Big Brother is Watching: Elizabeth Whelan on New York City's newest public health initiative - tracking and nagging diabetics:

Some are resigned to this new regulation, arguing that if government is assigned the role of paying for health care, it is entitled to intervene to reduce the risks of disease and thus reduce the costs. But as we set forth into this brave new world of public health, some facts cannot be ignored:

The implicit assumption behind these monitoring and follow-up programs is that government can be as successful in reducing chronic disease through legislation as it was in wiping out many infectious diseases through classic public-health measures like vaccination and chlorination of water. However, there is no evidence that these new government efforts will pay off in terms of better health.

Matters of patient confidentiality and personal responsibility have been totally overlooked. It is safe to say that most Americans do not want their medical profiles to be a matter of public record. And they do not want clerks from the local health department calling them and telling them how to live their lives. Since so many of the risk factors for chronic disease involve lifestyle factors — overeating, lack of exercise, smoking, and more — the emerging health policies are blurring the distinction between public health and personal health, the former lending itself to community-wide mandates, the latter more appropriately the sphere of individual action and commitment.

In contacting diabetes patients to urge them to follow various protocols to preserve their health, the city is not only shattering the confidentiality of the physician-patient relationship but assuming that personal physicians are incapable of performing this role.

When the government's phone calls and letters nagging people to eat better, quit smoking, and be more physically active don't work, the next phase of the war on chronic disease may be a harshly punitive one, with fines and other restrictions on those who fail to heed the health warnings. The message will be: Live a healthy life or the government will punish you.

New York City's law mandating the reporting of diabetic blood tests is a harbinger of more intrusive legislation to come — all in the name of public health. It is high time we reflect upon the difference between public and private health, critically evaluate what role the government should play in the prevention of chronic disease, and carefully assess what cost we might pay in privacy and individual freedoms as the government performs "interventions" to protect us from ourselves.

This is a disturbingly popular trend in the public health community - to assume that government can regulate every aspect of health. At its core, it ignores the most fundamental cornerstone of Western philosophy - the free will of men.