The Voice of Epidemiology

    
    


    Web EpiMonitor

► Home ► About ► News ► Job Bank Events ► Resources ► Contact
Articles Briefs People Blog Books Forum Quote of the Week Reprint of the Month
   

Epidemiology and Public Health Heavily Criticized By Essayists
 

Is public health a disease? This is the assertion of the headline writers at the online British magazine Spike. The magazine is publishing a provocative set of essays examining paternalism and attacking epidemiology and public health for the role they are playing in helping government to intervene in what is considered the private lives of citizens.

Useful Glimpse

Given the libertarian leanings of the magazine as expressed in their profile, it’s not surprising that the articles would seek to make the case for individual freedom and for a light-hand of government in regulating human affairs. That said, the articles by Sean Collins, a US based writer, taglined “Today’s nudging elites pose a threat to our everyday freedoms”, and by Christopher Snowdon, a British book  author, taglined “We  are in the midst of an epidemic of lifestyle moralism” give a useful glimpse into the thinking of persons who do not share some of the underlying values which are at the heart of epidemiology and public health.

Nudging People

According to Collins, the publication in 2008 of the book “Nudge: Improving Decisions About Health, Wealth, and Happiness” has set off a concerted effort by governments both in the US and in Europe to engineer environments and structure decisions so that the average person makes the “right” choices when it comes to diet and other lifestyle matters such as carrot sticks over French fries.

Collins in his essay is upset about the covert nature of these activities even though they do not actually force people to make certain choices. The driver of  paternalism according to the article is the concept that individuals consistently fail to do what is best for them and therefore the intervention of government to make the right choice easier is justified. Collins views these interventions as a change from government working for us to government working on us, and “is an assault on the idea of people as rational subjects.”

Good Decisions Hard To Make

Poor decision making is a major point of contention since behind the nudge movement are new findings which reveal that people have inherent biases and other natural flaws in making decisions and cannot be counted on to do the “right thing” for a variety of reasons. Collins continues to believe in the capacity of individuals to overcome these tendencies . In his view, the elites of today are simply too pessimistic about people in general. The fear is that once government intervention proceeds along these lines for health reasons, it will not take long for these authoritarian tendencies to extend to other aspects of life besides health. 

Attack on Public Health

The arguments made by Snowdon are of a different sort and more directly target public health. According to Snowdon, the meaning of public health has gradually expanded over the years from protection against contagion to become increasingly concerned with private behavior or private property. Many problems today such as climate change are now presented as a “public health issue”. This phrase has been applied to bullying, unemployment, and other public concerns recently. According to Snowdon, this is a slippery slope and he says  “the endlessly accommodating field of ‘public health’ is a magnet for unelectable social scientists and moral entrepreneurs.” He labels ‘public health’ as “lifestyle regulation”

Problem Magnitude

Snowdon attacks the practice used by epidemiologists of identifying low level risks and multiplying them by population figures to estimate the magnitude of problems. He calls this a “sleight of hand” and states “issues which are of minimal concern to individuals cannot magically become pressing concerns for society by multiplication.”

In even more strident terms, Snowdon says the general public “puts little faith in epidemiological trash. They know that chocolate will be said to cause cancer today and will be said to cure cancer tomorrow.”

Who Decides Risk/Benefit?

Snowdon resists societal judgments about risk. For example, he asks “Is a greater mortality risk a price worth paying for a lifetime’s smoking? Who is to draw the line? Adds Snowdon, “The mandarins of ‘public health’ would draw it as near to zero as is politically feasible, but in an enlightened society the judgment can only be made by the one person who bears all the risk and enjoys all the benefits: the individual.” He ends by saying it is time to “denormalise the demagogues of ‘public health’”

The articles have drawn several comments by the magazine readers. To access the Collins article, visit:

http://tinyurl.com/mc9dpe5


To read the Snowdon article, visit:

http://tinyurl.com/l528awm


Reader Comments:
Have a thought or comment on this story ?  Fill out the information below and we'll post it on this page once it's been reviewed by our editors.
 

       
  Name:        Phone:   
  Email:         
  Comment: 
                 
 
       

           


 

 
 
 
      ©  2011 The Epidemiology Monitor

Privacy  Terms of Use  Sitemap

Digital Smart Tools, LLC