Friday 2 February 2018

Public health versus 'public health'

Regular readers will know that I put the term 'public health' in speech marks when referring to the morally bankrupt crusade for lifestyle regulation that has co-opted the name.

I explained the distinction between public health and 'public health' in Killjoys:

The case for government action on public health issues is strongest when there is a threat to health that can only be countered by collective action. Collective action does not necessarily mean government action, but if the term ‘public health’ meant anything in Mill’s day, it meant tackling health risks in the shared environment which cannot be controlled by the individual, such as air pollution, or those involving people (or animals) who carry infectious diseases. Factories pumping coal smoke into a congested city and travellers coming home with Ebola pose a clear risk of unavoidable harm to others and are therefore a potential justification for coercion under the harm principle. It is not the scale of the risk nor the number of people affected that turns a health problem into a public health problem. It is the lack of consent from those who are put at risk and their inability to reduce the risk without collective action.

Since the 1970s, however, the scope of public health action has moved beyond hygiene and contagious disease to target self-regarding personal behaviour. As Richard A. Epstein explains, the modern ‘public health’ movement ‘treats any health issue as one of public health so long as it affects large numbers of individuals’. This has led to a focus on personal habits which are risk factors for non-communicable diseases, such as heart disease, diabetes and cancer. ‘Our public health problems are not, strictly speaking, public health questions at all’, write Gostin and Gostin. ‘They are questions of individual lifestyle’. In this view, ‘public health’ is the aggregated private health outcomes of the nation, and prevention involves modifying any factors that influence them. 

There is no shortage of genuine public health problems in the world, but 'public health' campaigners are not interested in them. Even if they were, the sociologists and psychologists of the 'public health' lobby don't have the medical knowledge to deal with diseases like AIDS, tuberculosis and malaria. Real public health problems do not respond to the advertising bans and price hikes.

Fortunately, there are organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria which are devoted to stopping poor people dying from contagious diseases. The Global Fund gets  most of its money from national governments but it also takes donations from foundations, individuals and businesses.

One of these businesses is Heineken, and the 'public health' lobby is not happy about it.

Health campaigners decry global HIV fund's deal with Heineken 

International health campaigners and alcohol concern groups called on a major global HIV and malaria fund on Thursday to end immediately a partnership it had signed with the Dutch brewer Heineken.

In an open letter to the director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, an alliance of more than 2,000 health organizations voiced “deep concern” and said the deal would only help Heineken broaden its marketing reach.

“Transnational corporations producing and aggressively marketing alcohol rely on the harmful use of alcohol for their sales and profits,” the letter said.

That is a lie, of course. Alcohol companies would make sales and profits if everybody drank responsibility.

It accused companies such as Heineken of undermining and subverting evidence-based alcohol policy implementation “at the same time as they expand distribution networks and marketing to grow their market in low-and middle-income countries”.

Alas, there was no room in the letter for them to give examples of Heineken 'undermining and subverting evidence-based alcohol policy'. Perhaps they had Mark Petticrew's weird theories in mind?

If these people knew anything about the alcohol market in low income countries - and if they cared about people's health - they would welcome the expansion of 'distribution networks' for high quality, regulated drinks companies. In Africa and India, in particular, the market is dominated by moonshine, counterfeit alcohol and surrogate alcohol which regularly cause acute death. If people in these countries could access and afford a few bottles of Heineken, it would be a great improvement (unless you think that Heineken making more 'sales and profits' is a Bad Thing per se).

In any case, Heineken's donation to the Global Fund is going to have no effect on its distribution and marketing. It will be used to tackle AIDS, tuberculosis and malaria. The anti-drink lobby simply wants to turn companies like Heineken into pariahs for political reasons and will use any excuse that comes to hand.

When SABMiller made a donation to the same organisation in 2012, the imbecile Anna Gilmore and the sociologist Gary Fooks resorted to mental gymnastics as they groped around for reasons to oppose it:

In the current example involving SABMiller, the world’s second largest brewer by sales volume, a conflict of interest arises because of well-established links between alcohol use, violence (including sexual violence) and risky sexual behaviour, making alcohol a risk factor in the spread of HIV infection. Reducing alcohol use can therefore be seen as key to reducing HIV infection. Yet this inevitably conflicts with SABMiller’s underlying goal of maximizing profits from alcohol sales.

Imagine spending an hour inside these people's heads.

It is hard to think of a better illustration of the contrast between public health and 'public health'. On one hand, there are health workers trying to raise money to help prevent people dying from infectious diseases in the poorest countries in the world. On the other hand, we have social scientists in rich countries trying to stop this money being spent because it offends their idea of ideological purity. They really don't care how many people suffer for their dogma.

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