The heart of the precautionary principle in democracy.

© 2002 Association of Schools of Public Health The cornerstones of the precautionary principle—transparency and inclusiveness of decision-making, action in the face of uncertainty, and accountability— are fundamental, not only to the practice and science of public health, but also to the success and maintenance of democracy. Both public health and democracy flourish when information is broadly disseminated and understood, when principles, benefits, and costs are publicly debated, when decision-making is shared by those affected by the policies, and when public interest is seen as more valuable than private gain. Both are diminished when information is withheld and data twisted, when the terms of the argument predict its outcome, when actions to protect and advance the health of the public are defeated by small private interest groups, and when government gives equal weight to corporate interests as to public well being. In the case of the public health debate, the danger is increased with the deification of a skewed view of science. The precautionary principle, which says that action should be taken when there is evidence that not to do so would cause harm, is being used increasingly to shape policy in Europe and elsewhere. Decades—sometimes centuries— before the understanding of germs, bacteria, viruses, infection, and immunology, leaders in public health improved health by implementing policies that were later supported and explained by an advanced understanding of basic science. The precautionary principle is based in science, in the two branches of science central to public health: epidemiology and bio-statistics. It is no coincidence that so many contributors to this special topic issue of Public Health Reports have cited the model and experience of John Snow. The branch of science that he established has laid the foundation for the greatest improvements in health in mankind’s history. Now, instead of developing policy to improve health and protect the public based on these proven scientific methodologies, proponents of an activist public health are fighting a rear-guard action to protect the cornerstones of public health. Where opponents of an activist public health agenda, which includes the implementation of the precautionary principle, have succeeded is in having health science narrowly defined in terms of laboratory science, physiology, and biochemistry. This limited definition ignores the breakthroughs in occupational safety, environmental science, maternal and childcare, infection control, sanitation, and behavioral The Heart of the Precautionary Principle in Democracy