A few weeks ago, I wrote what I said was the first of a two-part article about public health. A couple of news stories I tucked away whilst doing the rounds for my column this week reminded me that I really needed to get round to doing the second part.
Those stories were a now apparently deleted item in the Daily Mail about Labour wanting to force drinkers to one drink a day (more here), and an op-ed in the Times (£) from Camilla Cavendish arguing that we need to tackle “big food”.
My last item explained why it was foolish for the lovers of various vices to allow tobacco to be split off from the herd and taken down in isolation, as the same justifications could easily be turned on other targets. And true to form Ms Cavendish repeatedly draws, and cites others who draw, parallels between “big tobacco” and its modern counterpart, “big food”.
This week I’ll look at what strike me some of the troubling ramifications of public health ideology more generally, starting with my claim from last time that the concept of preventable death is “a work of totalitarian genius”.
We are all familiar with preventable/premature death statistics. These are deaths that could have been prevented (or more accurately, postponed) if only the Government had taken some action or other. The implication of this is always clear: when someone starts ascribing premature deaths to something, they want that something restricted or banned outright.
I called this totalitarian genius because, when you think about it, it creates a dynamic whereby government action is made morally necessary by virtue of being possible. If your aim is to wage war on premature death, then whether you acknowledge it or not you subscribe to the unlimited strategic aim of forcing people to live their maximum possible lifespans.
Of course very few people look at it this way: most puritans focus on whatever they view as the chief evil of their time, be it alcohol at the turn of the last century, tobacco in the last few decades, or food now. Warnings about slippery slopes are shrugged off or rejected – in some cases with undoubted sincerity.
But as I outlined in my last article there is always a fresh dragon to slay, and over time a reasonable campaign to put printed warnings on cigarette packs mutates into Lord Darzi’s creepy dream of turning the public square into a theatre for state-sanctioned virtues.
Further to that, the anti-choice foundation of public health relies on a profoundly disempowering view of the citizen, because you have to believe that we do not have the ability, and thus the right, to make informed decisions for themselves that trade immediate pleasure against longevity.
In her article Cavendish represents this tendency in two ways. The first is by describing examples of where situational or societal factor lead us to eat more than is biologically necessary, illustrating the limits of conscious choice. But far more instructive is her concluding paragraph:
“The story that convinced me legislation is needed came from someone who has followed shoppers round supermarkets. Far from using the new “traffic light” labels to choose the healthy option, people are actively seeking out pizzas with red labels, assuming they will taste better.”
The individuals in that story are not being steered by situational demands or misled by wicked corporations: they are using consumer information lobbied for by public health activists to make informed decisions. They just happen to be making the wrong decisions.
To Cavendish this is where the depths of our helplessness are truly revealed: even with the facts at our disposal, we cannot take the obviously correct decision that she would take. Personal preference doesn’t come into it: choosing the full-fat pizza is always wrong.
The notion of turning the realm of individual choice into one where objective right and wrong exist has some troubling political implications all on its own, just as arguments for advertising bans do for our capacity to choose between, say, two different political leaflets. They all depend on the notion that driving down cigarette and fast food sales, and by extension extending lives, should be presupposed as a moral good which trumps individual choice in such matters.
It is this, to me, which is the widest and deepest of the holes at the heart of public health authoritarianism. A doctor can demonstrate to me the effects that smoking, drinking, drug-taking or over-eating will have on my physical health and life expectancy. It is not at all apparent what then gives them the right to force me to stop doing those things.
Where is the moral imperative to physical health, and what lends it sufficient strength to trump personal autonomy?
Is it that I am biologically ill-suited to the modern age, as Ms Cavendish suggests? I concede that many of us are wired differently inside but to accept that as an argument for being ruled over in such a fashion I would need to accept that Ms Cavendish’s wiring were not just different but superior to my own.
I can’t see how this can be done, because the evidence – that the hypothetical Ms Cavendish is healthier than I – depends upon the presupposition that physical health is the “good” outcome in objective terms that transcend our divergent personal inclinations. I can see no way to build this argument without it eating its own tail (a happily weight-neutral meal, at least).
The other common line is to cite the intolerable burden that vices place on our healthcare systems. But this is absurd. Not only do things like tobacco duty ensure that your average smoker bears the cost of their habit to the state several times over, but the biggest and fasting growing threat to our health service is people living too long.
The prospect of providing decades of expensive end-of-life care to the inevitably decaying bodies of the long-lived is giving the forward planners of our social safety net conniptions. People living longer is the pre-eminent strategic challenge faced by the welfare state. But where the right hand is deeply concerned about the implications of our living longer, the left hand is forcing us to do it.
Viewed in this light, modern public health looks little different to a less religious revival of the Temperance movement: a puritanical instinct which aims to save us from disapproved habits by flattering the superior attitudes of the powerful and treating mere data as if it carried inherent arguments.
I read an excellent piece recently, which I have been unable to locate, which described the Puritan doctrine that a man possessed liberty only so long as liberty led him towards God, which was obviously no liberty at all. In truth no despot seeks to deny their subjects the freedom to agree with them, and the root of any true freedom is the ability to make what those in power deem to be the wrong choices: to pick out the red-labelled food. To eat, drink, and be happily mortal.