Public Health Advocates: Memento Mori

Health Policy

On Facebook earlier today a friend posted a article titled 5 Things They Say Give You Cancer (And Why They’re Wrong).  Cracked isn’t my main source for health journalism, but the ensuing conversation got me thinking about public health advocates and the causes that come in and out of fashion with that crowd.

Below the article, this friend posted a fully-cited list of things that Britain’s Daily Mail has said will give you cancer. The list contains some of the usual suspects, but some interesting entries caught my eye:

  • Money
  • Poverty
  • Age
  • Being female
  • Or male
  • Childlessness
  • Having children and being pregnant
  • Water
  • Pizza (have mercy)
  • Worcestershire sauce

Beyond the commonly accepted (repeated sunburn, smoking, etc), some of these seem blindingly obvious and some are straight-up bizarre; and while it may be scientific illiteracy on behalf of journalists, they frequently confuse correlation and causation.  Age is heavily correlated with cancer, but doesn’t cause it.  Other things that come with being 92 increase the chance that you have had, have, or will have cancer, not the age itself.

The bizarre aside (have they done a study on cancer in hermaphrodites?  Are they impacted doubly, or not at all?), my friend made a deeply insightful comment: when it comes to public health, “[this] paranoia is a manifestation of our fear of death. We’re living longer and more comfortably than ever before, but that is not enough! We must avoid all the things so we can live forever like our ancestors did. No, wait…”.

It’s that last bit which is particularly noteworthy.  It’s a fear of death and harm, but a fear exercised on the behalf of others.  It is common for public health advocates (not just with cancer or disease, but with things like alcohol, fun, etc) to adopt a “one is too many” approach to optimizing our health; however consider one of the entries: Wi-Fi.  Wi-Fi’s inclusion on the list is debatable at best, but it represents something which is deeply beneficial and profoundly transformative to human society.  If you asked me to make a trade-off between Wi-Fi, nuclear energy, computers, and various other modern technologies which substantially improve my quality of life and a non-trivial increase in the chance that I might get cancer, I would easily opt to live in the 21st Century.

We all make trade-offs between different alternatives.  I can’t spend all of my time reading blogs and finish the literature review for my thesis which I’m postponing to write this.  By taking risks, eating foods we enjoy, and taking advantage of the myriad of life choices available to us in a free and modern society, we might disturb the utopia of many public health advocates and die from something other than slow degeneration in our 120s.  If we make longevity the primary value of our lives, we cannot expect our lives to have much enjoyment (as humorously put by an excellent Saturday Morning Breakfast Cereal cartoon).

This doesn’t mean that this kind of research is useless – just the opposite.  It’s important that we know the chances we’re taking so we can make better decisions.  I’m pretty glad that I know that smoking causes cancer.  What’s dangerous is when advocates take their “one is too many” approach to policy.  We’re bombarded constantly with the threat of fat taxes, soda bans, prohibitions and regulations, ingredient bans and the like.  Advocates often say “Approach X is empirically proven to have beneficial effect Y”.  Even if they’re scientifically correct (which I, as someone who has reviewed a bit more public health literature than I’d really like, can say that isn’t always supportable), this doesn’t transfer (logically) in to policy.  There’s a difference between requiring calorie counts on menus and requiring that we maintain a certain diet.  Many public health advocates ultimately suffer from the nanny complex – we are their wards and they, the wise, know what is best.  Even if they are always right and always well-meaning, they have one essential and insurmountable handicap: they must always substitute their values for ours in making decisions that affect our lives.

Policymakers should hear what public health advocates have to say, and then make policy which ensures that individuals can make sound decisions while maintaining the freedom to live the life they want to live.  We should be less focused on what makes a long life and focus instead on what makes a fulfilling life.

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