Power to Public Health
I have been led to study public health by curiosity and hope, but mainly by frustration.
The frustration is born of eighteen years in clinical medicine. Those years have fundamentally changed my attitudes towards individual responsibility for health and wellbeing. In life in general, I advocate individual responsibility, I believe deeply in the importance of self-determination and personal freedoms. However, in my daily work as a General Practitioner, I meet an enormous number of people with non-communicable diseases. Where time allows, I discuss the power of lifestyle to prevent and treat disease; I encourage people to make lifestyle changes. But over the past few years, I have increasingly realised that this essentially means trying to motivate people to fight against their environment.
The world around us all promotes unhealthy activities. Environments built around car use; cheap and convenient, unhealthy food and the heavy promotion of alcohol and gambling all contribute to a toxic health environment.
I see clearly that many of those least able to resist this environment are those who are unempowered, using all their energy managing financial, employment, social and housing stresses. Those with the highest levels of non-communicable diseases are often those worst-placed to take control of their lifestyle choices, not due to laziness, or lack of caring, but due to their life circumstances.
I have seen this starkly in many patients over the years. But one really stays with me. A caring and hardworking husband and grandfather, his zero hours contract meant enormous financial pressure when he had to become a carer for his wife. He slipped back into alcohol dependence after almost 20 years of abstinence. Adverse childhood events and early social deprivation put him at high risk of addiction and ill health, and despite having overcome his addiction so long ago, his financial and social vulnerability meant he was not able to continue to make the choices he wished to. If his environment and his employment security had been different, I believe the outcomes for him and his family would have been different. His wish to live well and healthily was so great that he had beaten addiction, but he had no safety net when his circumstances changed.
In contrast, when life threw me extra challenges, my partner and family were able to rally round. They had the autonomy, power and financial flexibility, to rearrange their commitments, and support me. I often wonder how different things would have been if I had not been lucky enough to be protected by this privilege. I had lost the capability to plan, shop for and cook healthy food. In the face of adversity, my ability to make healthy choices and commit time and energy to a healthy lifestyle disappeared.
Preventing social deprivation and adverse events in childhood is a terribly complex issue. But I look at our current public health policies and see many opportunities for making dramatic improvements. I see ultra-processed food and harmful commodities marketing, and wonder why public health interventions are not being applied more powerfully. We seem to be protecting the financial interests of certain corporations, instead of the health of our societies. And I wonder how we can make public health policies more powerful.
I hope that this, my first step into public health, is my embarkation on the road to understanding some of these issues more, and adding one more clear and informed voice to the chorus calling for upstream changes to reduce the shameful health inequality I see around me every day.
