Siegal: View Public Health Dilemmas Through Lens of Collective Action

February 11, 2009

The legal community should reframe certain public health issues as collective action problems that deserve government intervention, Law School professor Gil Siegal told students at a Health Law Interest Group lunch talk Monday.

Gil Siegal

A classic collective action problem is people allowing their cows to overgraze a common pasture area, Siegal explained. When people try and solve these types of problems, they often look to the government to help, he said. When dealing with more general issues such as pollution or littering, citizens generally accept government involvement. But government involvement in public health is more complicated.

"Public health usually pertains to my body, my health," Siegal said. "It's so intimate, [and people think] that's not a subject for collective action because it's my body."

For example, if everyone were organ donors, there would be no waiting list for organs. But, only 40 to 50 percent of Americans are donors, which, Siegal said, contributes to the 7,000 Americans who die each year only because they do not receive an organ they need.

The logical solution would be to either force everyone to be donors or to allow only donors access to organs, but Siegal said legislatures all over the world have shied away from moving organs from a public good to an excludable good.

However, people have allowed degree of government intervention in public health through vaccinations. Most children receive a set of vaccinations before starting school, and have done so for so long that the public has reached what Siegal called a "herd immunity" to certain illnesses.

Because the vaccinations have been so successful, however, free riders are beginning to crop up. Siegal pointed out that parents today do not know what it feels like to watch their child die from diphtheria.

"That's what we call the tragedy of successful collective action," he said. "Once [the vaccinations are] so successful people think only about their costs, their risks — they don't think about the benefit, which has already been taken for granted."

In other words, instead of focusing on how the vaccines eradicate certain illnesses, parents obsess over the miniscule risk of side effects and opt out of the vaccinations. This gives rise to another issue.

"Here's the problem: You did that and he did that and she did that, and at the end of the day, you have an erosion of the public good, namely herd immunity," Siegal said.

A similar phenomenon is happening with organ donation; people know that they are eligible to receive an organ even if they are not donors themselves. Siegal advocated for a governmental role in ending this free-rider problem, even if the legislation would be regarded by some as paternalistic.

"Paternalistic legislation is warranted in selected instances to promote the program of public goods, and where people show proclivity to choose the option that makes them worse off," he said.

Siegal suggested that governments could provide incentives to organ donors, such as giving them priority over non-donors on the waiting list, or could work to change the social norms to stigmatize non-donors. Regardless of how governments choose to act, Siegal said they must motivate many to make a difference.

"One more donor card means nothing," Siegal said. "What [counts] is everybody, millions of millions, chipping in — That's the challenge to collective action."

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