In a Nutshell:
- Politically-driven efforts to undermine public health authorities put every person at serious risk
- Government functions that require high levels of technical expertise are best kept separate from the politics of the day
- Reforms to public health are needed, but these should be driven by evidence and experience, not knee-jerk emotional responses nor political posturing
In the midst of an ongoing global pandemic that is once again surging, efforts are underway in numerous states to undermine public health authorities. There is certainly ample room for public health reforms—the Citizens Research Council suggested many prior to the pandemic—but these reforms should be evidence-based and focused on public health improvement.
The emerging argument that placing public health authority in the hands of politicians will somehow make public health functions less political runs contrary to an understanding of the role of public health. Public health refers to a constellation of activities that assess the health status of communities, design policies and interventions to improve health, and assure that health needs are met by monitoring and evaluating health services and programs.
In practice, these activities include preventing illness and injury by:
- Controlling the spread of infectious diseases and other factors that cause harm
- Guaranteeing the safety and quality of food and drinking water
- Ensuring safe and clean environments
- Certifying the quality of the health care workforce and facilities
- Addressing the reasons that some people are more likely to suffer poor health than others
- Educating and empowering individuals to improve their health
Moreover, shifting public health authority from local governments and executive branch agencies to the legislature runs against principles of both local control and the separation of powers. The legislature has an essential function in government, but it lacks the technical expertise, analytical capacity, and ability for swift action that are needed to address public health emergencies.
The Politics-Administration Dichotomy
In 1887, future-president Woodrow Wilson highlighted a dichotomy between politics and governmental administration, writing: “A clear view of the difference between the province of constitutional law and the province of administrative function ought to leave no room for misconception…The broad plans of governmental action are not administrative; the detailed execution of such plans is administrative.”
Wilson believed that holding administrative functions of government separate from the politics of the day and placing them in the hands of highly-educated, well-trained civil servants reduced corruption and improved governmental efficiency.
From this view, then, it is the responsibility of politicians to articulate the will of the people they represent in a collective process that determines the will of the state; in contrast, public administrators and civil servants use their technical expertise to determine the most efficient, effective, and equitable ways to achieve the goals and objectives established in the political realm.
While subsequent scholars have questioned whether public administration could and/or should realistically exist separated entirely from politics, scholarly debates generally focus on how actively public administrators might engage in policy formation; few, if any, would argue that elected politicians possess the technical training and expertise to guide policy implementation.
While legislative oversight functions bring valuable democratic representation to the bureaucratic implementation of policy, proper oversight is best concerned with broadly ensuring that policy outcomes align with stated legislative intent, and that public resources are expended in ways that meet standards of efficiency and propriety. In other words, legislators should be concerned with broad goals, but not necessarily the means of achieving them. It is not the role of legislative oversight to micromanage or override expert determinations of how to best implement policy.
This rings especially true in the core governmental function of public health: Once the state determines that protecting public health is a priority, it should generally be left to experts in the field of public health to determine how best to do so.
Public Health Powers
More than 200 years of law underpin broad powers of state and local health authorities to take actions that secure the health of the population. For instance, while Gibbons v. Ogden, 22 U.S. 1 (1824) primarily held that the Commerce Clause give Congress authority over interstate navigation, it also clearly outlined states’ rights to exercise health laws (and quarantine) that impact commerce “flowing from the acknowledged power of a State to provide for the health of its citizens.” As outlined by the Congressional Research Service in 2014, police powers granted to public health authorities are legally-supported, long-established, and, indeed, desirable in the face of increasing spread of infectious disease.
According to the National Conference of State Legislatures, every state, the District of Columbia, and nearly every territory have laws establishing public health powers like quarantine and/or isolation. Michigan is no exception, with broad (but appropriate) powers outlined in the state’s Public Health Code. History has shown that stringent preventative and remedial public health measures are necessary and essential in the face of disease outbreaks and other public health emergencies.
While public health powers are essential for preserving the safety and well-being—and, by extension, freedom—of individuals, this is not to say that reforms aren’t needed. The local, state, and federal responses to the ongoing coronavirus pandemic have included missteps and failures that should be instructive for both lawmakers and public health professionals.
Public health data are extremely complex and may be prone to misinterpretation by laypersons (and even individuals with scientific training in other fields). Nonetheless, communicating both the scientific basis and goals of health orders to the public would be a sensible requirement for the future, and likewise fulfill core public health responsibilities of educating and empowering the public.
Citizen involvement in government is also paramount for effective and equitable implementation of policy. Intergovernmental and public/private advisory councils with multiple venues for public input is one of many strategies that could balance the need for technical reforms and public responsiveness. Too many people continue to think of health only as what happens in hospitals, suggesting that greater efforts must be directed to educate the public about the important (but often) invisible functions public health plays in preventative activities and health promotion. Public health isn’t just about managing hospital capacity—it’s about preventing harmful exposures that lead to hospitalizations and other long-term risks and consequences.
Public health reforms should above all begin by addressing decades of underfunding, understaffing, and neglect. Centuries of evidence support the conclusion that public health is a central government responsibility and function. Weaknesses and flaws in our public health capacity and infrastructure revealed by the coronavirus pandemic further underscore the point that revitalizing public health is the only way to effectively protect and promote the health of citizens. Politically-motivated attempts to erode public health authority not only run contrary to these goals, they put every citizen at greater risk of illness and death.