Page 170 - The Handbook of Persuasion and Social Marketing

162 The Handbook of Persuasion and Social Marketing

bureaucratization of the administration of public health, which also con-
verges with an unwanted consumerist redefinition of everyday life in
which, in order to rein in rising health care costs, people could be held
accountable for their decisions regarding exercise, diet, risky behaviors,
and anything else that could contribute to an escalation of costs. Left-
leaning critical theorists such as Horkheimer and Adorno (1944/1972)
lamented the rise of a “totally administered society,” reflected also in the
writings of a later generation of critical theorists, including Jürgen
Habermas (1987), who lamented the continuing colonization of the life-
world, where systems imperatives of efficiency, predictability, and cost-ef-
fectiveness distort the activities of actors in their everyday lifeworlds.
That the intent of public health administrators is benevolent, there can
be no doubt. But there is also wisdom in the old saying, “The road to Hell
is paved with good intentions.” Indeed, Merton (1968) taught Gouldner
(1980) well about the latent dysfunctions of any public program or policy,
insofar as any change—be it a program, policy, or law—will have a delete-
rious impact on some groups while, on balance, it (hopefully) improves
the lot of the many enough to offset any negative consequences for the few.
With the rise of the nation-state and the concept of citizenship, human
beings began being assessed and understood more and more in economic
terms—that is, in terms of citizens being “resources” that the state could
use to pursue collective political and social goals. This approach began
with practices such as taxation (forced payments to the state to offset op-
erating expenses) and conscription (forced military service) but then ex-
panded into more areas of social life, including the idea that people ought
not to do things that jeopardize their own or others’ safety. Because medi-
cine had already been on the scene to provide authoritative pronounce-
ments about the nature of human health and illness, it was only natural
that the professional complex of medicine would be placed in the service
of the state, largely through the granting of licenses for the provision of
medical services but also to inform legislative bodies about the health risks
citizens face.
In the United States, the history of public health initiatives has been at
best haphazard and sporadic, at least through the early 20th century. In
the southern United States, especially, public health initiatives were not
embarked upon in any systematic fashion until after full-blown health cri-
ses emerged. For example, it was not until the 1870s that major legislative
efforts to implement public health measures were enacted, the most well-
known of which was the response to a deadly plague of yellow fever that
had been introduced through the port of New Orleans and that had spread
as far north as Ohio (Warner, 1984). By an act of Congress, the port was