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Trevor Hancock: We should lift the siege on public health

I have worked in public health for most of my adult life, and am proud of my chosen profession.

I have worked in public health for most of my adult life, and am proud of my chosen profession. Not to be confused — as it often is — with publicly funded health care, public health is focused on keeping people healthy, protecting them from harm and preventing disease, injury and disability.

To be sure, we do not garner the headlines of the more flashy and usually over-hyped “medical miracles.” Nobody ever wrote a headline about the 100 cases of an infection or cancer that did not happen. But the work we do is vitally important — at least as important as the latest “life-saving” technology or drug.

Indeed, the evidence suggests that in the area of heart disease, for example, where mortality has dropped by more than half in the past 40 to 50 years, public-health measures — especially tobacco control — have been at least as important as treatment. Indeed, health care’s overall contribution to improving health outcomes is estimated to be only in the range of 10 to 20 per cent.

Yet public health is not accorded the respect it deserves, especially in a political context, where the focus is on the individual rather than on the collective. By and large, our politicians prefer to focus on lifestyle, on individual personal behaviour and responsibility, and on the use of media and marketing strategies to encourage healthy personal choices.

Yet, whether it is increased portion size, marketing of junk food and tobacco, reductions in the relative cost of alcohol, the creation of urban sprawl or many other areas of private enterprise and public policy, we have, in fact, made the unhealthy choice the easy choice.

Then we wonder why people make unhealthy choices, and blame them for doing so. Thus we shift the blame from those who create unhealthy conditions and market unhealthy products to those who live and work in such conditions and are persuaded to purchase such products.

This flies in the face of the evidence and experience we have garnered in more than 150 years of public-health history. Whether it has been sanitation and healthy housing, safe drinking water and food, seatbelts and drunk driving, or tobacco control and physical activity, we have learned that a healthier society requires the judicious use of legislation, regulation, taxation and the creation of physical and social environments that make the healthy choice the easy choice.

Just as in the 19th century, when infectious diseases were rampant in the industrializing cities of Europe and North America, we need a strong public-health system. That is why it is dismaying to see public health being undercut in many ways by the Canadian and some provincial governments.

In a recent editorial in the Canadian Journal of Public Health, Prof. Louise Potvin identified some examples of public health being under siege in Canada. These include the recent decision by the Harper government to downgrade the status of the chief public health officer of Canada, large and unjustified cuts to public-health services in Quebec, and attempts to limit the important and professionally mandated role of medical officers of health as advocates for the health of the public.

One particularly worrying viewpoint was stated by Peter Taylor in the Globe and Mail — not coincidentally at a time when the Harper government was in the process of undermining the role of Canada’s chief public health officer: “It is not the job of public health to have an opinion on taxes, economic policy, free trade or corporate control. Neither should it be their business to interfere in the freely made choices of adults.”

Such a view is both remarkably ignorant of the history and purpose of public health and an attempt to muzzle opposition to the health-harming economic policies of certain governments and their corporate masters. Moreover, the notion is simply laughable that adults make free choices in a world saturated by sophisticated marketing strategies on which corporations spend billions of dollars, and in the absence of clear and transparent information of the real contents of all their products and their real health impacts.

Far from undermining the professionals whose role is to protect and promote the health of the public, governments at all levels should understand that a strong, independent, well-resourced system of public-health services is a fundamental determinant of the health of Canadians.


Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria's school of public health and social policy.

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