Effective public health requires “deep prevention”

The philosopher Derek Parfit, introducing his 1984 book Reasons and Persons, sets out a few basic concepts—that we have reasons for acting, that some ways of acting are morally wrong, and that some outcomes are good or bad in a sense that has moral relevance.1 Reaching for what he presumably judged to be an uncontroversial example of a poor outcome, he notes that “it is bad, for example, if people become paralysed.” Whatever hopes one might have about the arc of the moral universe bending towards justice, the US elections have placed enormous power in the hands of a Republican Party intent on sabotaging vaccination programmes and medical research, while withdrawing support from international programmes funded by USAID.2 This threatens the health and wellbeing of millions of people risking the resurgence of polio (and thus paralysis) as well as other existing and novel infectious diseases. While basic human decency calls for action to try to ensure that such policies, which will shorten the lives of many of the most vulnerable people, can be stopped, mitigated, and ultimately reversed, it is easy to feel right now that this is too hard or perhaps impossible. Bobbie Jacobson’s …