the difference between health and public health
For the second time in two months (and despite getting a flu shot), I’m sick. This is strange for two reasons; the first being that I grew up in a developing country and have an immune system bolstered by 1+ billion people living in an area smaller than half the United States; the second, because I’m a relatively healthy individual who exercises regularly, doesn’t (didn’t used to) get sick often, and maintains a fairly healthy diet (sleep schedule notwithstanding).
(photo courtesy of… )
If I had to guess, I picked something up at work. Because workplaces, like elementary schools, are incubators for illnesses. It’s all fine and well to be a healthy individual with a strong immune system, but throw that healthy individual into a building for 9+ hours a day with others of varying immune capabilities, and it makes no difference how healthy they were to begin with. Essentially, I need my coworkers to stay healthy if I plan on staying healthy, and I derive a very real benefit (in economic terms, an externality) from my team not being sick.
That’s the difference between health, and public health. Healthcare, like education, provides benefits not only to the individual that purchases the good, but also externalities to others in society such as increased productivity, lowered disease transmission, and reduced microbial resistance to medication.
Here’s the real kicker (and especially in the context of healthcare reform): if all of society derives these benefits from me not being sick, who in society deserves to pay for my health? We’ve managed to answer that question in education - society pays to educate its children because society benefits from an educated population. Should society be paying for healthcare when that society derives benefit from a healthy population?
And let’s take it one step further. In the developing world, individuals cannot afford to pay for the most basic of health services. In these places, though, because of the prevalence of infectious disease, keeping individuals healthy delivers huge impact to others in the population. Globally, preventing an outbreak of infectious disease in Niger means a smaller chance of a compromised population in Atlanta.
So, today’s good question: who should pay to keep people healthy?