1 . 1 Public Health as Social Justice * DAN

Anthony Downs* has observed that our most intractable public problems have two significant characteristics. First, they occur to a relative minority of our population (even though that minority may number millions of people). Second, they result in significant part from arrangements that are providing substantial benefits or advantages to a majority or to a powerful minority of citizens. Thus solving or minimizing these problems requires painful losses, the restructuring of society and the acceptance of new burdens by the most powerful and the most numerous on behalf of the least powerful or the least numerous. As Downs notes, this bleak reality has resulted in recent years in cycles of public attention to such problems as poverty, racial discrimination, poor housing, unemployment or the abandonment of the aged; however, this attention and interest rapidly wane when it becomes clear that solving these problems requires painful costs that the dominant interests in society are unwilling to pay. Our public ethics do not seem to fit our public problems. It is not sufficiently appreciated that these same bleak realities plague attempts to protect the public’s health. Automobile-related injury and death; tobacco, alcohol and other drug damage; the perils of the workplace; environmental