Using a large, U.S. dataset it is shown that children are more likely to receive needed mental health specialty treatment when women have greater decision-making power, as measured by an index of wife-favorable divorce laws and by the sex ratio at the time of marriage. Stratified analyses show that this effect is modified by the degree of marital conflict. Marriages characterized by high conflict conform more closely to the unified household model. The paper then presents a model of household decision-making consistent with these results that incorporates both objective determinants of bargaining power as well as the role of violent coercion in maintaining otherwise unsustainable equilibria. Implications for improving children's access to mental health treatment are offered. © Springer Science+Business Media, LLC 2006.

Policy Points The historical mission of public health is to ensure the conditions in which people can be healthy, and yet the field of public health has been distracted from this mission by an excessive reliance on randomized-control trials, a lack of formal theoretical models, and a fear of politics. The field of population health science has emerged to rigorously address all of these constraints. It deserves ongoing and formal institutional support.

The ethical principle of autonomy is among the most fundamental in ethics, and it is particularly salient for those in public health, who must constantly balance the desire to improve health outcomes by changing behavior with respect for individual freedom. Although there are some areas in which there is a genuine tension between public health and autonomy-childhood vaccine mandates, for example-there are many more areas where not only is there no tension, but public health and autonomy come down to the same thing. These areas of overlap are often rendered invisible by a thin understanding of autonomy. Better integrating newer theoretical insights about autonomy into applied ethics can make discussions of public health ethics more rigorous, incisive, and effective. Even more importantly, bringing modern concepts of autonomy into public health ethics can showcase the many areas in which public health and autonomy have the same goals, face the same threats, and can be mutually advanced by the same kinds of solutions. This article provides a schema for relational autonomy in a public health context and gives concrete examples of how autonomy can be served through public-health interventions. It marshals insights from sociology, psychology, and philosophy to advance a theory of autonomy and coercion that recognizes three potential threats to autonomy: threats to choice sets, threats to knowledge, and threats to preferences.