Plagues, Public Health, and Politics1

mayor and aldermen of the city of London put into place a set of orders " concerning the infection of the plague, " which was then sweeping through the population. He intended that these actions would be " very expedient for preventing and avoiding of infection of sickness " (1). At that time, London faced a public health crisis, with an inadequate scientific base in that the role of rats and their fleas in disease transmission was unknown. Nonetheless, this crisis was faced with good intentions by the top medical and political figures of the community. Daniel Defoe made an observation that could apply to many public health interventions then and today, " This shutting up of houses was at first counted a very cruel and unchristian method… but it was a public good that justified a private mischief " (1). Then, just as today, a complex relationship existed between the science of public health and the practice of public health and politics. We address the relationship between science, public health, and politics , with a particular emphasis on infectious diseases. Science, public health, and politics are not only compatible , but all three are necessary to improve the public's health. The progress of each area of public health is related to the strength of the other areas. The effect of politics in public health becomes dangerous when policy is dictated by ideology. Policy is also threatened when it is solely determined by science, devoid of considerations of social condition, culture, economics, and public will. When using the word " politics, " we refer not simply to partisan politics but to the broader set of policies and systems. Although ideology is used in many different ways, in this case, it refers to individual systems of belief that may color a person's attitudes and actions and that are not necessarily based on scientific evidence (2). Public Health Achievements Science influences public health decisions and conclusions , and politics delivers its programs and messages. This pattern is obvious in many of public health's greatest triumphs of the 20th century, 10 of which were chronicled in 1999 by the Centers for Disease Control and Prevention (CDC) as great public health achievements, and several of which are presented below as examples of policy affecting successes (3). These achievements remind us of what can be accomplished when innovation, persistence, and luck converge, along with political …