Public Health / Individual Health

For a few years now I’ve been thinking really seriously about the future of public health. Particularly about what strategies might be both useful and reasonable in helping to bring about a ‘more healthy’ population. One thing that is hard to get past in these thoughts is what exactly would a ‘more healthy’ population be? I think in previous decades the answers to these questions have been quite apparent, via science, even if industry worked hard to avoid the realities. So things like reducing smoking and vilifying drunk driving have been clear wins for public health campaigns, as the State became cognisant of its role in protecting its citizens.

But thinking about the ‘now’ now is always much more difficult than hindsight. Now, people commenting in the popular press focus on the things that are most easy to quantify – almost always using ‘obesity’ as a proxy for unhealthy for instance and focusing specifically on diet and exercise as the mainstays of future public health policy direction. Here the commenters attempt to leverage individual health behaviours and extrapolate these to public health strategies.There is a good example of this here in the NZ Herald, from Niki Bezzant. Entitled ‘You can’t run off a bad diet’ the article’s main premise revolves around the public health campaign to ‘combat obesity’ and is generally an attack on the non-interventional strategy of this government towards things like taxing sugar (which I have written about with the economist Dr Bill Kaye-Blake here) and fat. Overall I completely agree with Niki Bezzant that our government is not working hard enough with regard to public health, but I do not agree with her conclusion:

So as with our national strategy, our personal strategy needs to include changes to diet and exercise.

You may be thinking: Huh? What planet are you on Andrew? – this statement is so darn reasonable, of course it is right! But I would urge you to think a little deeper here, the reasoning that Niki Bezzant (and most others to be fair) are using here is that ‘the public’ is made up of a collection of individuals. Thus the start point is targeting individual behaviour change as opposed to thinking about ‘the public’ as an entity in its own right, a level of analysis all on its own. So what are the effects of this line of reasoning? One that Bill Kaye-Blake and I drew out (here again) is that any State tax on sugary drinks would likely to measured in terms of success by its change (or not) on Body Mass Index, rather than say its impact on dental decay in kids or type 2 diabetes rates across the population. We argued that this is fantasy, not illness and is one impact of measuring individual behaviour change not population level trends. The tendency to lean on individual change as the answer takes us as a society away from the requirement of the State to provide the conditions for health.

This brings us to a difficult point – what can we do differently that doesn’t fall immediately into the trap of individualism that the neoliberal State promotes? Well as it happens Dr Anastasia Boulais and I are going to present a possibility at the Social Movements, Resistance and Social Change II Conference in Auckland September 2-4. Our presentation titled ‘Towards an ancestral public health: Exploring the interstices between science, knowledge and truth in public health nutritionism’ will paint a picture of an alternative public health, one that respects the rights of citizens to health from birth. This presentation will be expanded on in a range of areas by Anastasia and I and a whole variety of International and local speakers at the Ancestral Health Society Conference ‘Looking Back, Moving Forward’ in Queenstown 23-25th October. We warmly welcome you to both.

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