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September 18, 1991

Free to Be Foolish: Politics and Health Promotion in the United States and Great Britain

JAMA. 1991;266(11):1575. doi:10.1001/jama.1991.03470110121048

Howard Leichter has a story to tell us, and an analysis to present. His book is about politics and health, and his theme is the tension between the libertarian desire for "freedom to be foolish" and the paternalist desire to act for the public good.

His story is of history as experiment. He begins with a historical review that charts the subtle shift in the focus of public health legislation from the environment to the person—from clean air to clean living, as it were. Then he considers in turn the legislative battles over tobacco, alcohol, road safety, and the acquired immunodeficiency syndrome (AIDS). There is a second theme here, of health vs wealth, since smokers and drinkers help fill the coffers of government.

He then describes the legislative actions taken, or avoided, by various states in dealing with these issues and compares the parallel debates in the United States and