By John Steen
Editor’s note: John Steen is a retired scholar and teacher of philosophy, followed by a 20-year career in health care planning, health regulation and public health, ending as a professor of health policy and a private consultant. He is immediate past president of the American Health Planning Association. He lives in South Burlington.
Public health has always had an important story to tell, that of the human condition, and to fulfill its own ethic, it must complete the story. What makes it so terribly difficult to do that are the political, economic, social, and cultural defects in our nation.
Public health can find little support in a nation where the market distribution of income is seen as moral, and its unequal distribution is seen as representing social justice. These are among the perverse effects of capitalism.
The problem with American politics is that in promoting the unfettered right to enjoy what we have earned, it fails to leave room for the obligation to support the less fortunate to share in what is also their heritage.
Nothing gives greater testimony to that than the credence given to the ideas of Ayn Rand by our conservative political leadership. Her ideas are totally lacking in any moral values, even in those – compassion, concern for the welfare and wellbeing of others, community solidarity – that are among the defining qualities of what it is to be human, and the qualities that make society possible. Instead, she promotes capitalism as a moral system, and egoism as if it were a duty. It promotes government by sociopaths. Governing with amoral principles is immoral.
Without a moral compass, the ship of state is foundering in the storm of a culture war of Social Darwinism.
Culture is the foundation for all the social determinants of health, but national directions are a function of politics. Daniel Patrick Moynihan, the late senator from New York, explained it this way, “The central conservative truth is that it is culture, not politics that determines the success of a society. The central liberal truth is that politics can change a culture and save it from itself.” Our politics today are fueling the worst aspects of our culture, not improving that culture.
When a cynically evil oxymoron like “compassionate conservatism” is used to gloss over pathological political policies, public health must be one of the voices calling its proponents to account for the misery, morbidity, and mortality being produced in the greedy pursuit of wealth and power. Nothing less is requisite in dealing with the social determinants of health.
If public health defaults on its obligation, that is de facto an apology for the aggrandizement of the 1%.
Primary prevention is the defining approach of public health, but it is failing to practice precisely that: The nation’s health issues stem ultimately from how power is exercised politically, so public health must reveal that and how power and resources can be redistributed more equitably to benefit the entire population. Public health routinely identifies the agents and vectors that infect populations with virulent pathogens while ignoring the deadliest one of all, our political system.