Ed note: Please welcome Dr Travis Saunders back for another guest post. Travis Saunders has a PhD in Human Kinetics at the University of Ottawa. His research focuses on the health impact of physical activity and sedentary behaviour. He blogs regularly about both on his blog, Obesity Panacea.
We get it. Maclean’s Editor-at-Large Peter Shawn Taylor thinks that public health people (e.g. myself) should stay away from chronic disease (I guess it’s time to wrap up my research program and call it a career!). And he thinks that we should definitely stay away from any policies related to chronic disease that have anything to do with personal choice or the economy.
Earlier this month I sounded off on a recent Maclean’s editorial arguing that public health should prioritize infectious diseases like Ebola, rather than chronic diseases like cancer or obesity. This week, Mr Taylor repeated the same arguments in an opinion piece for the Globe and Mail concluding that:
It is not the job of public health to have an opinion on
taxes, economic policy, free trade or corporate control. Neither
should it be their business to interfere in the freely-made choices of adults.
Public health ought to stick to their needles, and leave the economy alone.
To recap: Mr Taylor (an economist and journalist) is well equipped to tell public health agencies how to run their business. Those of us trained in health research are not (one presumes it is because we are not economists). The level of condescension implicit in that line of reasoning is nothing short of astounding (if I ever meet Mr Taylor, I hope to ask him what he thinks of health economists… does their economic training qualify them to speak on important matters of public health, or are they disqualified by their training in public health?).
Unfortunately Mr Taylor does not present much in the way of arguments
to support his conclusions. He simply doesn’t believe that public health should include a focus on chronic diseases, because this might result in policies that impact the economy or personal choice. He does not claim that this would result in better policy, a healthier
society, or a stronger economy. The gist of his argument? We shouldn’t focus on chronic disease, because Mr Taylor doesn’t like it.
Here are some of Mr Taylor’s comments from the Globe and Mail, along with my responses (emphasis mine throughout):
The mission drift rampant in public health extends all the way up to the World Health Organization. At the peak of the
Ebola scare and with her organization under fire for mismanaging the on-the-ground response to the outbreak, last month executive director Margaret Chan was in Moscow attending a tobacco conference where she argued cigarettes are a bigger threat to global health than an African virus. Last year she threw her lot in with the anti-corporate crowd, railing against “Big Food, Big Soda and Big Alcohol.”
As I noted last time around, this argument borders on willful ignorance for two reasons. First of all, Maclean’s (Mr Taylor’s magazine) has argued that the WHO failed to respond to Ebola not due to its focus on non-communicable diseases, but because it is chronically nderfunded. Second, smoking is the # 1 preventable cause of death worldwide. At the risk of repeating myself, tobacco kills more people than Ebola every three days. So it absolutely makes sense to continue to focus on tobacco, even while we try to get a handle on the Ebola crisis.
The original − and very necessary − purpose of public
health was to combat infectious diseases and impose sanitary standards on water, food and waste. From this perspective, the field has enjoyed many successes, such as the eradication of polio and smallpox and the remarkable safety of Canada’s food system. Lately, however, public health departments seem to have lost sight of their primary mission. In a search for new things to control, or perhaps to pursue
personal ideological views, public health officials have pushed their way into areas they simply don’t belong.
As I noted in response to the Maclean’s editorial, this line of thinking is driven by ideology, rather than any clear logic. If you want to improve the health of a population, it makes no sense to draw an arbitrary line separating communicable and non-communicable diseases (keeping in mind that any line between the two is already blurring anyway).
By Mr Taylor’s logic, it would perfectly acceptable for public health campaigns to hand out condoms on university campuses, but not to warn people about the dangers of binge drinking, or drinking and driving (freely made choices of adults, etc). Take seat-belt laws – another unmitigated public health success story, despite infringing on our freedom to be thrown from a moving vehicle. A paper in the Review of Economics and Statistics concluded that “mandatory seat belt laws unambiguously reduce traffic fatalities”. And yet an exclusive focus on communicable diseases would have taken this option off the table
(unless, I assume, it was suggested by an economist).
Clearly Mr Taylor has an issue with public health agencies, in particular the public health unit in his hometown of Waterloo (although I know nothing of their policies, I can assure Mr Taylor that they did not invent the term “food swamp”). But I fail to see any convincing arguments (or any arguments at all really) in this new piece, or the earlier editorial from Maclean’s. There is no logical reason to allow public health to deal with infectious disease, but to bar it from dealing with other health-related issues. Arguing that you don’t like something isn’t really much of an argument.