Trust Issues


When Mayor Bloomberg attempted to ban soda in New York City the general public responded with a variety of reactions. Some people thought: Who is he to tell us what we can and cannot purchase? While others saw the obvious threats of obesity and felt that this policy would  benefit the general public. When we (the general public) are subject to new policies, I’m sure some people (like myself) cannot help but wonder what goes on behind closed doors when these decisions are made. Who is making the decisions? What factors contribute to these decisions? What gains do these decisions makers foresee? After all, this is America and everyone seems to have ulterior motives.

Setting public policy agendas are essential in that there will always be competing powers fighting for their issue to be at the forefront of the public health debate, at the top of the list on the millennium development goals and in the race for receiving the most funding. And as Reich suggests, public policy agendas are greatly affected by those who are in control and have power (Reich, 1995).  Again, who are these people? There is no big election held with campaigns so that the general public can elect who will represent the leaders of W.H.O. and U.N.I.C.E.F.  and support the issues that matter most in their eyes. Has the head of W.H.O. or U.N.I.C.E.F. even talked to people in the community? How do they know what issues we face? And who convinces them that the issues they support are the ones that matter?

As a possible answer to the final question stated above, Reich proposes that, “Politicians make choices based on their sense of what is both feasible and beneficial,” (Reich, 1995). The question then becomes what is this “sense”? And to whom are these decisions beneficial? This brings me to the concepts presented in a piece written by Roberts and Reich in the Lancet surrounding ethical analysis in public health (Roberts and Reich, 2002).  The authors present the idea that there is no method to analyze the serious ethical dilemmas that arise every day in public health decision-making. They do however offer the use of utilitarianism, liberalism and communitarianism as tools for ethical decision-making. If we as the general public were at least privy to the method of ethical analysis an organization or a politician employed would you perhaps feel more comfortable with allowing them to make decisions for us? Would you trust that they are making decisions that are “beneficial” to the general public?  I think I would at least trust in their process. Asking myself if they are indeed backing the “right issues” is another story.


Reich, MR. “The Politics of Agenda Setting in International Health: Child Health Versus Adult Health in Developing Countries”. Journal of International Development. 1995: 7(3): 489-502.

Roberts, MJ and Reich, MR. “Ethical Analysis in Public Health”. The Lancet. 2002; 359: 1055-1059.


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