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Abstract

This article explores the tensions between creating an effective public health system that would be able to respond to and protect against any public health threat, and protecting individuals against unnecessary intrusions on their civil liberties. It then considers approaches to this issue that might best strike a balance in a democratic society. While many Americans may recognize and even accept that greater security would entail some intrusion into individual rights, there is no formula for striking the appropriate balance. This article attempts to arrive at a workable framework by examining how the United States' public health system works. This includes reviewing its policy response to several recent public health threats, exposing the shortcomings of the current system, and comparing it to the approach of other democratic and non-democratic societies. based upon this review and analysis, the article suggests an approach that might best incorporate effective techniques from a variety of alternative systems, while addressing some of the main problems of the current framework. This analysis is broken down into seven main parts. Part I provides an introduction to public health and the essential components of an effective system. It explains why public health historically has not been high on the priority list of medical approaches to combating disease, and describes how this view of public health has evolved, particularly in recent years. Part II examines some of the shortcomings of the United States' public health system as it currently stands. Part III introduces the central controversy between civil liberties and a strong public health system by focusing on three of the most commonly used tools of public health authorities, namely: quarantines, mandatory screening and immunization, and health information sharing as well as their effects on liberty and freedom of movement, individual autonomy, and privacy. Part IV builds on this analysis and explores how the United States historically has struck a balance between these competing considerations by examining orders and legislation arising out of recent public health threats such as AIDS, SARS, and 9/11. Part V investigates other approaches to resolving the tensions between public health and civil liberties by reviewing the approach advocated by one renown public health expert, Lawrence Gostin, and the response of Canadian and Singaporean societies to the threat of SARS. Part VI continues to explore alternatives, focusing solely on the Model State Emergency Health Powers Act ("MSEHPA"), developed in response to 9/11. Finally, Part VII identifies the shortcomings of MSEHPA and recommends amendments to MSEHPA that might help to strike a better balance for the American people. Addressing the criticisms and concerns voiced by the American public is an essential step toward creating a viable, stronger public health system going forward.

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