Government Agencies

Although governmental agencies at the federal, state, and local levels play an important role in issues related to obesity in the United States, not everyone approves of the current level of involvement. Some feel that governmental involvement in public health should be restricted to matters such as providing municipal water treatment and monitoring communicable diseases, and that the government should not be involved in diseases that have a strong volitional or lifestyle component, while others feel that the governmental role should be greatly increased, in recognition of the societal costs of obesity and because they do not see the purpose in drawing a distinction between infectious and chronic diseases, both of which are harmful to human health.

Of course, opinions about the proper level of governmental involvement are informed by differing conceptions of who is responsible for obesity; some place the blame on the obese individual as a person [Page 335]who makes poor food or lifestyle choices, while others point to an environment that encourages overconsumption of unhealthy foods and discourages exercise. These are differences in philosophy rather than questions of fact, and fruitful lines of investigation have been instigated from both points of view.

History

Governments have been involved in public health at least since the Roman Empire, where the government constructed aqueducts, sewer systems, and public baths and appointed officials to oversee the public water supply, drainage system, and food supply. Charity medical care was also offered in both classical Greece and Rome, and the Roman Empire established charity hospitals by the 4th century b.c.e. Unfortunately, these health measures were not maintained in Europe during the Middle Ages, during which time cities often lacked secure water supplies, drainage systems, and garbage collection systems. These deficiencies in infrastructure are among the factors implicated in the epidemics of communicable diseases, which were a regular feature of European life during this period.

The Renaissance brought a greater interest in public health matters, boosted in part by increased interest in collecting and analyzing data. Notable in this effort was John Graunt (1620–74), who produced the first calculations of life expectancy and noted the association of demographic variables with mortality. The first widespread public health campaigns that involved individual treatment rather than creation of public works such as sewers, were the variolation campaigns that began in the late 18th century. These campaigns offered vaccination against smallpox to large numbers of people within a geographic area, and in some cases, made the vaccination mandatory in recognition of the public benefit of reducing the susceptible population.

The development of the modern public health approach is usually dated from the mid-19th century, when the concentration of population in cities lacking adequate housing and sanitation led to frequent outbreaks of disease. The sanitarian movement in Europe and the United States was founded on the belief that provision of basic public health facilities such as a municipal water supply and sewage system were a worthwhile investment in securing the population's health, and were best provided by governments rather than leaving such matters to the choice of individuals. Public health was often organized the city level in this period, and the Metropolitan Board of Health, created in New York City in 1866, was one of the earliest municipal public health authorities.

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