Map of life expectancy at birth from Global Education Project.

Monday, January 10, 2005

Stayin' Alive

I wanted to say a couple of things about this blog.

First, and most important, I am so impressed and gratified by the comments. I hope that every visitor will read them, the commenters say so many things better than I can. And I also hope more people will begin to participate in the conversation.

One of the main reasons I started this project was because I, and others, would frequently post diaries on Daily Kos about public health and health care policy, and they never seemed to get enough recommendations to stay around. People there are mostly interested in other important issues -- and I agree that we face a crisis of democracy in the U.S. But I am convinced that the public health perspective is the most effective way to talk about issues of justice, equity and the future quality of life for Americans and for the world, and that if we really want to build an effective progressive movement, we have to emphasize the problems we talk about here and we have to organize around them.

Some of the commenters have already started to say all that. So let's continue that discussion -- about political strategy as well as policy and ethics.

At the same time, I do plan to continue to talk about the micro-level -- the culture of the medical institution, how doctors relate to patients, how people can advocate for themselves and the people they care about effectively. To some extent, these are all shaped by the political and institutional context, but there is also an irreducible importance to culture which can't be addressed through politics. Outlawing racial discrimination didn't eliminate racism, and giving women equal legal rights didn't eliminate sexism. The health care system, no matter what we do to eliminate financial barriers, mandate that people be treated fairly, and emphasize wellness, is still going to be hierarchical, paternalistic, culturally inaccessible, incomprehensible and frequently inhumane if we can't reform the culture of medicine.

As for public health, that is really a way of talking about the common good -- about a society that is right for human beings: a society that is just, humane, and meets people's needs, not just their material needs but their emotional and yes, spiritual needs. (And I am an atheist who has no problem talking about spirituality.) So we have a broad enough scope here, I think.

Finally, I want to address my using a pseudonym. Like most people in my business, I depend heavily on federal funding. I could just say that anyone who isn't paranoid right now must be nuts, but in fact I have been given very specific instructions by federal employees (friendly ones) about things I mustn't say. For example, I am not allowed to advocate for needle exchange. I am very strongly in favor of needle exchange -- and the harm reduction philosophy in general, "harm reduction" also being a phrase I am not permitted to use -- and many other enlightened approaches to public health which the "Christian" thought police in HHS are working to purge from legitimate discourse. Consequently, I felt it would be a courtesy to my employer, and would assure that I never had to hestitate about speaking my mind, if I distanced my identity here from my regular professional identity.

My secret identity is no secret, however. It's easy to track me down, if you want to. And in the appropriate forums, and using the appropriate professional language, I will say exactly what I have to say under my own name, as I have been doing. I just want to keep this space with a little extra freedom, at least for now.

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