Distinctions

This is the latest in my occasional series on critical thinking. In order to have a coherent and meaningful dialogue, and also just to think inside your own head, it is necessary to sort entities into categories. That is to say, we have to agree on the meaning of words. That is not always straightforward. I haven't taken a systematic inventory but it may be that it's seldom straightforward. 

 

Indeed, it can be quite arbitrary. The Supreme Court says you can't execute a person with a measured IQ of 70 or less. Presumably you can execute a person with an IQ of 71, but scores on IQ tests can vary by several points from one test to another. Psychologists generally consider this degree of variation not to be clinically significant but it obviously is significant when somebody, for some purpose, is sorting people into hard categories in which 70 is qualitatively different from 71.

 

The conclusion is that categories often have fuzzy boundaries. We may have no doubt that something is properly inside the category, but there may be other entities that we aren't so sure about. Nevertheless, we must do the best we can to come up with meaningful and reliable definitions, and acknowledge when we're on a fuzzy boundary.

 

So here's a definition of public health from the CDC Foundation:

 

Public health is the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases. Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country or region of the world.

Public health is often distinguished from clinical medicine, which is concerned with the health of specific individuals. However, access to clinical medicine, and effective practice of clinical medicine, are one factor that protects the health of populations, so it is properly a subset of public health. 

 

Note that disease and injury prevention are very largely functions of public policy. While clinical medicine does matter for health, it contributes only a  minority fraction to the health of populations. Clean air and water, good nutrition, physical safety -- including avoiding intentional as well as unintentional injury -- social support, access to open space, all sorts of so-called "social determinants of health" are more important. So homicide is just as much a concern of public health as is air pollution.

These determinants are very strongly affected by public policy, and that means all sorts of policies, not just those that are explicitly labeled as being about public health. We are concerned about everything from food deserts to mass transit to economic opportunity and inequality to automobile safety and gun safety when we study and advocate for the health of populations. 

But public policy is not synonymous with politics. Politics obviously affects public policy because it matters who gets elected and what policies voters support. However, elections are determined by a whole lot of silly factors that aren't related to public policy. In fact most voters have little understanding of policy or how government actions affect their lives. They are swayed by rhetoric and distracted by pseudo-scandals and ridiculous issues like flag lapel pins and proper or improper saluting, and a lot of voter behavior is based simply on tribal identification.

Yes, there are some fuzzy boundaries. I am interested here in policy, not so much in politics, but to the extent they can't be separated some politics will find its way in. But politics for its own sake -- horse race coverage, whether a particular politician is a nice person or somebody I'd like to have a beer with -- that's not so much of interest, nor is simple corruption or malfeasance in office except to the extent it affects public health. (E.g. fossil fuel interests bribing politicians is within scope here.) 

For the record, like the vast majority of Democrats, I would prefer that Andrew Cuomo resign rather than force the NY legislature to remove him, which they will do if necessary. Republicans, for some reason, don't feel the same way about their own politicians who sexually assault women. But there is no particular reason why that should be a main topic here. 

Department of give me a fucking break: The Environmental Protection Agency is generally considered by everybody with one neuron to rub against another to be a public health agency. It's mission is the protection of public health. As for violence, it is a public health problem, and to the extent that law enforcement is capable of reducing violence that is a public health function. Duhhh.