I read an interesting article by Micah L. Berman titled “From Health Care Reform to Public Health Reform” appearing in the Journal of Law, Medicine & Ethics (Fall 2011, pages 328-338).
In the article Micah L. Berman discusses how the Affordable Care Act contains an “individualist/biomedical paradigm” which includes a number of provisions and programs which focus on public health but are in fact misaligned and at odds with public health research. He does this by first (A) arguing that in America there is a large cultural emphasis on personal responsibility which is shaped by powerful political, social, and psychological forces and second (B) that influential industries profit at the expense of public health.
A)
Micah states:
“This paradigm focuses on what can be done by or to individual patients, and it leads to policies that seek to either (a) encourage more responsible decision making about personal health, or (b) promote early detection of disease by improving or expanding access to biomedical screening and testing. By contrast, a broader “public health paradigm” more aligned with public health scholarship … “emphasizes the environmental and social determinants of health and how they affect the well-being of populations [and not just individuals],” and leads to policy interventions designed to address the population-level structures contributing to poor population health.”
Micah states that
“…Because people’s decision making is so deeply influenced by the social, cultural, environmental, and economic contexts in which such decisions are made, health education campaigns that seek to alter individual behaviors have been shown, in example after example, to be ineffective if not coupled with more systemic environmental changes.”
Micah provides a quote which states:
“Psychological research suggests that people are deeply invested in the notion that they are fully autonomous agents impervious to external influence. Acknowledging otherwise is taken to be a concession of weakness or personal failure…even in the face of compelling evidence to the contrary, “[w]e like to believe that we are independent, intelligent consumers of life’s many options — the attitude-driven, reasoning, choice-makers of commercials and Westerns.”
Micah offers a suggestion modeled around obesity to help public health advocates reach a message to the American public:
“The fact that nearly every country is encountering a rise in obesity as its national wealth increases suggests that structural and cultural factors are far more important sources of the problem than a mass failure of individual willpower… The obesity epidemic has resulted in large part from collective, societal choices (or, in some cases, by our collective failure to act), and, as a result, it can only be addressed through communal policymaking.”
B)
Micah argues that corporations that contribute to poor health such as tobacco and fast food companies spend a large amount of advertising and lobbying dollars to promote the personal responsibility narrative which is incorrect which is argued above.
Micah describes how in 2009 The American Beverage Association created a group called Americans Against Food Taxes which launched a $10 million advertising campaign against a potential soda tax. Micah states:
“In addition, “beverage lobbyists attacked some of the country’s most distinguished nutrition scientists, accusing them of bias and distorting available evidence,” while the industry simultaneously financed questionable research supporting its scientific claims.”
Due to the strong lobbying power at the federal level, Micah argues that public health advocates are better served at the state and local level. He notes the progress that tobacco control advocates have had in enacting smoke-free laws in communities and how numerous communities have enacted projects to ensure that walking and biking along roadways is safe and convenient.
The article by Micah is definitely interesting and enlightening for all those involved in advocating for a healthy public.