This is the heart of the community decision-making that is necessary for promotion of the public’s health. We are long past the parentalistic model under which the state might appoint a health officer who can individually demand that others follow instructions with no recourse. The establishment of environmental regulations, decisions to require immunization of all children, and the move to limit or eliminate use of tobacco products all represent a balance between what individuals might prefer to do if left unchecked and actions that appear necessary for the good of the whole group.

The HIV epidemic has provided us with some of the most vivid examples of this tension, including debates about disease reporting, partner notification, syringe and needle exchange and access to substance abuse treatment.