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Sunday, June 10, 2007

The Politics of Public Health, and the Public Health of American Politics

The Politics of Public Health, and the Public Health of American Politics
Image © Austin Cline
Original Poster: National Archives
Click for full-sized Image

In many ways, questions about public health are scientific in nature. Medicine is a science, after all, in which biological problems are discovered, diagnosed, and treated via the scientific method. Modern science has brought us a wealth of knowledge about how the body works plus important information about how to fix the body when it's broken, and thus also great improvements in both life expectancy and quality of life. The science of public health is indisputable — but it's also not the whole story.

There is an unavoidable political side to public health, something which has been reinforced by several recent stories. A man diagnosed with drug-resistant tuberculosis managed to fly out of the United States, get married, then return without getting caught. This is a significant political issue because it raises questions about the extent of government authority (and ability) to detain and quarantine people who might be deemed a threat to public health — remember, it's public health, not personal health.

Your health can affect the health of those around you and your entire community, not just yourself. This is what makes vaccinations a matter of public policy, not just personal health care. A certain minimum number of people need to be vaccinated in order to create enough immunity to prevent an epidemic — that's why most vaccinations are mandatory and allow for few exceptions. The vaccination against HPV to prevent cervical cancer isn't quite as serious as a vaccination against small pox because HPV can't be spread as easily, but the fewer vaccinations there are, the more HPV will probably be spread.

Unfortunately, the HPV is an example which demonstrates there are also countervailing political forces where public health is concerned. Some issues are political matters not only because they require debates about what's best for protecting the public health without overly impinging on basic rights, but also because they are dragged into the so-called "culture wars" waged by reactionary, religious authoritarians against the modern world of science, liberty, and Enlightenment.

This sort of politicizing of public health was made especially prominent by President Bush's nomination of Dr. James W. Holsinger Jr. for Surgeon General. A founder of a religious ministry that seeks to "cure" homosexuality, Holsinger is also author of a 1991 paper arguing that homosexuality is unnatural and unhealthy. According to Hoslinger, male and female genitalia are complementary while body parts used for gay sex are not: "Anatomically the vagina is designed to receive the penis. ...The rectum, on the other incapable of mechanical protection against abrasion and severe damage to the colonic mucosa can result if objects that are large, sharp, or pointed are inserted into the rectum."

Some may regard the nomination of such a person a sign of arrogance, but perhaps it's really more naiveté. What's so remarkable about Holsinger's views is, I think, how unremarkable they are — at least in the conservative, evangelical community. Those who have aligned themselves with the forces of authoritarianism in the "culture wars" will regard Holsigner's comments as obvious and uncontroversial, I think, just as they regard it as obvious that a vaccine against a sexually transmitted disease should not be administered to young girls and that abstinence-only education should be funded by the government.

Yes, abstinence-only education doesn't work. Yes, HPV vaccines will work to save lives. Yes, the whole "complementarity" argument is nonsense. So what? Truth and facts aren't the motivating force behind these positions — ideology is. They are trying to promote a political and religious ideology, not health, science, or truth. They are trying to ensure that people live according to the way they believe their god has instructed us and they are more than willing to use the power of the state to ensure that it happens.

This is why the current politics of public health tells us so much about the current public health of American politics: it's been infected by a serious and possibly drug-resistant strain of authoritarianism. I doubt that there are many other nations on this planet where there would be a serious debate about providing HPV vaccinations, about dumping sex education tactics that have proven worthless, and about naming someone Surgeon General who treats homosexuality like a health problem that needs to be cured.

Lest anyone imagine that I'm simply castigating the Republicans, I believe that Democrats have also been infected by this authoritarian virus. Anyone who invokes their god or religious scriptures in a public policy debate isn't doing so to help inform the public, but rather to keep the public from asking questions. Whenever someone invokes gods or scriptures as a basis for public policy, they are not trying to convince through the power of reason by rather they are trying to coerce through the authority of religion — even if they don't intend to or don't realize it.

This is not a criticism of personal faith or for having personal religious reasons for supporting some public policy. If someone supports an anti-poverty or anti-abortion program because of how they read their religious scriptures, that's their business. This is, instead, a criticism of how politicians and public leaders attempt to justify how they would govern — that isn't their personal business, it's all our business because it's our community they want to govern. The coercive, authoritarian use of religion has no place in public policy, but it's become ingrained in American politics — even to the point where it threatens other nations as well.

It might be nice to imagine imposing a quarantine on America to prevent the infection from spreading, but so many other nations are infected with their own strains already. The public health of politics in some nations appears to be pretty good and shows no signs of degenerating towards religious authoritarianism, but will that be enough to provide any resistance to the rest of the planet? Alternatively, there are times when it actually pays to get very sick in order to produce sufficient natural resistance — at least for a time. Although it may initially sound counterintuitive, perhaps making religion even more of a public, political issue will create resistance to the intrusion of religion into public policy debates.

The above poster was originally a World War II recruitment poster for the submarine service. The submarine service. You know what submarines are filled with, right? I didn't touch his eyes, his hands, or take off his shirt — that's all in the original. Every time I look at his, I get the song "In the Navy" running through my head.

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We'll try dumping haloscan and see how it works.