Should Public Health Be More Mean?

Warning: Rambling screed approaching.

More mean? Maybe, but only if you can empower and inspire people to make a change. Let me give you a three good examples:

1) Breastfeeding is best. By miles. Still, not everyone really knows about the benefits. So there are intense campaigns around to pressure mothers to breast feed. The consequence is that more mothers breast feed, which is great, but also that mothers who can't for one reason or another (sometimes medical but usually logistical, a problem disproportionally besetting the poor) feel like they are bad mothers; that they aren't taking care of their child.

2) EPA has been carping about air quality since the day they were set up. We know it's unhealthy but we can't seem to say, "Hey you polluting truck driver/factory owner/energy hog, you're giving kids asthma!"

3) Smokers. Clearly the spawn of the devil who should be relagated to a life in the lowest social caste.

There has become such a moral component to public health, especially environmental health. If you're not doing the right thing, you feel like a bad person. In some situations this needs to be softened, especially when people sometimes don't have a choice (like #1), or where sometimes we go too far (#3). But it's stuff like #2 that gets me angry. Why shouldn't we be able to talk about the facts because it makes people feel bad. A little guilt can be healthy. It lets you know when you aren't living up to your own standards.

But that's just not acceptable in our current social climate, apparently. Everything has to have a positive spin on it. Can't be 'alarmist'. Can't be a downer. Can't make people feel bad about themselves. Can't tell the truth.

This speaks to a wider problem that we have. Now, I'll admit that I've been just about saturated with bad news for the past 7 years or so, so I don't like reading about all the things we need to do or fix in our world anymore than anyone else. I appreciate the truth, though, and I'd appreciate even more a way to make a difference. There is no sense whistling in the dark when we have real problems to confront. It's that lack of feeling that we can all get together and do something that is the problem. It's guilt with no way out. Something that has become more and more evident in the past couple of years is that Americans seem to be looking for a challenge. We know we have many problems (you really don't need me to list them, do you?), and people are willing to roll up their sleves, sacrifice, and tackle them. But everyone in leadership positions is too afraid to make the call to arms and bring us together as a society. They try to placate us by saying if we just do X or Y (cap and trade carbon, get out of Iraq, repeal NAFTA, create a flat tax, lower taxes...ETC) then things will be alright, nothing for you to do, have a tax rebate. From our President on down we haven't been asked to do anything, in any area since the fall of communism, other than the implicit request to trust and sit on our collective ass*.

With all due respect to the bard - A leader, a leader! Our kingdom for a real leader!

*Okay, after 9/11 Bush asked us to shop; if that doesn't sum up the problem, I don't know what does.

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Hmmm.... I see what you're saying, but I think there's another component. The things that "we" are happy to get all moralistic and prescriptive about are issues which can be reduced to personal choices, whereas the issues "we" don't seem to be able to deal with usually apply to profitable businesses, or other institutions (e.g. the military) which are regarded as sacrosanct.

For example, here in the UK the current bugaboo is "binge drinking". So there's lots and lots of wailing and moaning about how people (especially young people) are drinking too much (i.e. making the "wrong" personal choices) but there's almost no mainstream discussion of the role advertising (especially that targeting young people) plays.

I'd contend that "we" are absolutely fine with making people feel bad about themselves. What "we" are not fine with is restricting how businesses operate to make money. Economics overrules public health.

I'd contend that "we" are absolutely fine with making people feel bad about themselves. What "we" are not fine with is restricting how businesses operate to make money. Economics overrules public health.

This was my response to point #2 as well. Fear of hurting truckers feelings is not the problem, it's an unwillingness to face the economic consequences. Who will pay for it?

By Kerry Maxwell (not verified) on 25 Jan 2008 #permalink

I think that in the large majority of cases, women can breastfeed their children, even with a full time job. Women can also breastfeed when they are with their child and provide formula while they are away at work. It's not a one or the other proposition. Women would also breastfeed more children and for longer if they had access to support valid information. I have heard too many stories on women being pressured to stop breastfeeding by their partners, mothers, friends, etc.

Breastfeeding is one area of choice where I think there should be some guilt for people who choose formula without any attempt at breastfeeding. We know that formula is inferior to human milk. So we should educate the public and provide some social pressure on parents as well.

By Nicole J. (not verified) on 25 Jan 2008 #permalink

Why are we waiting for someone in government to tell us how solve things? That's just silly. The government is happy to have people who are content "to trust and sit on our collective ass"; such people do as they're told and don't cause trouble.

Each of us has the power to help with most of our real problems, individally or together. Drive less, or drive something more efficient, or motorcycle. Eat better, buy food from healthier sources, vote with your dollars. Exercise on your own. Be an informed consumer of everything you consume. Unplug the damn TV. Buy good used items, fix it instead of throw it away, reuse, recycle. Turn down the heat; put on a sweatshirt. Contribute to a charity. Do something nice for a neighbor, or a stranger. Adopt a kid, or even just provide a smile and a bit of guidance for one who needs it.

Also, of course, keep informed about your government, write your representatives, vote responsibly, actively support good candidates and work to defeat bad ones. Hold *your own* political party responsible for acting properly; threaten to vote third party if it doesn't behave; mean it, and do it.

All of these things are within our grasp and will improve the world. A bit of a PITA, yes, but also many of those things will turn out to be the same actions that make life worth while. In the past year, I have done all things on the above lists, including adopting a teenager who needs a decent home.

The government is not going to get up and do the right thing and get us all organized for that purpose; that's not how government actually works. To expect this to happen is to ignore pretty much the entire history of governance. And it's lazy and irresponsible to put the duty to do that off on "the government" and complain that things aren't getting done.

What we really need is a lot less government and a lot more people behaving responsibly and doing the right things on their own. And we can each do that, and encourage others to do that.

PhilB

By Phil Boncer (not verified) on 25 Jan 2008 #permalink

My beef is with politicians in Congress (on both sides of the aisle) who are making the national debt even higher with all of the earmarks and pork. There has to be a breaking point somewhere, right? The government can't just keep going farther into debt. But most politicians seem to care first and foremost about themselves, so they'll continue to do what they do without thinking of the long term effects of it. Hopefully someday someone will get into Congress and actually try and get a handle on spending.

By Jon Kruger (not verified) on 26 Jan 2008 #permalink

So there are intense campaigns around to pressure mothers to breast feed.

I think these attempts would be more sucessful if similar pressure were applied to grandparents, husbands, partners, friends, extended family, employers, doctors and other healthcare professionals, and every member of the general public who gets all in a dither when a mom does that to her child in public. They'd probably work better too if they weren't undermined by financial interests.

Just saying.

Of course people are going to be upset if they can't do the best thing by their children.

Should we lie to them to make them feel better? I don't think paternalism is the answer - as a society, we shouldn't be trying to shape our research so as to make everyone feel good about themselves. Instead, we should release as much of the truth as possible, as accurately as possible, and let the chips fall as they may.

Excessive concern about how people feel isn't healthy for a society.

By Caledonian (not verified) on 28 Jan 2008 #permalink

This was my response to point #2 as well. Fear of hurting truckers feelings is not the problem, it's an unwillingness to face the economic consequences. Who will pay for it?

Posted by: Kerry Maxwell | January 25, 2008 9:19 AM

I think this is a very important point. There is usually an economic aspect to all of this. The truck driver will say, sorry I am giving your kid asthma, but I have to drive the truck to be able to feed my kid. These kinds of problems need to have solutions worked out from the aforementioned leadership!
Dave Briggs :~)

"Can't make people feel bad about themselves."

Not really important or really toward your topic. But, in my post-secondary school of technology, with ADULTS... the higher-ups decided that using red pens aren't nice to us, so all the teachers are now not allow to mark our work in red pens ever.
Yeah, kinda ridiculous.

It kinda makes me wonder, if thats how they try to make us feel better about ourselves in school, I really probably couldn't imagine the things they aren't telling the masses.

This was my response to point #2 as well. Fear of hurting truckers feelings is not the problem, it's an unwillingness to face the economic consequences. Who will pay for it?

Posted by: Kerry Maxwell | January 25, 2008 9:19 AM

There is usually an economic aspect to all of this. The truck driver will say, sorry I am giving your kid asthma, but I have to drive the truck to be able to feed my kid. These kinds of problems need to have solutions worked out from the aforementioned leadership!
Posted by: Dave Briggs | January 30, 2008 4:32 PM

Nope. Hurting trucker's feelings is not the issue. Feeding the trucker's kid is not the issue. The aforementioned leadership can't solve the problem. Kerry asked "Who will pay for it?" THAT is the issue - YOU will pay for it. And so will I. And when it starts cramping our own style, THEN we get touchy. If you stopped buying ANYTHING from Wal-Mart or even the local grocery store, and only buy what's been grown or manufactured locally (and carried around in a local farmer/producer's pickup truck), THEN the truck drivers will start running out of stuff to be hauled to your neighborhood, and stop polluting the world. But as long as you keep buying the goods they deliver, they'll keep bringing them. The government won't/can't stop the free market, and you probably aren't willing to take such a drastic action. Why do all our textile mills move to third-world, low-wage countries? Because who wants to pay $50 for a decent shirt when you can get one for $12 at Wal-Mart?

Stop blaming the truckers and the manufacturers - they are only delivering the goods you (we) demand.

hmmmm ...

http://www.sciam.com/article.cfm?id=plastic-not-fantastic-with-bispheno…

------------excerpt follows-------
A recent report in the journal Reproductive Toxicology found that humans must be exposed to levels of BPA at least 10 times what the EPA has deemed safe because of the amount of the chemical detected in tissue and blood samples. "If, as some evidence indicates, humans metabolize BPA more rapidly than rodents," wrote study author Laura Vandenberg, a developmental biologist at Tufts University in Boston, "then human daily exposure would have to be even higher to be sufficient to produce the levels observed in human serum."

The CDC data shows that 93 percent of 2,157 people between the ages of six and 85 tested had detectable levels of BPA's by-product in their urine. "Children had higher levels than adolescents and adolescents had higher levels than adults," says endocrinologist Retha Newbold of the U.S. National Institute of Environmental Health Sciences, who found that BPA impairs fertility in female mice. "In animals, BPA can cause permanent effects after very short periods of exposure. It doesn't have to remain in the body to have an effect."
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But my teeth look perfect!

http://www.ada.org/prof/resources/positions/statements/bisphenola.asp

-----excerpt follows-----
November 26, 2007, the U.S. Department of Health and Human Services (HHS) announced the availability of the Bisphenol A Expert Panel Report [ Link ] ... on the reproductive and developmental effects of BPA1. The report states that, Dental sealant exposure to bisphenol A occurs primarily with use of dental sealants bisphenol A dimethylacylate. This exposure is considered an acute and infrequent event with little relevance to estimating general population exposures.

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Wait, what does "acute" mean there?

By Hank Roberts (not verified) on 19 Feb 2008 #permalink