Who is my neighbor? We are all familiar with the parable of the Good Samaritan Jesus told in response to this question. The story punctuates our obligation to care for the person in distress, even if he is a stranger. But what about our obligation to prevent harm coming to our neighbor? I do not want to stretch the point of the parable too far, but let me ask you: what obligations do we have toward others when we make decisions for ourselves or our children?
This question highlights one aspect of the field of public health. It is concerned with disease prevention and promotion of health, with issues such as pandemics, immunization, clean water and sanitation, reduction of infectious diseases, and responding to natural disasters. Public health is interdisciplinary (just like bioethics), involving not only physicians, but demographers, epidemiologists, nutritionists, public health inspectors, nurses, and lawyers, among others. Public health may not be as dramatic as medicine, but its impact may touch more lives overall.
Public health also illustrates the potential tension between autonomous choices for ourselves and our family, and the impact of those choices on the larger community. Let me give an example from current events.
Just last year, there was an uptick in outbreaks of measles, whooping cough, rubella, mumps, and polio, some affecting more than 10,000.[1] So far in 2012, whooping cough has increased 1,300 percent over 2011, potentially the worst outbreak in fifty years.[2] Several explanations have been offered, including a change to a weaker form of the vaccine, which also causes fewer side effects.[3] Another factor is a complete rejection of childhood immunizations, often by wealthy, well-educated parents.[4]
Neglect or outright refusal of vaccinations can be deadly. In 2010, ten infants died from whooping cough in California; they most likely contracted it from a family member or caregiver.[5] Infants, people who do not develop full immunity, and those who cannot be immunized due to illness such as childhood leukemia, are protected through “herd immunity,” which is achieved when 90% of the population is immunized.
Parents may refuse vaccinations for their children, and the children may do just fi ne. But, do they consider how their decisions could affect others? The cumulative impact of dozens, even hundreds, of individual choices could be the resurgence of nearly-vanquished diseases that can seriously injure or kill. An unimmunized child can be a disease carrier and infect other children and adults. As Christians, how personally do we take the injunction to love our neighbor as ourselves?
How do we balance personal freedoms and obligations to others? This is just one example of disease prevention, a central concern of public health and one that is a hot button topic right now in public discourse.
I would like to suggest that public health awareness has not been on the radar for many of us. I wonder if our reluctance is due in part to the politics of world players in public health: the World Health Organization and agencies within national governments. Specific policy proposals and responses tend to politicize and polarize. We may also suspect that public health is a close sibling of secular social justice.
Or, it could be that our understanding of “health and human flourishing” is confined to the personal rather than the communal. Autonomy holds pride of place in Western bioethics. Our autonomous choices matter more to us personally than consideration of conceptually remote consequences, and we may need to be reminded to attend to the common good.
Evangelical theological resources in public health tend to be thin. Roman Catholic scholars, with a robust contemplation of the common good, are far ahead of many of us on this path. At CBHD, we believe it is important to engage in this conversation, but inspiring robust Christian bioethical reflection in the public health arena eludes us.
We intend to broaden the theological and bioethical conversation about what it means to care for our neighbor. Will you join us?
[1] In a six-month period, nearly 2,000 people—mostly young men—in New York and New Jersey had mumps. In 2010, there were nearly 12,000 cases of pertussis, or whooping cough, in just three states. In the first eight months of 2011, there have been over 300 cases of polio, primarily in two African nations.
[2] “Whooping Cough Cases Reaching Record high: CDC,” MedlinePlus, July 19, 2012, http://www.nlm.nih.gov/medlineplus/news/fullstory_127412.html (accessed august 21, 2012) and Christian Nordqvist, “Whooping Cough Worst Year Since 1959, Says CDC,” Medical News Today, July 22, 2012, http://www.medicalnewstoday.com/articles/248135.php (accessed august 21, 2012).
[3] Steven Reinberg, “Is ‘Improved’ Vaccine Causing Whooping Cough Outbreaks?” Yahoo! News, July 31, 2012, http://news.yahoo.com/improved-vaccine-causing-whooping-cough-outbreaks-200513029.html (accessed august 21, 2012).
[4] Kevin Crowe and Roxanna Popescu, “Local parents increasingly skip children’s immunizations,” North County Times, august 18, 2011, http://www.nctimes.com/news/local/sdcounty/article_975accd5-a125-5ae4-b425-8316ce5bd7a5.html (accessed august 30, 2011).
[5] David Olmos, “Whooping Cough at Highest Levels Since 1950, with 10 Deaths,” Bloomberg, October 22, 2010, http://www.bloomberg.com/news/2010-10-22/whooping-cough-deaths-reach-10-in-california-as-cases-highest-since-1955.html (accessed august 21, 2012).
Paige Comstock Cunningham, "From the Director's Desk,” Dignitas 19, no. 2 (2012): 2–3.
