jurisdiction to address public health concerns. (Gostin, 2000). The powers the federal government can use to promote public health are the powers to tax, spend and regulate interstate commerce. (Gostin 2000). The tax and spend powers allow the federal government to raise and allocate resources for public health problems. (Gostin 2000). The power to tax can also be used to discourage unhealthy behaviors such as tobacco use and alcohol consumption and the power over the purse is used to ensure the states' cooperation with federal public health goals. (Gostin 2000). For example, in the 1980's federal highway funds were restricted to states that increased their legal drinking ages to 21. (Gostin 2000). The single most important power the federal government has in promoting the population's health is the power to regulate interstate commerce and it has used this power to influence such areas as environmental protection, occupational safety, clean water and food and drug safety. (Gostin 2000).
The states influence and promote public health by using their police powers. Police powers does not refer to law enforcement, but rather is the state's inherent authority to "enact laws and promulgate regulations to protect, preserve, and promote the health, safety, morals, and general welfare of the people." (Gostin, 2000). The use of police powers can create conflict between the interests of society and the interests of individuals. (Gostin 2000). Think of how a state's enforcement of the police powers may benefit the health of the population but infringe upon individual liberties. A quarantine law protects the public from the spread of communicable disease but restricts the infected person's freedom of movement. A restaurant inspection law protects the public by ensuring safe and clean food but it infringes upon the restaurant owner's right to privacy. A nuisance law that protects the population from the ill-effects of a business that pollutes the environment may cause the business owner to lose his property and livelihood. Because the "regulatory techniques of public health . . . interfere with economic liberties" (Gostin 2000) it is easy to see how corporate and business interests would not be the strongest advocates of the use of police powers to promote and protect public health.
In Lochner v. New York case the Supreme Court struck down a New York law that limited the work hours of bakers. The Court found that the law interfered with the Constitutional freedom of contract and was not a valid use of state police power. (Gostin 2000). The Lochner era was a period from 1905 to 1937 "when the [Supreme] Court valued and protected economic freedoms and aggressively invalidated numerous attempts at social and economic regulation." (Gostin 2000).
Lochner was overruled during the New Deal and since then "the judiciary has granted public health regulation a presumption of validity even if it interferes with economic and commercial life." (Gostin 2000). It was also during the New Deal that the Supreme Court greatly expanded the federal government's power under the interstate commerce clause and it was not until 1987 that the Rehnquist Court struck down a federal law that was based on the federal government's regulation of interstate commerce power. (Gostin 2000). In United States v. Lopez, after invoking the federal power to regulate interstate commerce as the basis to make the possession of a firearm in a school zone a federal offense, the Supreme Court held that Congress was instead attempting to regulate intrastate activities. Through Lopez and a series of other cases the Court found "that Congress, even if empowered to act for the public good, must exert its authority in ways that do not excessively intrude on state sovereignty." (Gostin 2000). In other words, the Court prevented Congress from infringing on states' rights or sovereignty. This "New Federalism" established by the Rehnquist Court has so far been used to strike down federal laws providing for the disposal of radioactive wastes, portions of the Brady gun law and provisions of the Violence Against Women Act. (Gostin 2000). By limiting the power of the federal government to deal with public health threats the Court has put the onus for dealing with such threats back on the states.
With the drafting of the Constitution we saw the main source of power to deal with public health problems allocated to the states. By the late nineteenth and early twentieth centuries, as our country industrialized and economic interests consolidated, we witnessed states exercise the police powers to protect their population's health and well-being. These attempts were struck down by the federal courts who put the economic interests above public health. With the coming of the New Deal the Supreme Court altered its stance and public health regulation was presumed valid even if economic interests suffered. The federal government used this new presumption of validity along with its power to regulate interstate commerce to expand the federal presence in promoting public health issues. Most recently, with the rise of New Federalism, the federal government's role in promoting public health is being curtailed and states' rights is championed over public health interests.
An argument can be made that the US population is healthier now than it was sixty years ago. Life expectancy has increased and infant mortality has declined in the US since 1950. However, obesity increased and is an indicator that Americans are not as healthy as they were sixty years ago. Also, with the inherent conflict between protecting our population's health and economic interests it is easy to see how the health of our population may not be a strong goal of a federal government inescapably linked to those economic interests.
Bezruchka, S. Give our children the best. Seatle Post Intelligencer. April 28, 2007. Available at: http://seattlepi.nwsource.com/... Accessed October 2, 2008.
Gostin L. Public Health Law in the New Century: Part II: Public Health Powers and Limits. JAMA. 2000;283(22):2979-2984.
Health Olympics 2005, Population Health Forum. Available at: http://depts.washington.edu/... Accessed October 2, 2008.
Health, United States, 2002, Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/... Accessed October 2, 2008.
Human Development Report 2007/2008. Available at: http://hdr.undp.org/... HDR_20072008_EN_Complete.pdf Accessed October 2, 2008.
World Population Prospects 1950-2050: The 2006 Revision. Available at:http://www.un.org/ esa/population/publications/wpp2006/wpp2006.htm Accessed October 2, 2008.