Friday, July 19, 2013

If We're Serious About Public Health...

If we seriously want to improve the quality and accessibility of healthcare services available to the general public, we first have to acknowledge and cater to the nature of the average person who would benefit from these services. One problem with existing public health initiatives is when they sound great to highly-educated people who already take care of their health, but do not actually appeal to the general public.

Case example: Patient education. Most ordinary people hated school, got out as fast as they could, and still cop an attitude when someone tries to correct their erroneous thinking, so how are they going to respond to someone telling them that they are not taking care of themselves the right way? Not enthusiastically. Furthermore, patient education programs often assume that people are actually willing to make sacrifices in the present for the sake of having a better future. Few people actually think that way, especially when those sacrifices require enormous willpower, as in the case of quitting smoking. The people who actually understand that their present actions will pay off in the future are already taking care of their health. In fact, they are probably already working in healthcare, thinking that everyone enjoys learning as much as they do and that patient education will work.

Recently a woman walking down the sidewalk asked me if I had a lighter for her cigarette. I said, "You shouldn't smoke. It's bad for you." She said, "I know that, but for some reason I just don't give a shit." I don't think we can ignore this kind of attitude or pretend that it will be educated away. Instead, I think we should accept this feature of humanity and think about constructive ways to reach a healthier middle ground, even if it falls short of our ideals.

The idea that I'm getting at is likely to be a controversial one. If health-destroying products like cigarettes, drugs, alcohol, and junk food are not going away, then the next best solution is for the medical establishment to enter those industries, offer healthier versions of the current products, and use the profits to fund public health projects. Why should all of the money currently spent on tobacco, alcohol, and junk food go straight to corporations who do not give a shit about anyone's well-being? Why should all of the money currently spent on recreational drugs go to gangs and drug cartels? Why shouldn't it be diverted toward healthcare? If people are going to seek out this stuff anyway, isn't it better if physicians are involved to guide them toward a slightly better outcome?

The first counterargument I would expect to to hear is that for moral reasons doctors should not endorse, let alone provide, such unhealthy products to patients. However, my rebuttal is that there is a sort of moral opportunity cost here. If a doctor does nothing, the patient buying cigarettes at Rite-Aid will be worse off than if the doctor sold the patient a less unhealthy cigarette product. Furthermore, if the patient goes to Rite-Aid, the money will be going to a tobacco company's marketing campaign to rope in new smokers instead of toward someone's healthcare. Therefore, the doctor is theoretically doing more harm by doing nothing. If he wanted to help people by doing nothing, he should have become a Buddhist monk instead of a physician.

A second counterargument would be that this idea is unnecessary because there are already "sin taxes" on alcohol and tobacco products that are partially used to fund health services. My rebuttal is that such a tax intervention could not be as efficient as a direct entry into the free market. Direct competition would divert more money toward public health projects, divert money away from companies that push these unhealthy products through advertising, provide healthier alternatives, and lead to an overall improvement in the quality of public health.

Another counterargument might be that if people are interested in healthier alternatives, then someone will fill that need in the market without doctors having to get involved. This is indeed already true; look at the e-cigarette phenomenon. There is clearly an interest for a less unhealthy cigarette, and medical scientists did not have to provide it. However, my rebuttal is that money from this product also could be diverted toward public health, and the most effective way to do this is through the direct involvement of health care providers, rather than through taxes.

The next counterargument is that having doctors endorse drugs and junk food would encourage people to start these unhealthy habits. My rebuttal is that people are already inundated with peer pressure and advertising for this crap; if they're going to be persuaded, they've already been persuaded. Just because doctors are providing their own versions of the same crap doesn't mean that they would push it on people who aren't already hooked on it. The point is to provide an alternative and fund public health services, not expand the market for crap.

The last counterargument is that doctors would never do this; it's not their business. Also, I'm sure there are tremendous legal and liability issues.

Well, I can't argue with that one.

In that case, this looks like a project for M.P.H. graduates.

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