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The Pox of Liberty

How the Constitution Left Americans Rich, Free, and Prone to Infection

The United States is among the wealthiest nations in the world. But that wealth hasn’t translated to a higher life expectancy, an area where the United States still ranks thirty-eighth—behind Cuba, Chile, Costa Rica, and Greece, among many others. Some fault the absence of universal health care or the persistence of social inequalities. Others blame unhealthy lifestyles. But these emphases on present-day behaviors and policies miss a much more fundamental determinant of societal health: the state.

Werner Troesken looks at the history of the United States with a focus on three diseases—smallpox, typhoid fever, and yellow fever—to show how constitutional rules and provisions that promoted individual liberty and economic prosperity also influenced, for good and for bad, the country’s ability to eradicate infectious disease. Ranging from federalism under the Commerce Clause to the Contract Clause and the Fourteenth Amendment, Troesken argues persuasively that many institutions intended to promote desirable political or economic outcomes also hindered the provision of public health. We are unhealthy, in other words, at least in part because our political and legal institutions function well. Offering a compelling new perspective, The Pox of Liberty challenges many traditional claims that infectious diseases are inexorable forces in human history, beyond the control of individual actors or the state, revealing them instead to be the result of public and private choices.

256 pages | 28 halftones, 7 tables | 6 x 9 | © 2015

Markets and Governments in Economic History

Economics and Business: Economics--History, Health Economics


"This excellent book provides a deep and subtle critique of the idea that when it comes to economic development, all good things go together. Troesken neatly separates and contrasts the public requirements for debate on individual liberties and rights that is an inherent part of a healthy democratic society, with the coordinated action necessary to address collective problems, where the actions of one individual affects the circumstances of another. The two are not always in line, as the recent difficulties with vaccinations for children makes clear. An insightful and timely book."

John Joseph Wallis, University of Maryland

“Troesken’s The Pox of Liberty fits into the broader category of works by Jared Diamond, David Landes, and Daron Acemoglu and James Robinson, as well as others who attempt to understand the relationship between disease, institutions, and economic outcomes. What I like about Troesken’s book—and what I think fills a significant gap—is that instead of coming up with a singular story, he recognizes and elucidates with clear and careful prose the subtleties that exist in a complex relationship.”

Melissa Thomasson, Miami University

“Unquestionably an important piece of work. With The Pox of Liberty, Troesken successfully ties episodes in America’s public health history to its legal history and makes many interesting points about the impact of the legal system on public health. The book will appeal to a wide range of scholars with a historical bent.”

Louis Cain, Loyola University Chicago and Northwestern University

"The Pox of Liberty is the product of a daring, eclectic, and challenging mind. Troesken’s admirably interdisciplinary analysis and graceful prose will speak compellingly to a variety of audiences: economists, historians, political scientists, sociologists, legal scholars, and public health policy makers. Above all, he asks: Could it be that democracy and constitutionalism actually promote disease? Troesken’s powerful argument that Americans can’t necessarily have both the liberty and the public health that they desire and expect is an intriguing and important intervention."

Robert D. Johnston, editor of The Politics of Healing

“A fascinating and insightful volume that provides balanced, highly readable analysis about the relationship among the US Constitution, American ideological beliefs about the nature and scope of individual liberty, and sociopolitical public health efforts to eradicate various diseases throughout the history of the country. . . . Troesken convincingly achieves his goal of demonstrating that constitutional interpretation is a very useful lens through which to examine governmental policies that addressed diseases like smallpox and yellow fever.  Overall, The Pox of Liberty is an engaging and educational read. Highly recommended.”


"The book continually challenges us to rethink the simple story that poverty equals disease and ill-health. It presents a much more complicated and nuanced view where institutions matter and there are trade-offs everywhere.... Too often when I talk to policymakers, they seem to think that one problem can be fixed without creating other problems elsewhere. This book is a great example of the very real and very complicated trade-offs that exist everywhere in policy."

Economic Record

Table of Contents

Chapter 1. An Introduction
Chapter 2. From the Ideology of the Township to the Gospel of Germs
Chapter 3. The Constitutional Foundations of Health and Prosperity
Chapter 4. The Pox of Liberty
Chapter 5. The Palliative Effects of Property Rights
Chapter 6. Empire, Federalism, and the Surprising Fall of Yellow Fever
Chapter 7. Concluding Remarks


Economic History Association: Alice Hanson Jones Prize
Honorable Mention

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