Over the course of the last century, significant improvements have been made in regard to public health. Working conditions have been made infinitely safer through advocacy, investigation by independent news outlets, scientific studies, and ultimately the creation of regulatory agencies. Smoking has been on the decline in recent years in part due to regulation on advertising on the part of tobacco companies as well as aggressive scientific research on the negative health outcomes of cigarette smoking and advertising campaigns against smoking, particularly among adolescents and potential new smokers. In assessing the historical events leading to improvements in occupational health and smoking rates in the United States through an ethical and human rights perspective, public health professionals will be more able to judge the role of the United States government as well as regulatory bodies in assessing future and current public health problems.
It is readily apparent from a historical perspective that government inaction on the part of public health does not reach an equilibrium in which citizens' health is prioritized by private corporations. In the early portion of the 20th century, it was clear that companies were covering up the occupational illnesses of their employees, without making meaningful changes to prevent these instances from occurring again. In fact, it became commonplace for industries to blame their workers in the event of illness or injury, rather than taking personal responsibility for their actions. Thus it is imperative that governments take action to protect the rights of its citizens. However, many times throughout history it has been the case that government action has been reactionary and effectively meaningless as far as enacting change. For example, the U.S. Bureau of Mines conducted surveys regarding the health impacts of leaded gasoline that were underwritten by General Motors. The influence of the company on the results went so far as to require approval by the company on the final product. The level at which the bureau was influenced by private industry rendered it ineffective. Another instance of conflicting interests occurred in the Ohio Department of Health during this same time period, when Dr. Emery Hayhurst acted as an industrial hygienist for the department, but also worked at the Ethyl Corporation as a consultant, leading to misinformation for groups such as the Workers' Health Bureau. Another factor in the relative of the weakness of the government during this time period was the lack of funding for the Bureau of Mining and other regulatory agencies. In conclusion, for a government to be effective in regulation endeavors, it must be free of influence by corporate interests, must have individual loyalties only to the regulatory body, and most have the budget and power to enforce regulatory policies.
Governments are not the only bodies that are able to regulate corporate action on the behalf of workers' health. Indirectly, the press and scientific experts are able to call attention to public health problems. For example, journalists played an important role in drawing attention to workplace deaths in the early part of the 20th century. However, the angle of each article was heavily determined by the independent interests of the journalist. For example, some spoke of workers' health in terms of class and social context, while others were motivated to speak of the issues in business terms such as inefficiencies or cost. Therefore it is important to note that the press has not in the past, nor will be entirely nonpartisan and objective. The issue of partisan slant has only intensified with recent decades and the advent of technologies that allow distribution of sometimes false or slanted information at much quicker rates. Another potential issue is the dissemination of information that could potentially alarm the public, such as in the case of lead poisonings in factories causing fear over lead exposures in car exhaust, which did not differentiate between organic and inorganic lead. Scientific experts are more authoritative voices that contribute to public discourse on public health issues, often publicly dissenting with potential conflicts of interest, as in the case of the GM study on worker health.
Lastly, another mechanism by which governments have been able to regulate the work environments of private businesses has been through the legal system. In the case of Stefan Golab, a worker that died as a result of cyanide poisoning, three managers were convicted of manslaughter. This represented the first time that executives faced legal action for their participation in working conditions that lead to worker deaths. This frightened a number of businesses into making adjustments for worker safety, as they could potentially be personally liable for their health. However, many workplace accidents could not be taken to court as they were included in workers' compensation plans. It is important to note that these legal repercussions were at the state level, and interpretations of occupational accidents as manslaughter could vary across the country. Thus, regulation that is enacted and enforced by the government is required in order to maintain worker safety.
The authority of the government to interfere with private business or individuals is rooted in the concept of paternalism. Paternalism is defined as “interference of a state or an individual with another person, against their will, and justified by a claim that the person interfered with will be better off or protected from harm.” The government has the right and the duty to protect its citizens from harm. It is from these ethical concepts that municipalities can employ police officers to keep individual citizens safe, even if they do not appreciate the services provided. These rights extend until they violate the rights of individual citizens. In the case of occupational health, the government has a responsibility to protect workers from potential harm by private corporations, whose safety may pose a hefty cost to the corporation. From a human rights perspective, governments have a legal obligation to respect, protect, and fulfill. It is also widely accepted that “Health is a human right,” and it was included in the Universal Declaration of Human Rights in 1948. It is also quoted as part of the framework used by NGOs to evaluate “States have obligations concerning healthy natural and workplace environments.” Internationally, protections from industrial disease and accidents are part of the responsibilities of the government. As such, the United States government must prioritize workplace safety.
The early half of the twentieth century was characterized by an enormous increase in smoking rates, in part due to aggressive marketing campaigns. In the 1950s and 1960s, rates began to plateau with the publication of reports detailing the clear dangers of smoking, such as the Surgeon General's Report on smoking. Rates of smoking decreased with the enactment of taxes on cigarettes, as well as restrictions on marketing, such as product labeling, restrictions on ads, and mandatory disclosure of certain ingredients. These along with aggressive campaigns to disseminate information about the deleterious effects of smoking greatly reduced the number of smokers in the United States. The funding and publication of this information by the government, as well as creative regulations on cigarettes such as taxation and marketing, have created a culture wherein no citizen is able to cite ignorance of health consequences as a reason for continued use of cigarettes. These regulations have saved countless lives from lung cancer, heart disease, and other negative health impacts of smoking. The government must continue to fund research and regulation in order to continue to decrease disease morbidity.
Ethically, smoking can test the extent of paternalism as the justification for government action on behalf of the health and safety of the individual. Many would argue that interfering in the choice of an individual to smoke is a violation of the rights. The definition by the Nuffield Trust of libertarian paternalism is that “the baseline option of policies should express value judgements about what is good for one's life, although individuals should be able to opt out at relative ease and low cost.” An individual is not truly able to make an objective decision about their health in the context of occupational health. Employees need jobs and their salaries to support themselves, and are thus coerced into agreeing to less than ideal working conditions. In the case of smoking, individuals are able to make the decision whether or not to smoke for themselves, excluding the externalities of second-hand smoke. Thus, in the case of interference in an individual's right to make health decisions, governments should be able to set and enforce regulations that encourage individuals to make positive health decisions, but that do not violate the citizen's ability to make their own health decisions. In learning from historical cases of public health problems and viewing current and future issues through human rights and ethical lenses, governments will be able to protect public health interests without violating the rights of individuals.
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