Book Reviews: Leichter - Free To Be Foolish: Politics and Health Promotion in the United States and Great BritainHoward M. Leichter Princeton: Princeton University Press, 1991, 281 pp. US$35.00 cloth. ISBN 0-691-07867-X. Princeton University Press, 41 William St., Princeton, NJ 08540, USA.

Précis

The author is Professor of Political Science at Linfield College and Clinical Professor of Public Health and Preventive Medicine at Oregon Health Science University. In this book he traces a recent and “important shift in the debate over how people can maximize their chances of staying healthy” (p.7). Populations in both the United States and Great Britain for most of the century have regarded equitable access to health care as the basis for individual health. Within the last two decades, however, assumptions have shifted. Health is now thought to be a preventive exercise to be secured by reducing dangerous and foolish behaviors. In seeking to regulate dangerous behaviors of citizens, policymakers confront deeply seated values of individualism and choice.

Leichter advances the thesis that policies that regulate life-styles are fundamentally different from other health policies. As a consequence, a distinct framework for evaluation is necessary, which he presents and elaborates upon throughout the book. He uses historical experiences in two countries—the United States and Great Britain—to develop and refine his thesis.

Following historical overviews of the two health revolutions (access to health care and personal life-style monitoring), Leichter deals with four areas in which governments have sought to limit individual activities: smoking, alcohol control, road safety, and behaviors relating to AIDS. In his final chapter he evaluates “when and under what circumstances [it is] appropriate for the state to intervene in life-style decisions” (p. 31). This literate book is supplemented by four figures and thirteen tables.