A tale of liberty

The childish refusal of so many Americans to take simple actions and endure what is at most a minor inconvenience to save the lives of their neighbors in the name of "liberty" has reminded me of many of the paradigmatic tales in public health history. I'm going to give you one: the story of milk.

From the late 19th to the late 20th Century, life expectancy in the U.S. and other wealthy countries essentially doubled. In 1880 life expectancy at birth in the U.S. was about 40 years. Now it's nearly 80. (We've actually lost ground recently but that's another story.) While the death rate at all ages has declined, the biggest impact has been on deaths of infants and children. Today we think of the death of a child as an unbearable tragedy, but in 1890 something like 1/4 of all children died. It was commonplace. Children mostly died from infectious diseases. Why was that?


At its founding, the U.S. population was predominantly rural, but by 1900 the majority of the population in the northeast lived in cities, and by 1910 the same was true in the west and Midwest. Cow’s milk had to come into cities like New York from farms tens of miles away, at a time when there was no refrigeration, and it was often contaminated with pathogens that killed the children who drank it.

Louis Pasteur invented pasteurization in 1865, which made milk safe to drink. But the mere existence of the method didn’t matter, even 25 years later milk was not pasteurized. Then a German immigrant in New York City, a wealthy merchant named Nathan Strauss, learned about pasteurization. In 1892 he used his own money to establish a pasteurization plant in Manhattan’s East Village, and in 1893 he established “milk depots” in low income neighborhoods to sell pasteurized milk below cost. He also established a second plant to provide pasteurized milk to an orphanage on Randall’s Island, where the mortality rate was something like 15% a year. The death rate immediately dropped substantially.

 Strauss’s efforts attracted the attention of scientists and physicians, and incited a campaign to outlaw the sale of unpasteurized milk. This then attracted the attention of president Theodore Roosevelt, who in 1907 appointed a commission to study the matter. The report came back the following year with the conclusion that pasteurization would save many lives. As the reaction to public health mandates more recently might lead you to predict, the campaign to mandate pasteurization got a furious backlash, including from most milk producers. Why they thought it was good business to kill their customers I cannot say. Many in the general public also opposed the ban on raw milk, claiming that pasteurization negatively affected nutrition and taste. Nevertheless Chicago did ban the sale of raw milk in 1909, but New York didn’t get around to it until a typhoid epidemic in 1913. Nearly all major cities followed suit in the next few years, and the infant and child mortality rate plummeted.

Today, federal law bans interstate sale of raw milk, but state laws vary. Eleven states allow raw cow’s milk to be sold in retail stores without restriction, but others allow sales only directly at the farm, while 20 prohibit it entirely. I do not believe there is any validity to claims that it is nutritionally superior, but it is less dangerous than it was in 1900, because of refrigeration, because it is likely to be fresh, and because cattle today are unlikely to be infected with pathogens that can pass into their milk. 

Nevertheless I do not believe there is any "liberty right" to kill your children. Children who are sick or dead don't have any liberty. On the other hand today we enjoy the liberty to buy milk and serve it to our children with the knowledge that it is safe. That is the real meaning of freedom -- the right to make rules that create liberty.