Disease and Democracy: The Industrialized World Faces AIDS

Disease and Democracy: The Industrialized World Faces AIDS

Disease and Democracy: The Industrialized World Faces AIDS

Disease and Democracy: The Industrialized World Faces AIDS


Disease and Democracy is the first comparative analysis of how Western democratic nations have coped with AIDS. Peter Baldwin's exploration of divergent approaches to the epidemic in the United States and several European nations is a springboard for a wide-ranging and sophisticated historical analysis of public health practices and policies. In addition to his comprehensive presentation of information on approaches to AIDS, Baldwin's authoritative book provides a new perspective on our most enduring political dilemma: how to reconcile individual liberty with the safety of the community.

Baldwin finds that Western democratic nations have adopted much more varied approaches to AIDS than is commonly recognized. He situates the range of responses to AIDS within the span of past attempts to control contagious disease and discovers the crucial role that history has played in developing these various approaches. Baldwin finds that the various tactics adopted to fight AIDS have sprung largely from those adopted against the classic epidemic diseases of the nineteenth century--especially cholera--and that they reflect the long institutional memories embodied in public health institutions.


This is a book about the influence of the past on the present. Its central arguments are three. First, faced with the acquired immunodeficiency syndrome (AIDS) epidemic, the developed nations adopted surprisingly different approaches to a public health problem that confronted them all with similar challenges. Second, some of these industrialized liberal democracies were markedly more interventionist than others, favoring the commonweal over the rights of infected and at-risk citizens. Which nations subordinated individual liberties to the collective good, and which instead employed voluntary and consensual tactics, was sometimes surprising. Restrictive polities were often otherwise concerned with civil liberties: the United States, for example, and Sweden. Others, including nations usually willing to allow the state to impose on its citizens, like France and Germany, adopted a much more laissez-faire attitude. The general political ideologies of developed nations certainly influenced their public health policies. But it was not obvious what the connection would be. Often, it was the reverse of what one might expect.

Third, the industrialized nations of Europe and North America took divergent approaches that broadly corresponded to the preventive tactics they had adopted during the nineteenth century when dealing with earlier epidemics of contagious disease: plague, cholera, yellow fever, smallpox, and syphilis. In each country, policy makers were convinced that they were now responding in ways dictated by the nature of the threat they faced. In fact, their actions bespoke the influence of past decisions. As this book shows, such divergences among the industrialized nations are due to precedence— a kind of deep historical public health memory.

The variety of preventive approaches was remarkable, too, when held up against most observers’ implicit presumptions that these nations employed . . .

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