单项选择题

While disease is present prior to social organization, communal life creates special hazards. While the organization of society can reduce the dangers of disease, trade and urbanization, with their consequent problems of sanitation and pollution, can also aggravate such dangers. Even in the mid-twentieth century, during the brief calm between the polio and AIDS epidemics, epidemic health risks associated with carcinogens (cancer-producing substances ) from polluted air threatened the industrialized world. 　　To the economist, efforts to combat these risks are at least partially public goods. The benefits from public goods are indivisible among beneficiaries. A sole private purchaser of health care would give others in society a "free ride" with respect to the benefits obtained. To market theorists, such goods are lawful objects of governmental intervention in the market. While the theory of public goods helps explain aspects of public health law and assists in fitting it into modern economic theory, it omits a critical point. Ill health is not a mere byproduct of economic activity, but an inevitable occurrence of human existence. As a result, wherever there is human society, there will be public health. Every society has to face the risks of disease. And because it must, every society searches to make disease comprehensible within the context of the society’’s own particular culture, religion, or science. In this sense, health care is public not only because its benefits are indivisible and threats to it arise from factors outside of the individual but also because communal life gives individuals the cultural context in which to understand it. 　　Governments typically have assumed an active role with respect to health care, acting as if their role were obligatory. How governments have fulfilled that duty has varied throughout time and across societies, according not only to the wealth and scientific sophistication of the culture but also to its fundamental values--because health is defined in part by a community’’s belief system, public health measures will necessarily reflect cultural norms and values. 　　Those who criticize the United States government today for not providing health care to all citizens equate the provision of health care with insurance coverage for the costs of medical expenses. By this standard, seventeenth and eighteenth-century America lacked any significant conception of public health law. However, despite the general paucity (scarcity) of bureaucratic organization in pre-industrial America, the vast extent of health regulation and provision stands out as remarkable. Of course, the public role in the protection and regulation of eighteenth-century health was carried out in ways quite different from those today. Organizations responsible for health regulation were less stable than modern bureaucracies ,tending to appear in crises and fade away in periods of calm. The focus was on epidemics which were seen as unnatural and warranting a response ,not to the many prevalent and chronic conditions which were accepted as part and parcel of daily life. Additionally ,and not surprisingly ,religious influence was significant ,especially in the seventeenth century. Finally, in an era which lacked sharp divisions between private and governmental bodies, many public responsibilities were carried out by what we would now consider private associations. Nevertheless, the extent of public health regulation long before the dawn of the welfare state is remarkable and suggests that the founding generation’’s assumptions about the relationship between government and health were more complex than commonly assumed. The author’’s primary purpose is to