The Public Health

      5 Comments on The Public Health

A thing I’ve been musing about over the last few months, for some reason, has been the phrase public health.

Here’s the part that sticks for me: there isn’t actually any such thing as the public health.

In much the same way, in fact, that Margaret Thatcher observed that there was no such thing as society. That is, it’s perfectly true, and yet also utterly false. The public does not get sick or stay healthy; individuals do. But for something that doesn’t exist, the public health sure has a massive effect on all those individuals.

For the last few months, and for the next few months, we need everybody to protect the public health, a thing which does not exist. It may not be enough for us to pretend that there is such a thing as the public health. We may all need to believe that there is such a thing as the public health. We need to wear masks to protect the public health. We need to close schools or open them based on public health outcomes. We need to stay out of shopping malls and dance clubs, barbershops and bookstores, because of the effect on the public health.

We should also take into account individual health, of course. Absolutely! If you are particularly vulnerable to a severe case, you need to protect yourself; if your mother is, you need to protect her. That’s one layer of activity we need to do, one level of risk assessment we need to constantly take. That’s terrifying and exhausting enough. I understand that. But in addition to—maybe even before—assessing individual health, we have to protect the public health, which, as I say, doesn’t even exist.

I am bothering writing this for my Tohu Bohu because of the story about national security advisor Robert O’Brien having contracted this disease on a family vacation. And I can’t help thinking that for Mr. O’Brien and his family, thinking of themselves as individuals, choosing to go on some sort of family vacation, involving some risk of contracting this disease, is not altogether unreasonable. After all, if one of them were to get ill (as did happen, of course) they would get the best of medical care. There was no chance that they would be the ones stuck in the hospital hallway. If there were a shortage of any particular treatment, they would still have access to it. The chances of any individual in that family dying are much less than the general population—I have no idea how much less, but it’s not out of reason to call it one in a thousand. Somewhat more likely is a long and serious illness, but if that were to happen, they would still have the best of care, and of course it wouldn’t bankrupt them. Even if (the Divine forbid) their daughter were to have chronic problems for decades, it’s very likely that those would be ameliorated by her access to superb medical care; she would likely still finish her college degree and have a long and fulfilling life and career, despite that terrible, unlikely outcome.

Did the O’Briens make that sort of cold-blooded calculation? Of course, I have no idea. Maybe they did. Maybe they just relied on an internalized notion that they are generally protected from the consequences of bad decisions. Maybe they’re just dumbfucks. I don’t know.

What they clearly did not do was ask themselves whether going on a family vacation was fulfilling their responsibility to the public health. And I don’t just mean Mr. O’Brien’s position as a public figure and thus a role model, or the putative danger to our national security should he be unable to carry out his duties. I don’t even mean the exposure of waiters and housekeepers and other vacationers, and in his case his counterparts overseas on his scheduled trip, and eventually the doctors and nurses and respiratory therapists and pharmacists who will need to interact with them. I mean the increased risk—slight, but accumulating—to everybody in the public when a person takes that individual risk.

When I decide whether to go out for ice cream, or visit my mother-in-law, or replace a broken dishwasher, I need to do risk analysis—I should say that’s not purely a pandemic thing, but most stuff I generally do is sufficiently low-risk that it’s normally pretty easy. I’m not doing a lot of bungee jumping or hang-gliding or walking home alone at night, drunk off my ass. But during a pandemic I have to think about the public health, not just my own. Because if we mostly focus on our own individual risks, people will continue to get sick, because all of the individual and individually reasonable risks to individuals will mean overwhelmed hospitals, rationed care, and temporary refrigerated corpse storage.

I don’t know how to convince people to believe in the public health. I wish I did. I wish I knew how to convince people to believe in the public welfare—in society. I see people trying, and failing, in various ways, and I want there to be some perfect meme to retweet or sign to put in my garden, or even phrase to use in conversation. There isn’t one. But I will keep trying.

I do think it would help, at least a little, if public figures acted as if they believed in public health, too.

Tolerabimus quod tolerare debemus,

5 thoughts on “The Public Health

  1. Chris Cobb

    The lack of regard for public health is just one aspect of the push for privatization that has dominated political discourse in the United States for decades up until quite recently (privatization meaning in practice that the rich get to own whatever it is and everyone else has to pay them for access to it).

    Also, we might consider that, as far as the current White House occupant and his like-minded followers are concerned, the problem with the public health isn’t that it doesn’t exist (I’m inclined to think that it does, myself, fwiw)–they believe in lots of things that don’t exist, as long as it is convenient for them to do so. That part is easy. The problem is that the public health does not work as a zero-sum system in which there are winners and losers. Instead, everybody wins or loses together, and they hate that.

    The basic problem we face, then, is not that a group of people don’t believe in public welfare: they are actively opposed to it, and they devote very considerable resources to keeping enough other people confused about public welfare to prevent policies that protect public welfare from being put into place. To change the views of people whose hearts are not rotten (i.e. they are not narcissists, sociopaths, or psychopaths) but who have been indoctrinated by the rotten hearted liars and manipulators who have captured a large slice of public discourse takes more than an information-based communication strategy.

    1. Vardibidian Post author

      When I wrote this up, I had not yet read Paul Krugman’s column The Cult of Selfishness Is Killing America. His point encompasses, I think, my note and your reaction to it: “Many on the right are enraged at any suggestion that their actions should take other people’s welfare into account.”

      To some extent, that’s what I was getting at by dragging Margaret Thatcher into it. For people to reject the existence of the public health has substantial consequences, just as rejecting the existence of society did. And if people choose to believe in the public health, to believe that there exists this thing of value that doesn’t belong to individuals, well, that could have consequences, too.


  2. Cbris Cobb

    It occurs to me that “personal health” is actually a much more artificial construct than public health. Sure, our body sense gives us some ongoing awareness of the condition of the body, but maintaining each personal body and personal mind in good condition is obviously a social endeavor in which everyone relies heavily on others. I wonder if we started to call it “private health” instead of “personal health” the absurdity would become more obvious?

    1. Vardibidian Post author

      I do like the idea of talking about the “public health” and the “private health” as reliant on each other, as we talk about the “private sector” and the “public sector”… except we don’t actually talk about the interconnectedness of those, either. Phooey.

      But I think that everybody knows what it means to be personally sick, to be personally injured or even to personally die. While those things are caused by the public health environment, which is a way of saying that everything is connected to everything, the outcomes that people care about are the private ones.


  3. Michael

    “Public health” is a risk environment affecting individuals, just like “the economy” and “society”. It doesn’t make sense to me to think of any of them as the aggregation of individual health, individual financial security, or individual identity and/or beliefs. In each case, the risk environment matters to the future prospects of each of those aspects of individuals, but that’s very different from trying to take a mean or median.


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