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.

Share

Tweet