摘要：Personal freedoms have been characterized as “positive” (freedom to pursue opportunities) and “negative” (freedom from external constraints on decision making). An ecological analysis of US data revealed a strong positive association ( r = 0.41; P = .003) between state-level negative personal freedom (defined in terms of regulation of personal behavior) and state-level age-adjusted rates of unintentional injury. A conceptual emphasis on positive freedom construed as freedom to pursue a life without risk of unintentional injury could help motivate a conversation to improve public health. In the United States, state governments influence people's lives largely through the nature and extent of freedoms that they offer to their residents. For decades, there have been 2 major competing political definitions of freedom: “positive” and “negative.” 1 , 2 Negative freedom is characterized by the absence of external constraints on personal decision making, and positive freedom is portrayed as the exposure to conditions necessary to pursue desired opportunities. In terms of the current health care financing debate, a system in which the government removes itself completely from the provision of health care so that individuals are permitted to do whatever they deem to be important for themselves without interference would exemplify negative freedom; providing a public option to ensure that all individuals receive a minimum standard of health care is an example of a government enabling positive freedom. There has been far greater emphasis on the negative view of freedom than on the positive view. A recent report measuring states across different aspects of freedom primarily based its measurements on the extent of existing negative freedoms, with states having the fewest and least intrusive regulations considered to be the freest. 3 The report defines “personal freedom” as the absence of state policies proscribing individual behaviors, exemplifying the concept of negative freedom, and it characterizes personal freedom as an inherently good quality that is the opposite of “paternalism.” Although paternalism carries the connotation of an authority that dictates overbearing rules, it also suggests a philosophy of protection that could give individuals the security necessary to pursue important goals—an example of positive freedom. We conducted this study to assess the relation between negative personal freedom and death from unintentional injury in the United States.
