Monday, 27 October 2014

Health über alles

During the closing overs of the farcical WHO conference in Moscow (COP6) delegates agreed to something called the Moscow Declaration. In keeping with the fog of secrecy that surrounded this covert meeting of unelected tax-spongers, the text of this declaration has not been released, but I've seen a draft. It contains some delusional prohibitionism (eg. "The desired goal of tobacco control measures at the international and national levels is complete victory over tobacco"), but there is also this striking assertion:

The right to enjoyment of the highest attainable standard of health, guaranteed by international law and national legislation of the vast majority of States, takes precedence over any laws related to tobacco use. There is no fundamental right to tobacco use.

Leave aside the question of whether it is really a fundamental right to have ‘the highest attainable standard of health’ in the sense that such a right could ever be asserted in court. Leave aside the fact that in a free society you don’t need a specific right to smoke; if it hasn’t been explicitly forbidden you have the right to do so. Leave aside the fact that this 'right' can, it seems, not be revoked by smokers even though it's their body; the WHO wants to enforce it without their consent. And leave aside the fact that the WHO has no democratic legitimacy and that this quote comes from a meeting held in Russia from which the public and the media were banned.

Instead, look at what is being said here, namely that the supposed right to perfect health takes precedence over democratically decided laws and other written or unwritten rights; that the pursuit of health is the highest priority, trumping all other concerns.

This is obviously untrue. Obvious, because not a single person lives their life as if longevity was the only, or even main, goal. If people wanted to attain the highest standard of health at the expense for all else, they would behave as if they did. They would sacrifice earthly pleasures and there would be no need for a public health movement. The very fact that a public health movement exists is proof that people don’t want it. What is not true for the individual cannot be true for the collective.

Faced with the awkward fact that people are free to live a life of purity but prefer to make trade-offs between health and other goals, the 'public health' lobby has come up with a range of ad hoc explanations which amount to a revival of the concept of false consciousness: that people buy products because they’re too cheap, or advertised too much, or too readily available.

These arguments cannot be supported by empirical evidence, personal experience or logical deduction. In reality, people offset costs against benefits, risk against pleasure, quality of life for longevity. The fatal conceit of the public health movement is it portrays one important, but narrow, goal as if it were the only thing that matters.

Carl Philips explained this very nicely in a blog post that should be read in full:

I recall a conversation with a fellow economics-trained assistant professor of public health. I forget the specific trigger for our observation, but it came after a meeting of faculty, when we both realized that we were surrounded by idiots. The issue was public-health-based policy recommendations and their absurd implicit objective function. Our observation was that in economics we often lean on the convenient myth that people’s goal is to maximize their lifecycle welfare, and that social policies should be based on that. It is easy to demonstrate that this is an oversimplification of behavior, and to argue from an ethical standpoint that there should be some departures from this in policy. But at least our simplified fiction is basically sound, both practically and ethically: Trying to maximize their welfare is roughly what people do, and there is an obviously defensible case to be made that trying to assist with such maximization is an important ethical goal — if not the ethical goal — of public policy.

We observed how sharply this contrasted with the implicit objective function in almost every public health policy discussion, which is basically “maximize longevity at any expense, and everything else be damned.” The economists who study medical care at least interject into this the caveat that some financial expenditures are too much to pay for the tiny bit of extra longevity they provide. But to the public health people, all other costs and benefits are trumped by the one objective. Economists’ objective function, we agreed, was not quite right, but at least it was generally defensible. The public health view, on the other hand, was utterly absurd. No one wants to live their life according to such an objective. Not even close. And therefore there is no possible way to justify it as an ethical goal for public policy.

The core belief behind 'public health' movement, as it is today, is so ridiculous that it can never be said out loud. Even the Moscow Declaration only hints at it.

As Carl points out in his post, the public healthists are not always consistent with their 'health über alles' mentality. They do not recommend that women have as many children as they can from a young age to reduce their risk of breast cancer, despite childlessness being a risk factor. They will not tell teetotallers to start drinking, despite teetotallism being a risk factor for heart disease. With some exceptions, they won’t support the use of e-cigarettes. But this only demonstrates how many moral zealots work in public health industry.

The public health industry is not a single entity. It is partly made up of those who have a connection with the medical establishment but who have taken the whole thing too far by ignoring trade-offs between longevity and other goals. And it is partly made up of moral entrepreneurs, puritans, and other single-issue cranks who, in the absence of a 'public health' movement to latch on to, would be campaigning under a placard outside some town hall or other.

It is hardly surprising that old school fanatics have been drawn to a movement that has more credibility and—crucially—more money than the impecunious moral reform groups of earlier eras. Once the public health lobby decided that a single objective trumps all other concerns, they became fanatics by definition and other fanatics were drawn in like moths to a headlight.


JohnB said...

The public health industry is not a single entity. It is partly made up of those who have a connection with the medical establishment but who have taken the whole thing too far by ignoring trade-offs between longevity and other goals.

They don’t just have a connection. “Public Health” is entirely monopolized by the medical model. The World Health Organization is a medical organization. And once again the medically-aligned have perversely reduced “health” to only a biological, absence-of-disease phenomenon. It’s this perverse definition that was at the heart of eugenics early last century.

JohnB said...

The root of the problem

The problem lies in what is understood by “health”.

Consider the World Health Organization’s definition of health instituted in 1948:
The World Health Organization (WHO) defines health in its preamble as "a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being." [This definition used to appear on the WHO home page. At some time over the last few years it’s disappeared from this high visibility position]

Notwithstanding a few questionable concepts such as “complete”, we can be sure that this definition was a direct result of the horrors of Nazi eugenics. Whatever was directed at Nazi eugenics was also directed at American eugenics. Eugenics is biologically reductionist (materialist/physicalist) or, as noted by the Nazis, “applied biology”. The WHO definition attempts to account for the fact that health is more that just absence of disease, more than just a biological phenomenon. It involves other dimensions such as psychological and social.

Given that this WHO definition was put into circulation by Brock Chisholm, the first director of the WHO and a eugenicist, there is always a suspicion as to how the WHO, a medical organization, could potentially warp this definition in the long-term. It could have been an “appeasing” definition, given the anti-eugenics sentiment of the time. (From my understanding, the “mental” and “social” well-being aspects were a last-minute inclusion).

However, what should be noted is the limited scope of the WHO. It does not have a monopoly on health. Being a medical organization, it is intimately bound to the biological level. It is not really a world health organization but a world medical organization – a global medical headquarters. It would have to accept that there are aspects of health that are not its domain or jurisdiction. Just this idea, properly applied, should discourage potentially destructive ventures into social engineering as was seen in eugenics early last century. The same can be said of government, that there are aspects of health that are none of its business. In relatively free societies persons are free to pursue happiness/health along variable combinations of the dimensions of health where the pursuit does not infringe on others. For example, a person who smokes derives some utility from the act, and they continue to smoke in a particular set of priorities (cost/benefit) along these multi dimensions that vary from person to person.

JohnB said...

Yet with all this history, as we have seen over the last half century, particularly pertaining to antismoking, the WHO and the medical establishment generally, and contrary to the WHO’s very own definition of health, have deteriorated back into a biological reductionist view of health and ventures into social engineering.

Over the last half century, health has been reduced to biology with an emphasis on the behavioral dimension of eugenics – anti-tobacco, anti-alcohol, prescribed diet, and physical exercise. The WHO adopted antismoking as a societal ideal many decades ago (Godber Blueprint) and now most nations are signed-up to the WHO Framework Convention on Tobacco Control. With this ideological stance comes social engineering, i.e., coercion to conformity.

Anyone that truly grasped the multi-dimensional definition of health above would not even contemplate, let alone enact, the idea of “denormalizing”/demonizing a group, this being an assault on psychological and social health (with physical health ramifications). But physicalists have no such grasp. And it’s physicalists that have set the current “healthist” craze in motion. The very conduct that the WHO definition of health was supposed to guard against has again been unleashed by the very promoters of the definition. The circumstance is utterly perverse.

We have seen smoking bans on hospital grounds where patients have to venture considerable distances in night-attire and in all manner of weather to have a cigarette. This becomes a psychological and social health issue, in addition to the physical health issue. Indoor smoking bans with no prospect of accommodation have alienated particularly the elderly. This is a psychological and social health issue. Denormalization, a repugnant, vulgar concept very much identified with eugenics, has again come to the fore. Smokers have been incessantly slandered, ridiculed, and terrorized by official, government programs of denormalization, i.e., hate campaign. This is a psychological and social health issue. Robbing smokers through compounded extortionate taxes, further impoverishing them and imposed under false pretenses, is a multi-dimensional health issue. Many nonsmokers have been manipulated into irrational fear and bigotry to advance the ideological cause. This is an issue of psychological and social health. Smokers are being bullied out of normal social life on a purely ideological basis. This is an issue of psychological and social health. With this propaganda barrage, medical care professionals are demonstrating a cruel, bigoted streak – again - that can compromise the medical treatment of those who smoke. This is an issue of psychological, social, and physical health. Not only are psychological and social health issues important in their own right, but these can also have detrimental ramifications for physical health. Health has again been reduced to incoherent quantification, dollar cost-benefit analyses, another eugenics trait. All of these detrimental consequences inflicted by ideology under medical authority is iatrogenic.

Everywhere we turn health has again been perversely reduced to only a biological phenomenon (e.g., behavioral) and with the [eugenics] intent of social engineering. Public Health has been hijacked by the “medical model”. Once again the medically-aligned have monopolized health. It is now commonplace to hear that draconian measures that invade personal autonomy have been instituted for a “healthier society” according to physicalism. “Get healthy”, “he’s looking after himself”, “I work out” all pertain to physicalism. In the obsession with the physical state, psychological, social, moral, and ideo-political aspects of health have been brutalized and discarded - again. And it is the WHO that leads this assault.

JohnB said...

Medicine does not have a monopoly on health – this was supposed to be the lesson learned from early last century. It’s obvious from the global antismoking hysteria that’s been produced by this organization that its bureaucrats are clueless as to psychological and social health. The organization should be renamed the World Medical Organization and fully cognizant of the severe limitations of the medical model.

Also problematic are Public Health courses, e.g., Master of Public Health. University Public Health Departments around the developed world are run under the auspices of Medical Faculties. This, too, is inviting disaster. What is taught in PH courses is dominated by physicalism and the “medical model”. It should come as no surprise that psychological and social dimensions have been jettisoned, with health again reduced to biology and disease fixation. Public Health Departments need to be removed from Medical Faculties and operate as multi-dimensional, stand-alone entities and where their major interest is keeping fanatics/zealots at bay.

And, so, we’re right back to the perverse definition of health (biological reductionism) that was prevalent in the “healthy living” hysteria (eugenics) of a century ago with nothing of value learned, a situation that the WHO definition of health (1948) was supposed to guard against.

The WHO definition of health somewhere on its website:

Cheapside said...

You say: "... if it hasn’t been explicitly forbidden you have the right to do so."

If only.

"Everything which is not forbidden is allowed" is true under (pre-EU) English law. It meant that freedom comprised an infinitesimal number of permissible acts and was fettered by only a handful of prohibitions which the people allowed the Crown to enforce as part of its very restricted mandate.

Over there, it was the other way around. Under Napoleonic law, the emperor was the overlord and owner of all of his subjects’ deeds – as well as their words and thoughts – and those subjects were not allowed to do anything without his express permission.

In other words, in Eurolandia "everything which is not permitted is forbidden".

And as Eurolaw has proven so effective in respectably neutering the ancient tenets of freedom in the Old World, it is the default preference for un-elected statists of the supra-national quangocracy.

And by those standards, it is perfectly logical to assert that there is no right to smoke unless and until the imperial government deems to grant such a right to its charges.

This haunting spectre of despotism is spookier than any demon spirited back to life on All Hallows’ Eve…

Christopher Snowdon said...

"In a free society..."

Cheapside said...

(humbly nods)