Voting for Health Promotion

At this time of year, maybe this year more than ever, the fever of electioneering is way hot.  There is a lot about our political campaigns that one could lament, but there is a core value that gives many people pride.  In the U.S. we do have a voice in determining what kind of community and nation we have.  Is there too much power held by special interests?  For sure.  Is there too much money spent on political and media campaigns by people with hidden agendas?  Absolutely.  Is it frustrating that political leaders seem to spend more time getting re-elected and less time working together to solve problems? Without a doubt.  However, there is no evidence that any other system is better, and most other places are clearly worse.  And by the way, the private sector is not so hot either: consider banks, coal and petroleum companies, health insurance corporations.

People have opinions and positions on many issues.  For people interested in health promotion, there are many health issues that either are or should be represented on election days.  In other words, for the issues we think are important, it may be that some candidates are more likely to take action to advance a particular policy.  This year there are a number of health-related issues that are being discussed by candidates, though there are many more issues important to health promotion that have not gained enough traction with the public to attract any attention by candidates.

One of the more common health issues debated is climate change.  In spite of people who believe climate change is either a total myth or at least "unsettled science," it is a slowly worsening problem that needs to be addressed sooner rather than later.  Once you find a candidate who believes the threat from climate change is real, then you've got to find one willing to risk jobs in the coal and petroleum industries, also willing to invest government funds in advancing the supply of alternative energy sources of fuel.  On some days it seems like the deniers are winning that debate and the American public seems to care about nothing but jobs.  It is hard to find a candidate willing to stand up to this barrage of opposition.  Profiles in courage are few.

The other huge issue in health policy getting discussed and debated by candidates is the health care reform bill passed by Congress last spring.  Many untruths have been told about the legislation, and since the opposition has spent the last six months shouting how it is going to ruin the nation's health care system, it is no surprise that people don't support the bill.  Of course if you ask people about specific provisions of the health care reform bill, large majorities support what the bill actually will do.  Nevertheless, even candidates who voted for the bill either don't cite it as an accomplishment in their campaign, or simply say it is a start which will need much more work in the future.  Of course about half of all federal candidates running say they will do all they can to repeal the bill.  It is not at all clear what these opponents are defending, considering all the problems in our current system.

There are many other more localized bills and policy proposals being debated in state and local elections.  In California, there is an effort to legalized marijuana.  Immigration reform has implications for health, both in terms of the way immigrants are treated but also how immigration policy will impact the distribution of wealth in the country.  Abortion is less of an issue in general, though many candidates will state their position to increase their support from various constituencies.

While still a small slice of the electorate, the libertarian banner seems more vocal and influential than in past years.  This is a mixed bag for health promotion.  Libertarians want to get rid of as much government as possible, and allow the capitalist market to create solutions to community problems.  They might say that the government should not be providing influenza vaccination, but should get out of the way so that the private system can efficiently fill this need.  Libertarians would generally oppose government regulation unless it is required to protect against immediate threat. For example, they would support a government imposed highway speed limit, but would oppose a public smoking ban in restaurants and other workplaces.  They would certainly oppose a ban on trans fat in the food industry, but would rely on educated consumers to mold the practices of the food industry.  On the other hand, libertarians would also oppose drug laws, and many people, not just libertarians, are being persuaded toward that view.  In general, it is hard to reconcile a hard libertarian view with public health, that believes government policy should be used as a force to improve life and health for all in our communities.

The challenge with voting with an eye toward health promotion is that candidates who are consistently true to health promotion values are rare.  Of course as a voter, it is generally better to be holistic in scrutinizing a candidate, not basing support on a single issue.   However, often you will find a candidate promising to support one health promotion idea or policy while disavowing support for another.  This is compounded by the difficulty of learning about a large field of candidates in multiple races.  In Kentucky this Tuesday, the average voter will be choosing candidates in 30-40 races at the local, state and federal level.  There are not many people going into a voting booth who really are well informed about all those office holder wannabees.

Our political system does give us wonderful opportunities to participate in deciding our future, including the formation of a sounder basis for a healthy population.  However, while these rights can be romanticized, exercising them can be bewildering.  At the same time, developing and advocating health promotion policy solutions is also very challenging.  Together they are even more confounding.

Nevertheless, good candidates who support health promotion initiatives are frequently elected.  There is good justification for health promotion advocates being optimistic, but it is an essential character trait for those who make this their business.