You can get garden variety health advice from the daily newspaper, the "health" section of most book stores, and of course thousands of web sites. I'm hoping to present thought provoking and maybe change provoking thoughts about individual and community health. This blog is not just what to do about health, but how to think about it. I'm looking forward to an exchange of ideas with readers. July, 2010


Monday, July 12, 2010

Values conflict and health promotion

Victor Hugo is quoted as saying "All the forces in the world are not so powerful as an idea whose time has come." It’s an inspiring vision for those wanting to change the world. Once in a great while it may prove to be true, but more often it is more realistic to see an ecology of ideas, in which perspectives around an idea are checking and balancing one another, trying to obtain critical mass of support to carry the day. This blog is not about politics, but health policy is part of the idea ecology, and often health promotion strategies do battle with competing perspectives in the political arena. Public health and other health professionals are guided by ethical standards, so often are at a disadvantage against political adversaries, who are less concerned about truth or accuracy.

Usually health promotion advice is tame and not controversial. People will act on it, or not, but usually don't get angry when they hear it. Americans love high fat foods, and consume far too much fat, salt, and sugar. This is widely known, but gets almost no active opposition, other than the food producers continuing to sell us unhealthy foods, and we continue to buy them. No important groups or individuals are trying to tell us that fat, salt and sugar are good for us, or condemning the health care system for trying to help us cut back on those unhealthy foods.

On the other hand, health promotion often relies on policy to bring about health improvement. For example, we have state laws requiring people to wear seat belts while they are in a moving vehicle. That's a policy solution to a problem that could be served by a public education campaign alone. We could just encourage and try to persuade people to wear seat belts, but instead we also have seat belt laws. The rationale is that education alone wasn't getting the job done (back in the 70s and 80s) so that large numbers of people still didn't buckle up. The number of highway deaths was so great that government (that's us) decided the education campaigns needed to be reinforced with a legal policy. Policy and education, together, have been successful, as the rate of highway fatalities has dropped dramatically compared to what it was in the 50s, 60s and 70s. However, many people rankle against health promotion policies, when they think their rights and freedoms are trampled.

In my state there is a U.S. Senate candidate who is a physician in his day job. He is opposed to smoking ordinances, where smoking is legally prohibited in workplaces and anywhere the public is served, such as restaurants. These ordinances are a policy solution. We could rely on public education encouraging smoking cessation, and we could encourage businesses to voluntarily ban smoking in their own establishments. More and more communities are enacting this policy to protect nonsmokers, including people exposed while they do their jobs. It is considered necessary because there are thousands of deaths associated with second hand smoke, and other options, such as no smoking sections don’t work.

This candidate opposes smoking ordinances, not because he thinks smoking-related illnesses are a good thing or because he has a financial interest in the tobacco industry, but because he values private property rights over health concerns. It is a values question.

How high on the scale of things do we place health? Do we think it is important to protect all people from exposure to tobacco smoke, or do we consider individual choice and property rights to take precedence? Do we think it more important to protect the health of Gulf of Mexico water and shore land, or is it more important to protect economic interests and drill baby, drill. Should we aggressively expect food producers to make and sell healthier foods, or should we instead try to change consumer demand by public education, relying on the market to eventually come around to healthier products? Do we demand unlimited access to guns as a right, or do we take steps to limit the homicides and suicides linked to the large number of firearms in our society?

It is hard to determine the political will these days. Some individuals and groups put a premium on individual liberty and level "a pox on your house" to those who believe that government policies are important to bring about a community where most people can thrive. Does that perspective really represent most people, or just a vocal minority? Maximum individual liberty at the cost of poor health doesn't seem like a way to assure that all can pursuit happiness.

No comments: