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Nov 22, 2012

Preventative health debate: in defence of liberty and diversity

The problem with the preventive health movement is the refusal to accept a basic trade-off of Western society -- that liberty is at times more important than maximising community welfare.

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I was most pleased to see a detailed response from two prominent members of the preventive health industry to my piece on Monday about how deep the regulate-and-tax instinct runs in those who are paid to tell us what is good for us. A few minor things …

Which schools are “removing alcohol from school-based events because they acknowledge that the normalisation of alcohol influences the drinking behaviours of young people”? Perhaps readers can tell us their experience on this. More to the point, do Thorn and Jones seriously think schools should be made to do so? Should the majority of parents be dictated to by a minority of obsessives with an urge to impose their views on others, using the convenient figleaf that it’s “for the kids”?

If so, why not make schools ban the consumption of junk food at fetes? Make them knock off the sausage sizzle — what sort of example does the consumption of those little bags of fat set? The logic goes further. Make sure the second-hand book stall has nothing anyone could object to, for fear a child might pick it up. Ban carny rides and the jumping castle, for fear a kid could be injured. That’s the remorseless logic at work here: once it’s OK to ban one thing, it’s OK to ban everything that someone objects to as dangerous, because you can’t be consistent and say no.

The president of the AMA said “if we start digging out the evidence about when people should be exposed to alcohol it’s actually 25 years of age, not 18”. Sounds like a case for lifting the legal drinking age to me. As for the claim that half of adult Australians support lifting the drinking age, the relevant National Drug Strategy survey question Thorn and Jones linked to wouldn’t pass muster in the most biased polling: asking if people support measures to reduce excessive alcohol use, after literally dozens of questions about the negative effects of drug and alcohol consumption — seriously?

And, alas, Jones still hasn’t produced any evidence that Australian kids frequent group buying sites. A stat from a US site about 18-34 year olds just doesn’t cut it, unless she wants to go beyond the AMA and lift the legal drinking age to 35.

Australia does not rank “about the same” as European countries in terms of alcohol consumption, unless you think a 30% difference is “about the same”. The data Thorn and Jones quote and link to shows Australia on 10 litres per capita per annum. Austria is well over 13, the Czech Republic over 16, Denmark over 13, France well over 13, Germany nearly 13, Ireland over 14, Italy 10.7, the UK over 13.

And Thorn and Jones appear to have missed my point about the 18th century. I suggest they have a look at how responses to the Gin Craze were predicated on confining women to reproductive roles and depriving them of economic opportunities as much as any high-minded middle class concerns for the poor. As for Hogarth, how about Visit to the Quack Doctor?

And “bingeing by young people is a modern phenomenon”. Where’s the evidence for that? And what about the greatest Australian binge drinking phenomenon of all, the six o’clock swill, a direct product of social control efforts by minorities?

“Suddenly, a regular part of the social rituals of people around the world is a mysterious and disturbing phenomenon that requires more study (funded by taxpayers, natch) and warnings.”

But the most revealing part of the response is the language of Thorn and Jones. The “middle class” apparently has a “new obsession with wine”. Everything the preventive health industry disapproves of has to be medicalised into some sort of psychological or social dysfunction, even if it’s a tradition embedded in human culture for thousands of years.

Take the lastest wheeze from the industry. This week, yet another taxpayer-funded study was wheeled out by some preventive health bodies to attack what they called “pre-loading“. That’s the simple act of going to your friends’ place before going out at night and having a drink while you’re there, often while getting ready to go out. Suddenly, a regular part of the social rituals of people around the world is a mysterious and disturbing phenomenon that requires more study (funded by taxpayers, natch) and warnings. The media release concluded with the inevitable demand for tax rises on alcohol.

As more than a few people on Twitter pointed out when I linked to it, the media release could have been written by the very industry the preventive health industry opposes, the pubs and clubs, anxious to make people spend more on their premises rather than at home.

The same logic of medicalisation extends to women. “Women’s drinking” is apparently a problem per se. Thorn and Jones defended the case I cited in my original article, in which GPs were urged to interrogate all women about their drinking. For the preventive health industry, simply being female is a kind of medical condition that predisposes them to harms that require extra surveillance, intervention and regulation. Just like their eighteenth century antecedents, the preventive health industry can’t help but see women through the prism of reproductive control.

The broader point is this: Western societies have always accepted that there is a trade-off between individual liberties and maximising community welfare. We could put CCTV on every lightpole and in every house and cut the crime rate dramatically, but we accept that our liberties as adults are more important. We could ban every form of risky activity, from skydiving to eating bad food, and reap economic advantages, but we accept that our liberties as adults are more important.

But the preventive health industry doesn’t accept that. A lot like the corporations it routinely rails against, the industry reduces citizens to consumers and workers whose only value lies in maximizing their economic value through precious QALYs. And where it is unable, or doesn’t dare to propose, banning things, it proposes to tax them out of reach. And all funded by taxpayers. In this sense, the preventive health industry is just another sector of the economy looking to make a buck from us.

Human diversity and a willingness to take different paths through life aren’t a problem to be medicalised.

Bernard Keane — Politics Editor

Bernard Keane

Politics Editor

Bernard Keane is Crikey’s political editor. Before that he was Crikey’s Canberra press gallery correspondent, covering politics, national security and economics.

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15 comments

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15 thoughts on “Preventative health debate: in defence of liberty and diversity

  1. slickrichard

    Thank you Sean and James. Bernard is way out of his depth on this one. As a medical student and frequent reader of Keane I’m shocked that he’s ignored and even ridiculed the incredible importance of preventative medicine and public health. It is nothing but plain offensive to compare the preventative medicine ‘industry’ (funny, I’ve never heard of this) to some of the other self-interested lobbying bodies in our society. Public health bodies ask for bucks from taxpayers because initiatives aimed at improving the health, disease-free lifespan and thus quality of life of members of our society costs money. Already in my three years of medical school I’ve seen too much of the devastating effects that alcohol has on individuals and families, biologically, psychologically and socially. Alcohol (and tobacco) are now a major factor in a truly scary proportion of hospitalisations, many of them for horrible chronic and incurable conditions. For those who think that people will simply do the right thing with alcohol (to protect their children from the harmful effects, for example), only need to stand outside any one of Sydney’s major hospitals and (perhaps with gas mask fitted) see how mums and dads with their young children at hip care to observe the suggestion/plead not to smoke around nsw health centres. Perhaps this no smoking policy at the doorstep of our centres, where people are incredibly being treated for and dying from diseases causes by smoking has gone too far? Using Mr Keane and his supporters’ similar straw man tactics (as if the cake stall, kebab shop and pizza kitchen wasnt enough already), maybe we should be opening up a bottle shop or two and a pub inside our hospitals where the friends and relos can forget their troubles outside of visiting hours? To argue that since prohibition of something doesn’t work, therefore any attempt at regulation to improve health is evil is simply ridiculous and commits some basic logical errors. Please just be a little more rational and think outside of your own head everyone who has jumped on the BK bandwagon (that’s not Burger King).

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