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.

The first point requires a bit of elaboration. The vast majority of research into the causes of the diseases of old age (cancer, heart disease, diabetes, dementia, etc.) is done using the science of epidemiology. Epidemiology is, however, a strictly mathematical science, not a medical one. Epidemiology is a specialization of statistics. It compares numbers of disease cases with numbers of healthy people in a comparative population, and looks for differences between the groups. These differences may be indicative of a risk factor for the disease being researched. Or they may not. The point is, the science of epidemiology leads to a relative risk factor as a final result, which is simply a number, with a so-called confidence interval which corrects for the effects of chance. Interpreting these numbers in terms of causation, excess or premature deaths, and preventive measures, is based on nothing more than the opinion of the researcher. Or speculation , if you will.

Public health researchers generally have pretty outspoken opinions on lifestyles and their effects on disease in later stages of life. Normally, mixing fact with opinion would not pass the scrutiny of the peer-review process of scientific literature. However, when there is a large body of researchers which pretty much holds the same opinion on issues regarding lifestyle and health, the peer-review quality assurance loses its rigour. A lack of criticism within the public health movement leads to relaxation of scientific norms and procedures. This effect is reminiscent of the socio-psychological phenomenon of “groupthink” and could also be compared to the internal functioning of orthodox religious movements, where dissenters are silenced or excommunicated.

Considering the second point, the public health movement turns a predominantly individual characteristic (health) into a common good (public health). By doing this, and by setting health goals for society, it turns healthy living into a new form of moral value. And public health is very much at work implementing this new moral norm in general society. To do this, it turns to every level of government for regulation of lifestyles, taxation of products deemed unhealthy by public health, and denormalization campaigns. This is a worrying trend. Many moral norms are debatable and should be debatable at any time. There is only a few moral norms which are so widely accepted that they can be upheld by the state for every citizen (“thou shalt not kill, thou shalt not steal”). But in general, moral norms are the domain of religion (which may be personal or institutionalized). One believes in certain moral norms, or not. Or one allows oneself the indulgence of breaking some norms now and then (“thou shalt not commit adultery”). What public health is doing, is setting a new norm of healthy living, and claiming the power of definition of what healthy living is, thereby taking away the right of the general people to listen to their own bodies to determine what is healthy for them. This type of group behaviour is not just religious in nature, but reminiscent of the most fanatical of religious sects.

Looking at public health from both these angles leads me to the hypothesis to start viewing public health as a religion, and treating it as such. In general, religions deal with moral questions and inspire their members into leading a morally good life, which will (in most cases) lead to a happy afterlife in the future. Some religions (most notably Buddhism) focus on a morally good life leading to a happy life in the present. Public health is certainly portraying leading a healthy life as morally good, and more importantly, is portraying industries which produce and market so-called unhealthy products as evil. The fact that they do this proves they are very much in the good versus evil business which is predominantly a matter of faith. Whether anything is good or evil cannot be proven, it can only be believed. And one can choose to believe either ones own conscience or some authority (such as public health or any other church). For me, this is enough to claim public health is a religion.

What is the consequence of this? First of all, we should start looking at applying the division between church and state. In essence this division is reciprocal: it entails protection of institutionalized religions from state interference in their internal affairs, especially concerning their world views, as long as they don’t break any laws, and it protects state citizens from interference in their lives by institutionalized religions of which they aren’t members. This last essence also holds for individuals who have turned their backs on religions of which they have been members. Freedom of religion, in this respect, is primarily the freedom of the individual to choose his own religion.

What public health is doing, is trying to interfere in the lives of people who have not chosen to become members of the public health movement. Assuming public health is a religion, the state should protect the people from this type of interference, not actively support it. Otherwise the state will turn itself into a religious state, instead of a secular one. Of course, public health has some rights to encourage people to live healthy lives and join their movement. But there should be limits. A few years ago, I have made a distinction between activism and fanaticism, which is very much applicable in this case, even though I made this distinction in the context of multicultural society. Activism is a well measured approach to encouraging certain views and behaviours, and is primarily directed at emancipation and making possible an open and objective debate about a subject. Fanaticism is a fundamentally unlimited approach to fighting a good versus evil battle, in which all means of reaching the end are acceptable in eradicating the evil among us. Fanaticism is based on an unshakable belief in certain truths, and shows itself by a lack of willingness to discuss the issue with non-believers, a lack of doubt in their convictions, personal attacks on critics, and discrimination of non-conformists.

The above characteristics of fanaticism apply just as much to religious zealots who strive for e.g. sharia rule as they apply to public health. In fact, a public health dictatorship could lead to a worse place to live in than strict sharia rule, as public health can take away practically any freedom it chooses on grounds of protecting health. In theory, it could ban any form of consumption except drinking (state-supplied) water and eating vitamin pills. It might force us to cover our skins when going outside, to protect us against skin cancer. If we don’t stand up against this movement, we might soon be welcomed to the Brave New World of Public Health.

One thing we could do is to encourage government to make sure public health restricts itself to recruiting new followers and using persuasion to inspire lifestyle changes of these followers. Public health should be restricted to an activist course and should shake off its fanaticism. Public health should not interfere with non-members of its movement. Its access to the media should be restricted until they have laid off their fanatical policies. It should lose its state subsidies (states should not subsidize religious organizations). And government should not consider any proposals for new regulations from this movement unless they have been debated openly first, with ample room for criticism. Government should make sure its own organizations are not taken over by public health representatives.

Michiel van de Sande, September 17, 2012.