Essays by Language:
Is Public Health a fascist movement?
When describing and evaluating my new definition of Fascism, I tended to go back and forth over the question whether the Public Health-movement qualifies as fascist. In order to keep my article on fascism focused on the important movements, I have decided to write a separate essay to delve into this question deeper. My previous answers to this evaluation are not yet satisfying to me. I have dismissed the classification the first time around (May 2019) and corrected myself when re-evaluating it in December 2019. And I found my arguments unconvincing when I last read them back. So I'll try again.
Verplicht inenten: goed idee?
Naar aanleiding van de recente discussie over de mazelenepidemie op de Veluwe, welke mede het gevolg is van de weigering van veel gereformeerden om zich te laten inenten, wil ik een eigen verkenning doen van het vraagstuk van verplichte inenting.
Hierbij spelen een aantal aspecten een rol:
Conclusie bijgewerkt op 31-7-2013.
Preventie is een individuele verantwoordelijkheid
Preventie in de context van de gezondheidszorg wordt in toenemende mate beschouwd als een publieke taak. Waar dit tot voor kort voornamelijk een adviserende rol betrof (neem bijvoorbeeld de consultatiebureaus) wordt preventieve gezondheidszorg steeds meer gezien in termen van regulering, toezicht en handhaving. Het autoritaire karakter van deze vorm van preventie wordt daarbij over het hoofd gezien of bewust weggeredeneerd. Ik wil het in dit essay met name hebben over preventie van niet-besmettelijke ziekten, waarbij de preventie met name bestaat uit interventies in de levensstijl van mensen. Over besmettelijke ziekten en (al dan niet verplichte) inenting heb ik een ander essay geschreven.
Om het dwingende karakter van preventie te illustreren, wil ik een uitstapje maken naar de wereld van de overheidsfinanciën. De financiële huishouding van de gemeenten staat onder toezicht van de provincies, en daarbij bestaan twee soorten toezicht: preventief toezicht en repressief toezicht. Gek genoeg geldt het preventief toezicht daarbij als het strengste regime. Dat zit zo: wanneer de gemeente zijn zaakjes goed op orde heeft, bemoeit de provincie zich niet actief met de financiën van die gemeente en grijpt alleen achteraf in op basis van de periodieke verantwoording die de gemeente aflegt. Dit achteraf ingrijpen staat bekend als “repressief toezicht”.
Wanneer een gemeente zijn zaakjes niet op orde heeft, kan de provincie preventief toezicht instellen. Dit komt erop neer dat de gemeente elke beslissing met financiële consequenties eerst ter goedkeuring moet voorleggen aan de provincie. Op die manier worden financiële problemen vooraf voorkomen door de provincie. Dit komt er dus op neer dat de gemeente onder curatele van de provincie komt te staan en daarmee zijn zeggenschap over de eigen financiën kwijt is. Essentieel hierbij is dat het niet de gemeente zelf is die aan preventie doet bij zichzelf, maar dat de provincie preventief optreedt naar de gemeente toe.
Wanneer het dus niet meer gaat om “zelf-preventie”, maar om preventief ingrijpen door een andere partij (overheid of bijv. een medisch instituut), ontstaat een regime dat strenger is dan repressie (achteraf straffen).
Libertarianism versus State-Nannyism: Who’s Right?
Let’s assume that we’re in a democratic society. The essence of a representative democracy is that we elect politicians, who then decide over the rules of society by majority. And consequentially, that we follow and respect the rules that are thus constructed.
Within this context, democratic society should be able to achieve some kind of balance between the two extremes: total state control and total individual freedom. Different political views will be debated and whoever gets the majority will decide the rules.
For representative democracy to be fully representative, politicians should make clear to voters their principles, aims and preferred methods of achieving those aims. And then they should vote accordingly. Of course, representative democracy doesn’t always work this way. The items of discussion are not always known up front, and coalition-building may lead to compromises. Furthermore, a party can be divided or unclear on certain issues, which leaves the voter in hope that their politicians will decide according to his preferences.
Thus, unfortunately, our democratic society is not flawless. Representative democracy can be vulnerable to outside pressures which can tilt the balance of power to one side or the other (state-nannyism or libertarianism). In the past, access of lobbyists for both sides of the spectrum was very similar. With the increased media-influence, however, the political process is primarily driven by control over the masses. Politicians are increasingly pressured by media to conform to “public opinion”, which seems like some form of “new democracy” but which is in fact opinion created by media. Through the use of opinion polls, junk science, pressure groups and media-picked experts, a powerful lobby is created to sway politicians towards more state-nannyism. This state-control will lead to a noticeable shift in consumption patterns, which will in turn benefit some and damage others. The ones benefited by this shift readily provide the funds for the lobbying and pseudo-research activities. These funders might include corporations, philanthropists and the state itself. Noticeable, however, is the relative lack of private donations that these pressure groups seem to get. And those that do get lots of private donations, usually get those for other activities, such as research into cures for cancer.
Public Health is a religion, and should be treated as one
The movement that calls itself “Public Health” is increasingly trying to outlaw personal behaviours, that have until recently been viewed as innocuous pastimes. This development started with smoking in public indoor spaces and is being copied in other areas such as the use of alcohol, fatty foods, sugary drinks and meat. The public health movement insists that action is imminent in the battle against cancer, diabetes, heart disease and various other so-called ‘lifestyle related diseases’. And the targets for regulation have been shown, statistically, to have some sort of correlation with these ‘lifestyle related diseases’.
Does public health have a point here? And what is public health exactly? It claims to be a science-based movement, aiming to protect the health of humankind. There are two anomalies in this previous sentence. At first, the science-based claim is actually a mixture of science and speculation (i.e. opinion). Secondly, there is no such thing as the health of humankind, there is only the health of individuals, with health meaning: absence of disease. What public health primarily deals with is physical condition and the associated risks of getting diseases.
Epidemiology in the context of changing society
During the last few decades (approximately since the late eighties) epidemiology has been used by both public and private sector for political purposes. Predefined political views have been scientifically legitimized by “proving” the correctness of the measures to be taken, using epidemiological “evidence”.
The problem is that epidemiology is not a medical science, but a mathematical one. It is purely a specialization of statistics. Epidemiology is therefore no more than a machine to crunch numbers. Every form of interpretation of these numbers is pure speculation and has no scientific ground whatsoever.
Epidemiology is useful, of course. It can be used very well to search for possible cause-and-effect relationships. Proving cause and effect is usually more difficult. It can be done by taking away the supposed cause and see if the effect ceases to occur. Or it can be done by actually observing the effect and analyzing the process that triggered this effect. This depending on the branch of science involved.