Thinking big

Our friend Ana from the land of holey cheese and tax evasion reminds me that I have been getting maybe a bit healthcare-ocentric here and may have wandered a bit from the public health beat. Fair enough. Perhaps one reason is simply frustration with the immense depth of our problems, and their apparent intractability in the current political climate.

I like to say that public health means any thinking or doing about health at the level of populations, rather than individuals. But as Rayner and Lang point out in this big picture essay (not sure it's open access, I have a magic cookie on my 'puter that gets me into most medical journals), even public health has tended to collapse into a cramped focus on individuals in the 20th Century.

In its early days, the field was largely about the physical environment, notably urban sanitation. Public health brought us sanitary sewers, clean drinking water, trash pickup, milk pasteurization, and later more extensive food quality standards, controls on air pollution, regulation of pesticides, workplace safety, all that good stuff. It had a huge impact on health and longevity, and by the way healthier people also became richer people.

Nowadays these problems are most acute in poor countries, and there is a powerful movement here in the U.S. to undo some of these regulations and neglect the public health infrastructure. You don't know what you've got till it's gone. Much emphasis here is on biomedical and social-behavioral models of public health, i.e. improving preventive medicine and trying to influence people's health related behaviors. Viz. Michelle Obama trying to get us to eat a healthier diet and exercise more. Obesity is indeed our most rapidly growing and urgent public health problem but . . .

It is not the case that obesity is explained by a sudden epidemic of individual irresponsibility, nor that the solution lies in convincing people to eat less. Obesity is, as today's featured essayists argue, an ecological problem, specifically a product of the social environment. Immensely powerful and completely amoral corporations spend more money on marketing junk food than the entire budget of  the World Health Organization, CDC, and state health departments put together. People do sedentary work, they live in neighborhoods where you can't walk to the store or work or anywhere else even if  it safe to do so, and they depend on processed and prepared foods because they don't have the time or personal social infrastructure to operate a quality kitchen.

All of our most critical problems are of this nature -- climate change, resource depletion, inequality, all contribute to poor health. And the solution to all of them requires truly radical changes in society, not campaigns about individual choices. By all means by more energy efficient light bulbs and fuel efficient cars, but that's not going to get it done. The fundamental organization of society, in which for-profit corporations acting in the interests of their wealthy executives, dominate politics, public discourse, and the economy, is fatally diseased.

What we don't have right now is a well-defined alternative vision. What would a post-corporatist, humane world look like?