Thursday, 21 February 2019

'Public health' and the aura of truth

Not enough is written about the ethics of 'public health' (spoiler: it's unethical) so it is always nice to see a new critique. This article by Ronald W. Dworkin is an absolute belter.

As I argued in Killjoys, the public health movement turned pernicious when it went beyond it's remit of tackling contagious disease and decided to use coercive measures against anything that could conceivably have an effect on an individual's health, including - in fact especially - self-regarding choices made by the individuals. It is now an authoritarian political movement masquerading as a branch of medicine.

Dworkin writes: 

... lack of humility has emboldened public health to insert itself into practically every conceivable public policy debate. Along with its traditional menu of concerns, including sanitation and immunization, the public health field now voices opinions on such issues as gun control, mental health, drug abuse, domestic violence, social justice, gender equality, sustainability, wealth redistribution, children’s day care, and foreign policy.

This is arrogance of the long-sighted kind. Public health activists drape themselves with the scientific method, declaring, “Why should not a method of investigation that has succeeded so well in solving problems in medicine be used to improve people’s well-being in a social, ethical, and political sense?” Because public health has a bona fide link to science, through medicine, which no social scientist can lay claim to, it has transformed itself into science’s emissary to policy debates once thought far removed from science. The fact that almost every life problem spills over into the public realm eventually, while also touching on somebody’s physical or mental health, makes public health’s portfolio potentially limitless. Not even social science claims such a range.

Dworkin considers 'public health' in its modern form to be arrogant, ideological and ultimately ineffective:

Arrogant because public health experts do not watch their science fail on a daily basis. Because they work with large populations rather than with individual cases, public health experts often think with words—for example, the American Public Health Association’s (APHA) goals to “reduce global childhood mortality” and “support global food security.” Goals like these are easy for the thinker with words; the delay between error and the serious consequences of error—a very short timespan for an anesthesiologist—is too long for the public health expert to learn humility or even responsibility. After articulating a principle, the public health expert sees nothing go right or wrong for years, if ever, and so the value of the words can only be judged by their good intentions.

.. Public health is ideological because all ideologies contain an element of hope and aspiration that can only be dampened by contact with reality. An ideology is a big set of ideas, a sweeping philosophy relevant on a large scale and for a long period of time. It thrives by ignoring details; it is so simple in its explanations that a single slogan can sum it up. Individual cases with particular details detract from the smoothness of an ideological system. Because public health experts do not manage individual cases, reality is less likely to quash their ideological enthusiasm.

I could quote much more from this article, but I will leave you with a few one liners and urge you to read the whole thing.

Doctors respect science, and most of what they do is anchored in science; but they will ignore science if the situation demands it.

Because many Americans think science is the last word on the art of thinking, public health’s historical connection gives the field cachet.

Public health activists are clever enough to understand the scientific method, but they are not clever enough to understand its limits.

The scientific method gives them an agility that others lack, but it also gives them the bad habit of believing that all is accomplished when they have indulged in a process of reasoning that has the aura of truth.

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