Covid-19, Public Health and the issue of Public Goods from an ILE Perspective

Given all of the news of the coronavirus or Covid-19, this seems like a good time to review ideas related to economics and public health and in particular a focus on how the ILE school would look at this issue.  The Covid-19 virus has raise all of our awareness regarding for this post, we will specifically explore what economists and other experts using economic concepts have to say in regards to what kind of economic good is public health.

Starting in 2011 (although certainly there was discussion of this issue much earlier) there has been a vigorous debate about the role of government and public health as a public good in the public health ethics focused especially in the Journal "Public Health Ethics". While these concepts are no stranger to economists, their use by other experts can illuminate how we think about these issues.

Prof. Jonny Anomaly wrote the first paper in 2011 where he argued that public health, defined as "attempt to promote health and prevent disease among populations of people for whom health outcomes exhi- bit the two characteristic features of public goods: non-excludability and non-rivalry." (Anomaly, 2011, pg. 251).  From here, he argues that restricting freedom is considered ok if it produces a collective benefit and is not just to change an individuals behavior (paternalism).  Ultimately, Anomaly's goal is to narrow the scope of public health to be only about public health and collective benefits and not justified on the basis of other reasons.  Anomaly mostly wants to sue the argument of non-excludability to argue for the general benefits of the "public good"aspect of the public health.  He focuses on the use of the concept of pure public goods as the basis for government intervention in society in the sense of public health.

Richard Dees writing in 2016 in the same journal is looking at a different aspect of public health.  Dees is critical of the Anomaly argument feeling his argument that only pure public goods can be the basis for public health policy is far too restrictive.  Dees agrees with Anomaly that something like herd immunity or protection is close to a pure public good.  However, he goes on to say that other aspects of health such clean water and sanitation while not pure public goods can be seen as still important to the overall public health of the community and can be called "normative public goods".  Dees wants an informed debate on the costs and benefits of various public health policies to be undertaken in recognition that there are some types of normative public goods beyond the narrow definition of pure public goods.

A third paper written in 2019 by L.Chad Horne of Franklin and Marshall College in the same journal stated that, "Public goods are goods that are both non-rival and non-excludable. What is significant about such goods is that they are not always provided efficiently by the market. Indeed, the state can sometimes realize efficiency gains either by supplying such goods directly or by compelling private purchase" (pg. 287, Public Health Ethics, 2019).  Horne wants to push us in the direction that market failures more broadly defined rather than pure public goods should be the basis for public health policy.  He uses the well-known concept that economic efficiency defined as "a situation whereby all pareto-improving trades have been made" or that no trades that will make one party better off without making anyone else worse off are done should be the basis for public health policy. He sees this as middle ground between Dees and Anomaly.

An ILE Focus
ILE would reject the use of term public good preferring instead to focus specifically on the characteristics of non-rivalry and non-exclusion and not prejudicing us towards public provision of the good which is definitely an option. In this sense, ILE would not be supportive of the Anomaly argument as it stands.  Further, there are an infinite number of economically efficient points and one cannot compare efficient points without making additional value judgements.  Party this is due to the fact that the distribution of income and, more importantly, the very definition of property rights and what is an "input" or "output" must be defined. This is a point where ILE would be at odds with Horne.  None of us this invalidates the claim that public health may in fact be a public good.  Rather it is to make the case that argument for public provision of the good "public health" needs to be made in a different context. Dees seems closest to the ILE perspective.

This may seem very elementary to some economists.  However, a review of literature in other fields shows how economic concepts can be used and misused and lead to major policy decisions that need to be carefully considered and how the importance of definitions and language matter.