Too Much Public in Our Public Health

A study looked at the public’s willingness to accept legal strategies when it comes to public health interventions found that:

There was much support for strategies that enable people to exercise healthful choices—for example, menu labeling and improving access to nicotine patches—but considerably less for more coercive measures, such as insurance premium surcharges. These findings suggest that the least coercive path will be the smoothest and that support for interventions may be widespread among different social groups. In addition, the findings underscore the need for policy makers to involve the public in decision making, understand the public’s values, and communicate how policy decisions reflect this understanding.

I have a number of concerns around this, but first and foremost I think that we need to be sure that public health is about making information and options available to the public, while taking care not to make the individual’s health the public’s business.  When we reward and punish people for “health”  and “healthy behaviors” we create an environment that ignores the complexities of health, dis/ability, individual circumstances, and individual choices, creating an environment of shame and blame that are the precise opposite of the goals of public health.

It also encourages people to deputize themselves into the “health police” which only serves to exacerbate these issues since, like drivers who think that everyone who drives more slowly is a slow-poke and everyone who drives faster is a danger,  but their driving is perfect, these people tend to suggest that everyone who does more than them is some kind of health nut, everyone who does less than them is lazy and their health practice is “Juuuuuust right.”

The danger of taking a vote on how we treat people in public health is exacerbated when we choose to equate public health with how people look, and can quickly slide down the slippery slope of hypocrisy. Public support for public health measures is not the same thing as evidence-based public health and even if 99.9% of people supported public health policies based on size bigotry, that still wouldn’t make it right. The other questionable premise is the fact that this study, like many others, freely switches out “poor diet and physical inactivity” for “fat” which always brings the scientific rigor of these studies into question.  Body size is not a behavior, or a set of behaviors (and any belief otherwise is just stereotyping), it is not a diagnosis, it is not a disease.  This kind of thinking does a disservice to fat people by promoting weight stigma.  It also does a disservice to thin people suggesting that if you are thin your diet must be “healthy” and you must be doing the “correct” amount of physical activity which is also demonstrably untrue and dangerously misleading.

Public health interventions that are focused on body size are extremely problematic and wholly unnecessary to an actual conversation about public health. We’ve already talked about that. 

I think it’s fine to present people with information (including the evidence to back it up and the limitations thereof) and I think it’s a good thing to work hard to give people access to options like the foods they choose to eat, movement options that are both physically and psychologically safe, and affordable evidence-based healthcare.  I think that we should do that while being fiercely anti-shame in all of our messaging and  remembering that nobody owes anyone else “health” or “healthy habits” by their definition or any other, that health is multi-dimensional, complicated, and not entirely within our control, that the rights to life, liberty and the pursuit of happiness are inalienable and not size, health, or healthy habit dependent, that our bodies are our business unless we ask for somebody else’s input, and that nobody is obligated to choose to try for the longest life and public health should be about giving everyone the same access to information and options and then allowing them to make their own choices, not about making the individual’s health the public’s business.

Check out the Fit Fatties Fight Song!

I’m super excited to share this video with you.  Nobody is obligated to exercise, and being involved in fitness should not be a barometer of worthiness or lead to better treatment. The good fatty/bad fatty dichotomy is bullshit.  So is the fact that fat people who participate in fitness face everything from online bullying, to street harassment, to physical violence.  So the FIt Fatties Forum made this video montage to remind the world that fitness/sports/movement is for Every Body who wants to participate:

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7 thoughts on “Too Much Public in Our Public Health

  1. I am extremely bothered by “In addition, the findings underscore the need for policy makers to involve the public in decision making, understand the public’s values, and communicate how policy decisions reflect this understanding.”

    I understand that we elect our representatives with the understanding that they will do what we want them to (although I really don’t think that should be the standard), but in the U. S., we’re not supposed to be able to vote democratically on what rights other people should or shouldn’t have.

    1. Exactly. Rights are just that, rights. Nobody gets to vote up or down on basic rights, or they wouldn’t be called “rights.”

  2. I’m in love with that video – that’s my new theme song! heheh Bookmarked and watched repeatedly!

  3. That video is amazing! @_@ I also recommend these videos 🙂

    I especially like the second one because I am so happy for Dancing Man / Sean O’Brian for the love people have shown him, and the ukulele background music is great – I like to play ukulele in that style 🙂

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