Map of life expectancy at birth from Global Education Project.

Saturday, May 07, 2005

Public Health and Contemporary Politics

Medicine is the discipline that addresses health at the level of the individual. Public health addresses the level of populations. Public health is inextricably entwined with politics. As it is continually concerned with public goods and market externalities, it finds itself in fundamental conflict with free market fundamentalism and conservative views of the proper role of government.

The Congress and presidential administration now in power represent private interests -- oil companies, investment banks, multinational manufacturers and industrial food producers, and weapons manufacturers prominent among them. Public health practitioners and scholars have always found themselves in conflict with such interests, in advocating for environmental and safety regulation, food labeling, and other measures which restrict capitalists in the name of the public good. More subtly, public health advocates, based on scientific proof of the relationship between material deprivation and inequality, and ill health, have tended to be advocates for the social safety net and for investment in human development. And of course, for universal health care.

The association of public health with these sorts of policies goes back to its origins in the late 19th Century. Public health was an essential froce in progressivism and the so-called Age of Reform, helped to energize the New Deal, and was a vital force in the post-war era right up to the Reagan Administration. Public health measures were always resisted by the powerful business interests that stood to lose a few dollars off the bottom line, often with considerable success. The most obvious example is that the insurance and drug companies have successfully blocked universal health care. Environemntal and safety regulations are still far weaker than they ought to be, and we still have children who are ill-nourished, ill-housed, and ill-educated. But we made a lot of progress during the 20th Century. No-one should doubt it.

Now that the obscenely rich are in total control of the federal government, we have been moving steadily backwards. There is no need to start reciting the horrors here. But this is an old struggle, between commanding private interests and the public good. What is most disturbing about the present situation is the introduction of a new conflict, between truth and fantasy, between science and faith. Public health contains a set of social objectives, but just as important, it is a scientific discipline, or rather the cross-disciplinary application of epidemiology, biology and medicine, sociology, psychology and behavioral science, and environmental sciences. Whatever their loyalties and passions, public health practitioners bow to scientific truth.

But the ruling Republican Party rejects truth as a basis for ordering our affairs. We do not decide based on reference to observable reality and logic. We decide based on the interests of our wealthy constituency, and then we declare the science to be whatever supports the chosen policy. This ruling cabal has made a cyncial alliance with religious cultists who reject science and reason on principle, in favor of the superstitious beliefs of pre-literate nomads. Wherever their obsessions are not immediately threatening to the greater enrichment of the plutocracy, the cabal is happy to overrule science in favor of these religious fanatics as well, even at the cost of thousands or millions of lives. Here the global HIV epidemic clearly reveals what is at stake for the future of humanity.

Sorry for such a long post, which really doesn't say anything new. But as we go about our lives we often forget the profound crisis and the stark choices that we face. This is a terribly dangerous moment in our national history.

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