Last week, I was forwarded an opinion piece written by the Honorable Leo Glavine for the King’s County News. Now, if there’s one thing that I hate, it’s when people who are in positions of power, wealth and/or privilege tell “the others” how to live their lives – whether that be “work harder,” or “be healthier,” with absolutely no idea or acknowledgement about their own privilege.
In short, the road to health that many prescribe to the unhealthy is a two step model:
1) Be healthy
2) Don’t be not healthy
Which is why, when I read pieces that blame the poor or unhealthy for their situation, it makes me very angry. And you wouldn’t like me when I’m angry.
But lets get back to Mr Glavine’s commentary. In case you didn’t know, Mr Glavine is the Minister of Health and Wellness for the Province of Nova Scotia, and has been in politics since 2003. Prior to that, he was a school teacher. By all metrics, he’s very popular in his riding – winning the last election with a whopping 74% of the votes.
Mr Glavine starts off his piece rather innocuously, stating that the objectives of government are to represent the people, to provide services, and to take care of their health. We’re in agreement there. He also points out that they have to do more with less funding, and that will require creative and innovative thinking to continue to provide services for the populace. So far, we’re on the same page, and I don’t envy how difficult it is to balance all those demands.
And then things take a wild left turn.
WARNING: If you are drinking anything, now is a good time to put down your glass.
“Canadian banking systems are highly regulated to help thwart abuses. Clients must be approved before receiving financial assistance. They must prove that they practice a healthy financial lifestyle before being able to borrow money … Imagine if healthcare worked like banks. Patients would have to prove they practice a healthy lifestyle before receiving assistance. They would have to prove that they practice the basic tenets of proper eating and exercise. “
To call this myopic would be generous. To say it misses the underlying problems would be generous. It would be like seeing that someone has a flat tire and offering them pancakes. It makes absolutely no sense, and starts the victim blaming this article is rampant with. Now, Mr Glavine then acknowledges the ridiculousness of this viewpoint, but then goes on to say:
“These people need help to break unhealthy habits, because the consequences of smoking, uncontrolled eating and avoidance of physical activity deplete funds that could otherwise go toward saving lives and finding cures. Then there are people who are cognizant abusers of the system. “
The first excerpt was him being factitious and providing a deliberately provocative example. This however, is clear victim blaming. If only you stopped smoking, if only you ate healthier, if only you got more physical activity, we’d all be fine. That’s all a great pipe dream, but the evidence is simply not there.
Lets start with smoking. Data suggest that 42.7% of all adult smokers in the US are trying to quit, and that only 4-7% can quit without medication or other help, and EVEN IF we give people intensive behavioural counselling and pharmacological treatment, this increases to… 20-25%. Yup, if we give people the very best in support and help, only 1 in 4 make it. How about healthy eating? Well, the data suggest that to healthy rather than unhealthy will cost you around $550 extra per year (and link to BMJ Open article, published under open access) So, unless you’re willing to help people afford to eat healthier through subsidies of healthy foods, providing them with the skills to cook healthy or a livable wage, the problem won’t fix itself. I’m not saying we shouldn’t give people support but implying that it’s as simple as “just have a little more willpower,” does a great disservice to the underlying issue.
Unfortunately, that’s what is being proposed. The “lazy, unmotivated person” who is a drain on our healthcare dollars is a character that people can despise and vilify. The populace can assign blame to this criminal mastermind for their lack of effort and desire to get healthier, along with stigmatizing them even further (in this narrative, they are also twiddling a moustache while eating pizza and potato chips).
The underlying issue here is a poor understanding of the social determinants of health – defined as what leads to health, what impacts our behaviours, and what factors result in illness in our society. It’s not as simple as one person deciding to “take responsibility for their actions” and “pull themselves up by their bootstraps.” These are nice slogans and political buzzwords, and look nice on a photo of a sunset on a beach somewhere, but are ultimately meaningless. We’ve covered the idea of social determinants of health extensively on the blog, but it’s still not something people outside of public health are familiar with. It falls to us to educate others about the multifaceted nature of health, and how dangerous preconceived notions can be.
Given the opinion piece opened with a story, I thought it appropriate to end mine in a similar way. This story is the opening to Inside the Outbreaks, and has been called the Parable of the Clinician and Epidemiologist:
The Brown River usually flows lazily through the middle of town. But today it is a torrent carrying human bodies. Some, still alive, are gasping for air and thrashing the water.
Approaching the river to enjoy lunch on its banks, two doctors, horrified by what they see, begin to haul people out of the water. There are no signs of violence, but the victims’ eyes are glazed, their weak pulses racing.
The doctors cannot keep up with the flow of bodies. They save a few and watch helplessly as the others drift beyond them.
Suddenly, one of the doctors lowers an old man to the ground and starts to run. “What are you doing?” yells the other doctor. “For God’s sake, help me save these people!”
Without stopping, she yells back over her shoulder, “I’m going upstream to find out why they’re falling in.”
Looking at why people are unhealthy rather than blaming them for their circumstances is the only way we’ll ever be able to help. Victim blaming and assuming their character, rather than their circumstances, are solely responsible for their conditions is not only callous, it’s an easy way to perpetuate the cycle of inequality that got us here in the first place.