Anthony Downs once observed (The Public Interest, 1972) that our most intractable public problems have two significant characteristics. First, they occur to a relative minority of our population (even though that minority may number millions of people). Second, they result in significant part from arrangements that are providing substantial benefits or advantages to a majority or to a powerful minority of citizens. Thus solving or minimizing these problems requires painful losses, the restructuring of society and the acceptance of new burdens by the most powerful and the most numerous on behalf of the least powerful or the least numerous.
As Downs notes, this bleak reality has resulted in recent years in cycles of public attention to such problems as poverty, racial discrimination, poor housing, unemployment or the abandonment of the aged. Thus, the attention and interest for remedying the problems rapidly wane when solving these problems requires painful costs that the dominant interests in society are unwilling to pay.
Our public ethics do not seem to fit our public problems. These are the politics of social justice for advancing health together.
The poor, the unemployed, and the underpaid not only face stiff barriers to policies relieving their condition; they can't even get into the doors of Congress to make vivid their plight.
[i] Anthony Downs,. "The Issue‑Attention Cycle and The Ecology Issue,” The Public Interest, 1972.