Sunday 17 January 2016

The case against modern public health


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. 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.



Unknown said...

Hallelujah ! Thank you for a very insightful post. I have been banging on for an age about the cult of the expert and am so happy to find I am not alone in my fear and loathing.

As usual, in my view, the media are massively implicated in this problem. I realise that, from the point of view of the average journo, anybody that knows anything at all probably seems like an expert... I always find journalists to be almost preternaturally lacking in knowledge of anything at all useful. Watch any news bulletin and you will observe that people who might properly be described as specialists are feted as experts, even when the topic at hand is, to anyone with any degree of knowledge of the subject matter, quite clearly not susceptible to the existence of expertise. And once a journo has bought the story of the expert they tend to be attached to it come what may. Even when the pseudo-science has moved on these sad creatures hang onto the faux-knowedge they think they have gained and keep pushing it come what may.

The real problem, though, is the centralisation of power and authority in the current 'big government' administrations that are now the western world's reality. In each subject area the government typically relies on a single, supposedly expert, authority to give guidance on subject matter that requires expertise. This means that those who would impose an agenda, be it ideological, commercial or whatever, only need to capture control of the relevant authority to drive their agenda forward. This has clearly already happened in public health and medical spheres and I'm sure has happened and is happening right now in other areas. Where there is regulation there is potential for gaining advantage from control of that regulation.

We need smaller government, now!

Kin_Free said...

On the button!!

nisakiman said...

I have for several years now adopted the attitude that any report where the nitty-gritty is preceded by the phrase "Experts have said" is almost certain to be exaggerated hyperbole in support of someone's agenda.

I agree, 'Public Health' should confine itself to making sure the water supplies are not contaminated, that the sewerage system works properly, and to be ready to deal with any outbreaks of contagious disease. It is certainly not within their remit to issue diktats on lifestyle choices. Yet we have organisations like the WHO (the big daddy of 'Public Health'), who when the Ebola epidemic was raging in Africa gave priority to necking champagne and caviar at a conference in Moscow to discuss how they could further persecute smokers.

They are completely out of control, and need to be reined in sharply.

Unknown said...

The Ebola drug was made from the tobacco plant in owensboro ky.that's what saved those 2drs. ZMAP

Chris Oakley said...

Well said Simon.