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Chapter 3

Morals and Health Policy

James A. Morone

© 2008 Delmar Cengage Learning.

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The Individualistic Model of American Politics

• Americans “born free without having to become so”

• Tocqueville historically relying on themselves – Not a paternalistic monarch or state to attain

privileges

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3

The Individualistic Model of American Politics

• Early philosophical liberalism written into U.S. Constitution and design of government institutions

• Self-interest often seen to trump hard science– Presenting continual challenges to health care

professionals

© 2008 Delmar Cengage Learning.

4

Considerations of the “Community” in American Politics• Political historians have discerned long

tradition of appeal to communal traditions and assistance– Broad public health programs launched by

cities at the turn of the 20th century • New Deal-era legislation

© 2008 Delmar Cengage Learning.

5

Divergence within the Puritan Tradition

• Early Puritan ethos elaborated into twin moral stream in American political history

• Individualistic “neo-Puritans” stressed sins of the individual, or the “other”

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Divergence within the Puritan Tradition

• Collectively-inclined neo-Puritans chose to focus on the sins of the community– Advocating collective action to solve problems

• Including those relating to public health

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Morality Politics in Practice:Case of School Health Clinics-1

• Public health officials by 1990s advocated opening health centers directly inside schools

• Conflicted with cultural conservatives– Recommended alternative course of

emphasizing individual discipline – “Just say no” anti-drug campaign

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Morality Politics in Practice:Case of School Health Clinics-2

• Despite opposition, clinics flourished and multiplied across country

• Developed home-grown constituency of parents, students, public-health advocates

• Achieved compromise with conservatives on certain issues

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Morality Politics in Practice:Obesity Debate-1

• Surgeon general first defined obesity as public health crisis in 2001

• Reactions focused on the individual obese

• Fast-food industry came to be blamed by new breed of “muckrakers”

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Morality Politics in Practice:Obesity Debate-2

• Villainizing of fast-food purveyors led, in turn, to villainization of the obese

• Policy options mooted include mandating high insurance premiums for the obese

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Morality Politics in Practice:Obesity Debate-2

• In the end:– Biggest impact of definition of obesity as public

health crisis may come in the way it informs the public

• Changing lifestyle choices

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Chapter 3 Summary• American political history often viewed

through the lens of individualism, community, or, in the case of this study, morality

© 2008 Delmar Cengage Learning.

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Chapter 3 Summary

• Original Puritan impulse led to divergent world views– One focusing on the sins of the individual

• Or groups thereof

– Other focusing on the ills of society• Social gospel

© 2008 Delmar Cengage Learning.

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Chapter 3 Summary

• Morality politics can be seen at play in the cases of school health clinics and the debate over obesity in America