1. © 2008 Delmar Cengage Learning. Chapter 3 Morals and Health Policy James A. Morone

2. © 2008 Delmar Cengage Learning. 2 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

3. © 2008 Delmar Cengage Learning. 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

4. © 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 20 th century New Deal-era legislation

5. © 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”

6. © 2008 Delmar Cengage Learning. 6 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

7. © 2008 Delmar Cengage Learning. 7 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

8. © 2008 Delmar Cengage Learning. 8 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

9. © 2008 Delmar Cengage Learning. 9 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”

10. © 2008 Delmar Cengage Learning. 10 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

11. © 2008 Delmar Cengage Learning. 11 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

12. © 2008 Delmar Cengage Learning. 12 Chapter 3 Summary American political history often viewed through the lens of individualism, community, or, in the case of this study, morality

13. © 2008 Delmar Cengage Learning. 13 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

14. © 2008 Delmar Cengage Learning. 14 Chapter 3 Summary Morality politics can be seen at play in the cases of school health clinics and the debate over obesity in America