Dissertation Title："Contested Boundaries: Evaluating Institutional and Government Authority in Academia and Public Health"

This dissertation explores tensions between individual freedom and institutional authority.

Chapter one examines public perceptions of the legitimacy of "new frontier" public health measures. I present results from a national survey of 1,817 adults concerning the acceptability of public health interventions for noncommunicable diseases. We found that support for these interventions is high overall; strongly associated with race and political orientation; and tied to perceptions of democratic representation in policy making. There was much support for strategies that enable people to exercise healthful choices, but considerably less for more coercive measures. These findings suggest that the least coercive path will be the smoothest. Additionally, the findings underscore the need for policy makers to involve the public in decision making, understand the public's values, and communicate how policy decisions reflect this understanding.

Chapter two provides a normative analysis of the legitimacy of public health efforts to address noncommunicable disease. I argue that we should move away from the harm principle as the basis for assessing the legitimacy of public health measures, and introduce John Rawls's legitimacy principle as an alternative framework by which to assess the state's moral authority to enact these new measures. I suggest that the legitimacy principle better frames the relevant liberty interests at issue in questions of public health policy, and may offer a more robust protection for individual liberty than does the Millian harm principle.

Chapter three examines institutional approaches to the oversight of faculty-industry consulting relationships within academic medical centers. I report on a Delphi study to elicit medical school administrators' views about the oversight of such relationships. We found strong support for two oversight strategies: providing educational resources to faculty regarding consulting relationships with industry, and policies that would bring consulting agreements under institutional review. Finally, respondents opposed the use of categorical prohibitions on consulting relationships with specific industries, recommending instead that agreements be evaluated based upon the specific activities of the relationship rather than upon the type of industry. We conclude with specific recommendations for medical schools for the management of faculty-industry consulting relationships.