Public Health and the Postal Service.
Lessons from the US Postal Service for Public Health
Once models of efficiency and social responsibility, the USPS and public health infrastructures face similar challenges from privatization campaigns and public distrust
When French political philosopher Alexis de Tocqueville came to the United States in the1830s, the postal service was in the process of becoming that century’s great example of innovation in administrative structure. The US had adopted the German model of applying a top-down form of organization (using a military model) to the public good, in this case the post office. An official letter-carrying service was a way of conveying information over long distances, holding first armies and then societies, together. Tocqueville, visiting rural America wrote, “There is an astonishing circulation of letters and newspapers among these savage woods.” To most Americans then, the post office was the face of the federal government, the only government officials people were likely to meet in small towns. There were over 3,500 offices across the nation and post office staff outnumbered all other branches and units of the government combined, including the army. Half the government budget was spent on the postal service.
The postal service of the 1830s was viewed as efficient, impressive, and organized. Its swift and accurate work was indeed remarkable and appreciated as such. It was the basis for an emerging civil service and became the model not only for private businesses, but also for the public takeover of once-private businesses like early subways and train systems, which to this day remain in public hands. A post office job became the paradigm of a stable, secure, respectable, service-oriented employment.
One hundred fifty years later in the 1980s, the popular image of the postal service was ruined by a “waste, fraud, abuse” and efficiency campaign to convince Americans that the government doesn’t work. Legislators defunded the post office and encouraged privatization. As a result, the postal service became the definition of everything wrong with the federal bureaucracy: apathetic and disgruntled workers who ignored piles of undelivered mail, and who ran the risk of “going postal,” and committing violence against their colleagues.
Over these same 150 years, public health followed nearly the same route as the postal service: a bureaucracy that was so rational and reliable we just took it for granted. A vast invisible army of workers delivered health to Americans—surveilled disease, tested our food and water supplies, provided vaccinations, came up with guidelines of care—just as the postal service delivered mail. Public health and the postal service were meant to be available to everyone. They were functions of social responsibility. Public health too originated in the care of the military, spreading to the care of the general population by stopping infectious disease.
And now, public health and its practitioners are under attack in today’s new wave of anger against “waste, fraud, abuse” in government and against cooperative, non-commercial efforts to provide a public good. Public health workers who are seen as overly political are this decade’s example of everything that is wrong with federal bureaucracy.
The postal service is mentioned in the US Constitution; some argue that this is enough to protect its existence as an essential public service. Some believe its full privatization would hurt millions of Americans, especially those in the most rural places who still depend on it for critical deliveries, including prescription drugs and vote-by-mail ballots. Current law requires the USPS to deliver to all addresses. Still, the U.S. Postal Service has been notably supplanted by private couriers (i.e. FEDEX, UPS) that don’t have to pick up from unprofitable addresses, and by the internet, a global, electronic post office. The current administration is talking yet again of privatizing the post office.
Will there be a similar move to “privatize” public health, which is already underfunded and therefore, one could argue, in need of private funding? What would our public health agencies and laboratories be replaced by in this new world and what might be lost for Americans along the way? Not to mention that “private” public health is an oxymoron. Who will be left out—those in rural areas who already have less access to health and are hard to reach? Will the appeal and benefits of the quiet, behind-the-scene work of public health only be apparent after it disappears?
The U.S. Postal Service hasn’t died. Instead, it remains one of the largest employers in the United States, with the largest delivery reach of all courier organizations, and carrying more packages than ever. Two hundred years later, the USPS remains popular and belongs to the people of the country. Most importantly, in its mission, no one is left out—the same aim as public health’s. Let us hope that both pillars of the US commitment to its citizens remain standing.
Michael D. Stein, MD
Dean Ad Interim
Boston University School of Public Health
mdstein@bu.edu
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