The Politicization of Public Health

The Wall Street Journal, December 12, 1996

By Sally Satel

The field of public health can point to numerous recent triumphs in protecting Americans by preventing disease — from subduing New York City’s tuberculosis epidemic a few years ago to testing water for dangerous bacteria after California floods. Public-health professionals do crucial, lifesaving work. So whom did the American Public Health Association choose to deliver the keynote speech at its annual scientific meeting last month? None other than AFL-CIO President John Sweeney, who, predictably, enjoined the audience to “help us rejuvenate the labor movement.”

Mr. Sweeney’s appearance is but a symptom of the politicization of public health. Activist researchers — some of whom aren’t doctors or epidemiologists but sociologists or cultural anthropologists — are moving the field in a pernicious direction. Forget about science and medicine: The official theme of the conference was “Empowering the Disadvantaged: Social Justice in Public Health.”

At a conference symposium called “Measuring Social Class in Public Health Research,” Paula Braveman, a University of San Francisco physician, made the case for radical redistribution of wealth. “Living in an unjust society damages physical health. Even if those living on the lowest rung of the social ladder had enough material resources, their health would suffer because they are deprived relative to others.” Illness is caused by the “power imbalance” inherent in a capitalist society, Dr. Braveman maintained, urging her peers to “counteract the free market with social programs.”

Another speaker, Harvard epidemiologist Nancy Krieger, bemoaned the “dismantling of social programs by the supporters of corporate America.” Dr. Krieger had her own 15 minutes of fame recently for a study she co-authored in the American Journal of Public Health (published by the APHA). Her article, “Racial Discrimination and Blood Pressure,” blamed black Americans’ greater risk of high blood pressure on the stress induced by racism. Dr. Krieger’s data were riddled with contradictions and failed utterly to support her case. But credulous reporters had already eaten her conclusions up — largely because of the self-promotional efforts of the journal, which spoon-fed journalists a predigested summary of Dr. Krieger’s article.

Dr. Braveman, Dr. Krieger and their colleagues are right, of course, to point out that the poor tend to be sicker and to have shorter lives than the better off. But while this is partly because their access to medical care isn’t as good, it is also partly because unhealthy habits are more prevalent on the lower rungs of the socioeconomic ladder. This is why a world view that regards the “patient” as a passive victim of malign social forces is a prescription for disaster. Some of the greatest successes of public health have involved efforts to change personal behavior by educating the public about the risks of such activities as smoking, unhealthy eating and unprotected sex. Indeed, more than half of all premature deaths are attributable to risky personal behavior, according to the Department of Health and Human Services.

Practical efforts to change behavior, however, seems far less glamorous than the politically correct goal of, as one symposium title had it, “Putting Politics Back Into Public Health Education.” Yet another panel featured Vincent Iacopino, who teaches a course called “Human Rights and Health” at the University of California at Berkeley School of Public Health. Urging his audience to “merge the academy with advocacy,” he cited the World Health Organization’s expansive definition of health — “a state of complete physical, mental and social well being, not merely the absence of disease or infirmity” — as justification for politicizing his classroom.

Along similar lines, Camara Jones, a professor at Harvard’s School of Public Health, teaches a course on “Race and Racism.” At the conference Dr. Jones described how she has her students spend weeks exchanging experiences of being discriminated against and exploring their own racist tendencies. Sharing the panel with Dr. Jones was Prof. Sally Zierler of Brown University, who teaches “The Health of Women,” a course with the “objective of involving students in public health activism.” According to the syllabus, “students will evaluate the scientific research . . . on diseases [such as] vaginitis and premenstrual syndrome . . . with a goal of moving this knowledge to useful forms of private and public action.”

Listening to a procession of these “experts” is profoundly dispiriting to anyone who truly cares about containing the spread of drug-resistant streptococcus bacteria and the Ebola virus, reducing infant mortality, screening for breast cancer or preventing birth defects. It’s a concern Fernando Trevino, the APHA’s departing executive director, shares. He insists that his organization’s activist leaders don’t reflect the rank and file, “most of whom are mainstream researchers and practitioners devoted to prevention of disease and injury.” These professionals, Dr. Trevino says, are “a silent majority . . . and unless the leaders are politically and philosophically in concert with these folks, the association runs the risk of becoming irrelevant.”

Dr. Trevino may be right. But there are powerful external forces driving the politicization of public health: scholarly journals that have taken to aggressive self-promotion, reporters who lack the expertise to evaluate studies like Dr. Krieger’s before giving them a wide audience, and the Department of Health and Human Services’ strong emphasis on minority health. As the field drifts from its scientific and clinical moorings, the health of all Americans stands to suffer. Worse than irrelevant, the politicization of public health is a public menace.