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.