The case against modern public health

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Public health is not healthcare. It is the authoritarian encapsulation of a nebulous concept usually called "wellbeing". Public health assumes that we, as humans, seek wellbeing and that our understanding of the concept is the same as they have determined.

...it is aggressively assertive, pursuing symptomless individuals and telling them what they must do to remain healthy. Occasionally invoking the force of law (immunizations, seat belts), it prescribes and proscribes for both individual patients and the general citizenry of every age and stage. Second, preventive medicine is presumptuous, confident that the interventions it espouses will, on average, do more good than harm to those who accept and adhere to them. Finally, preventive medicine is overbearing, attacking those who question the value of its recommendations.

Worse still this idea of 'preventive medicine' offers a further false prospectus by suggesting to the purseholders of health care systems that by embracing interventionist public health those systems will reduce their costs.

...the report also makes an economic argument for preventive care, highlighting the possibility of reducing healthcare spending -- which in 2011 reached $2.7 trillion, just shy of 18 percent of gross domestic product -- by billions of dollars. And that has health economists shaking their heads.

"Preventive care is more about the right thing to do" because it spares people the misery of illness, said economist Austin Frakt of Boston University. "But it's not plausible to think you can cut healthcare spending through preventive care. This is widely misunderstood."

As that quote indicates this argument is entirely false:

Despite the costs associated with the ageing population, it is sometimes claimed that people who are at risk of premature mortality due to lifestyle factors are a 'drain on the taxpayer'. Smokers, drinkers and the obese, in particular, are blamed for rising costs to the general taxpayer.

These claims do not stand up against evidence. If one looks at the lifetime costs to all public services, it is clear that the 'longevity-related' costs of healthier people are considerably higher than the 'lifestyle-related' costs of less healthy people. Acute healthcare costs are usually higher, long-term healthcare costs are invariably higher, and welfare costs (eg. pensions) are vastly higher.

And this, of course, assumes that the public health or preventative health measures are effective. The sad truth is that many of them - smoking cessation programmes being a good example - are expensive and largely ineffective. Local authorities are funding weight loss clinics - in direct competition with a huge private sector - when, again, the evidence of their effectiveness is pretty limited.

However the main objection to public health programmes isn't their cost or that they don't work, it is rather that their advocates seek to direct your choice - to urge you to eschew pleasure - in the expectation that you will see the benefits in a possibly longer, healthier life. Although the proponents of public health have laid claim to the idea of wellbeing, their approach to its promotion is to remove pleasure and happiness in order to impose an approved and safe form of wellbeing, a sort of dull, dreary '70s Sunday afternoon contentment.

Public health is an ideology of control not a healthcare programme. It dulls the senses of health management by suggesting their inevitable cost pressures will be relieved by patients embracing an approved lifestyle that eliminates the risks contributing to the growing number of people living with chronic conditions like type-2 diabetes. Above all public health represents a crusade to promote a moral and righteous life to the populace - don't smoke, don't drink, don't stay up late, do the right amount of exercise, eat the right diet, avoid salt and sugar. This lifestyle is promoted through the use of public funds to appeal, on one hand, to our fear of mortality through talk of cancer, heart attacks and dementia, while simultaneously suggesting that beautiful, successful people adhere to this stultifying, dull set of consumption behaviours. Across all this runs the argument that, if we want our children to be one or those beautiful, successful people - or even to live - then they mustn't be exposed to these sins of diet or pleasure.

It is hard to think of a section of government that so completely (and for its practitioners unconsciously) embraces the warnings about soft totalitarianism set out by Orwell and Huxley - and especially the latter with his observation that totalitarianism would be a matter of acceptance not something violently imposed by a powerful, all-seeing state. Restrictions on our lives - repeat the mantra of don't smoke, don't drink, eat the right food - are accepted because the experts with their evidence tell us that embracing these restrictions is the right thing. Just as as self-appointed stasi helped enforce the smoking ban, we will see similar as new fussbuckets arise to challenge those who drink openly, who eat sugary or salted foods.

The truth about public health spending is that nearly all of it is wasted, is money spent on promoting an ideology of control. No lives are saved by public health's actions. No money is saved for the wider health system by the interventions of public health. No-one's wellbeing is improve by public health. Indeed for many thousands the actions of these ideologues result in a worse life. Yet in my city of Bradford over £30 million is spend on public health programmes, money that could fix the roads, could provide care for the elderly, could smarten up parks. Instead we'll spend it on nannying the hell out of the population, on promoting an unpleasant controlling ideology founded on a myth of wellbeing that has no basis in fact or substantive value to the poor masses it is being imposed upon.

It's time to stop all this. There is no case for public health as practiced today.

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