Public Health Intersection

Prior to coming to PHFE, a significant portion of my career was spent in the public policy arena and a significant portion of that time was spent trying to implement population based policies that protected and improved the public’s health.

From time to time there would be cries of “nanny government” from those policy makers, interests and organizations that thought that public health interests were going too far and intruding into the people’s lives without any reasonable cause or tangible benefit.

Recent areas of contention include menus with fat and calorie counts, helmet laws, smoking bans, etc.

If history is any teacher we should have learned that sometimes the obvious, and even scientifically proven, benefit of a behavior or action isn’t in itself compelling enough for people to cause them to change their behavior.

How long were seat belts available in vehicles before we figured out we also needed laws to require them to be worn?

How many deaths and serious illnesses were prevented by vaccines before laws requiring childhood vaccines were implemented? (This is still contentious with regard to various exemptions and concerns about vaccine formulation, etc).

What about fluoridated water? Who knew back in the 1950’s that children in the 21st century would probably never drink water from anything but a plastic bottle thereby thwarting any cavity preventing benefit that fluoridating public water systems may have provided.

This last example also points out the need to regularly review policies to assess whether they still are effective in meeting the challenge they were implemented to address.

The recent discussion regarding whether the federal government should require reduced salt content in foods may be a good candidate to use to discuss whether the government is going too far into our private lives and restricting our free choice, (nanny government), or whether we should expect the government take seriously protecting our health and well being by implementing policies to protect us from harm, (social contract).

Also necessary to address in the discussion are the interesting permutations of attempting to reduce the use of products that have the potential to harm health, (tobacco, alcohol, foods and beverages with extremely high sugar or sodium content), by taxing them to increase their cost and thereby reduce consumption of those items.

There is often, however, a disconnect as the resultant revenues are not always dedicated to improving health but rather to increasing the overall revenue collected by the government.

Many recent efforts have also tried to include market driven solutions, an attempt, perhaps, to include business interests as promoters of improving health rather than just supporters of various health related initiatives or being in opposition to them all together.

It probably takes a village to keep a village healthy and that includes establishing and enforcing social norms and supports that promote and improve health, (social contract).

So while government definitely has a role it really falls to the rest of us to take action to make the village healthier. We need to be the ones who together establish and enforce the agreements that focus on keeping all of us healthier.

Oftentimes this is where personal responsibility gets discussed particularly among policy makers.

Some argue that people should “watch out for themselves” and if they make bad decisions that’s their problem.

Sometimes this seems a little disingenuous coming from legislators who have well paying jobs, high quality health insurance and other benefits.

On the other hand what good are laws without the social will to change?

Recent examples of those include laws to restrict cell phone use and texting while driving.

Of course the industry is willing to sell you apps that disable those functions while driving instead of making them part of each phone, (same with side curtain air bags, by the way).

Well there’s an accident up ahead so I’ll have finish this article and get my hands back on the wheel.

Being a good example is hard.