From quarantines to sanitation: Evolution of American public health governance

What is it about?

Throughout its history, USA has endured outbreaks of smallpox, yellow fever, cholera, and polio. These epidemics in some ways have shaped the public health legislation in the country. The author of this chapter in the book American Contagions: Epidemics and the Law from Smallpox to COVID-19 succinctly describes the evolution of health and sanitation regulations, and their enforcement in the USA throughout the nineteenth and twentieth centuries. Early American lawmaking and enforcement followed an authoritarian approach to curtail pestilence and ensure good public health, focusing on collective solidarity over individual freedom that defines the current national sentiment. Initial epidemic management encompassed regulations for quarantine, inspection, trade restrictions, interments, and penalties, subsequently expanding into sanitation and disease prevention focusing on clean public areas, planned waste disposal, clean water supply, sanitation codes, food standards, and mandatory vaccinations. With time, two differing schools of thought emerged regarding sanitation, with the progressive view advocating social welfare for the most vulnerable populations, and the conservative view advocating sanitation for poor laborers as a relief cost-cutting, productivity maximizing strategy. Despite their differences, both outlooks had the same goal—to safeguard public health through social wellbeing.

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Photo by Samuel Branch on Unsplash

Photo by Samuel Branch on Unsplash

Why is it important?

The recent covid-19 pandemic has forced global economies to reassess existing public health and sanitation and compelled actions to plug gaps in existing infrastructure. An understanding of the history of epidemics and public health responses under the purview of law in the USA can help in understanding the current government responses to tackle this and other disease outbreaks. KEY TAKEAWAY Health and sanitation regulations of the nineteenth and twentieth century America were based on Cicero’s principle of “salus populi suprema lex’— ‘the health of the people is the supreme law,” which aligned the interests of all social classes and succeeded in promoting sanitation strategies, improving the wellbeing of immigrants and working-class Americans, and laying the foundation for modern public health legislation.