From the multitude of personalities who have contributed to the field of public health across roughly five millennia, from the period of ancient Egypt through the Industrial Revolution, I chose to have dinner with Johann Peter Frank. I think my choice is interesting not because Frank contributed more to the field than any other figure, although some public health historians do refer to him as “the father of public health,” a title I thought was reserved for John Snow. Nor do I think he’s an interesting choice because his ideas were particularly revolutionary; as Baron points out, the concept of the “medical police” was discussed and implemented in Germany two full centuries before Frank was even born. The reason why I consider Frank an interesting choice for this topic is because, based on his principles, he seems like the least enjoyable dinner companion in human history.
Frank’s legacy in public health is his extreme promotion of enlightened despotism, the social philosophy that calls for the state to formulate thorough policies regarding the health of its citizens and to enforce these policies strictly. In his magnum opus, a six-volume, 6262-page tome entitled A System of Complete Medical Police, Frank attempted to lay out in painstaking detail such policies, regulating nearly every aspect of human health and behavior, including procreation, marriage, food, drink, clothing, entertainment, public safety measures, burial, and education. A few of the more absurd suggestions outlined in this work include a mandate that citizens at a dance party take a rest before leaving lest they catch a cold in the nighttime air, a ban on corsets as they restrict a woman’s breathing too tightly, and a ban on public performances in which too many characters are murdered, as these works lead to depression in the public.
His reasoning for such drastic intrusion into the lives of his countrymen was both humanitarian and patriotic. As a young physician, Frank observed that the diseases affecting people most severely were often preventable as they were rooted in social conditions. It seemed obvious to him that people could not reasonably protect themselves and needed guidance from the state to stay healthy and happy. Additionally, Frank reasoned that the best way to strengthen a nation was to strengthen its citizens, a feat best accomplished by regulating their behavior. Although the rigidity and intrusiveness of his methods seem abhorrent to modern-day democrats, it sounds like his heart was in the right place – he wanted to save lives and strengthen his country.
Despite his good intentions, I think Frank was terribly naïve and misguided, and were his plan to be fully implemented, I believe mankind would suffer dramatically. In addition to restricting all the things that might spice up a good dinner party, such as drinking, drug use, gambling, overeating, promiscuous sexual behavior, and entertainment with gratuitous violence, Frank spent his life promoting a theory with which I fundamentally disagree. If all that weren’t enough, his resemblance to Hannibal Lecter is uncanny. Why then would I have this guy over to my house for dinner?
However terrifying and prude he may have been as a person, and however totalitarian his ideology, I am intrigued by the concept he proposed. Frank resides on the farthest extreme of a topic which to this day remains relevant in public health debate - the question of state control versus individual liberties. Somewhere at the headquarters of the ACLU, there’s probably a dartboard with a picture of Frank’s head as the bulls-eye. His ideas represent a libertarian’s nightmare and the antithesis of Enlightenment philosophies on which modern liberal democracies were founded, although most have adopted many regulations similar to those Frank proposed. The continuation of this debate makes Frank’s principles pertinent, and I think it’s important that people consider the pros and cons of both sides.
The message I would like to convey to Frank in the preparation and setting of our dinner is the concept of personal choice, because after all, this is my house. For this reason, I’ve set up a buffet of American, British, and French cuisine, representing the various hotspots of Enlightenment thinking, and of course a selection of whatever German foods he deemed appropriate for the public in his manifesto. Wearing a t-shirt and sweatpants, I pile my plate high with steak frites, fish and chips, and a giant piece of apple pie with a piece of American cheese melted over it. I pour myself a giant beer, and sit down, being sure to leave the seat at the head of the table open for my paternalistic guest. Once he sits down, I get us rolling on the debate. “How’s your gruel?” I ask with a mouth full of steak.
“Delicious,” he replies, acknowledging my sarcasm. “It feels good to eat healthily.”
“True, but only if you’ve chosen to eat healthily, rather than being told to do so, right?”
“Wrong, it feels good to be healthy, regardless of how or why you came to be that way. Trust me.”
“And why should I trust you – what gives you the right to take away my right to choose what to eat and how much?”
“Because your decisions affect me in ways you don’t seem to understand. The ways you eat, drink, smoke, fornicate, dress, and entertain yourself all contribute to your health, or lack thereof, and as the behaviors in which you choose to engage weaken you, so you weaken my country, and thus weaken me,” he retorts. “I am helping you help yourself and your country.”
“I think you’re ruining my country. Yes, we’ll all be healthier and we’ll live longer under your system, but we’ll all be miserable wondering what life would be like if we could enjoy the wonderful, dangerous, unhealthy options you’ve taken from us. And how do you expect the state to progress when you’ve got us stuck in a vacuum? Personal choice combined with freedom of expression leads to new ideas and progress. A state that controls its public is stagnant, and that makes it unhealthy,” and as I bring the largest piece of pie I can hold on a fork to my face, Frank slaps it out of my hand.
“Wrong – you’re unhealthy.”
“Well, that does it.” I get up out of my chair, lift Frank out of his, and throw him out of my house. Just as it is society’s duty to revolt against a tyrannical government that breaches its social contract, so it is mine to throw out an aggressive house-guest.
Despite this outrageous hypothetical interaction, I actually believe a state should exercise a certain amount of control over its populace when it comes to healthcare decisions. The enlightened despotism that Frank preached invokes a miserable, Orwellian society, but as awful as that existence would be, there is an equally terrible alternative opposite the spectrum in a pure libertarian state. Without traffic laws to keep people from running each other over, or the FDA to keep carcinogens out of their breakfast cereals, people would be unsafe, unhealthy, and unhappy, living in fear of all the unregulated, unknown dangers lurking in their environment. The key is for the state to provide guidance only when absolutely necessary to protect its citizens, without sacrificing personal freedom. Such balance is obviously difficult to find.
As the causes of mortality rates in industrialized nations have shifted in the last century from communicable to preventable chronic diseases, the debate over state intervention versus individual rights has never been more relevant. The tricky part about government regulation of the behavioral factors in these diseases (e.g. tobacco, alcohol, unhealthy food) is that their diagnosis doesn’t threaten the public the way that communicable diseases once did. Therefore, the “well-being of the community” justification doesn’t hold up as much anymore for proponents of coercive public health measures. This reality forces society today to revisit the question Frank tried to answer two centuries ago – are coercive public health measures necessary to preserve the strength of the state, and if so, is there enough justification to sacrifice some personal freedoms?
When considering the modern debate about state control over public health, it is important to remember Frank’s legacy as a reminder that some government interaction is necessary but too much will crush the individual spirit. The key to a healthy state lies somewhere in the balance.
1 comment:
I absolutely love this. I will not repeat what the professor already told you about the quality of it. Thanks for the time you put in writing this and presenting me to this character. your writing was fun and i learned a lot about Johann P. Frank from your essay without feeling like i was putting a lot of effort into it.
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