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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
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