December 18, 2008 The Pump Handle 4Comment

by revere cross-posted at Effect Measure

The Holiday Season is upon us so we won’t post daily on the Public Health Conversation series. But you can join in at any time, in two ways.  Effect Measure and The Pump Handle, the two blog sites hosting the discussion, have comment threads for each post.  You can make a comment at any time on any post.  If you want to see all the posts on this topic, just click the Progressive public health category on the left sidebar on Effect Measure.  We will put an appropriate tag on The Pump Handle posts as well.  If you have produced a more polished piece, send it by email to The Pump Handle. We will be posting some on the Front Page we think are especially pertinent to various points in the conversation.  Get your 15 minutes of fame!

We want people to be part of this conversation.  I know from my own experience it can be discouraging to leave a comment that seems to draw no response.  If you leave a couple of comments and no one seems to care, it is tempting to stop commenting.  But the comments really are read by people.  One of the most common reasons a comment doesn’t draw a response is that people agree with it and don’t have anything to add.  Comments people disagree with often draw responses, so be careful what you wish for!  Either way we hope you join the conversation by reading, responding, thinking or contributing.

Our image of the public health system is of a huge chess board, with pieces of all varieties (elaborate to simple), all ranks and status, and a huge range of inherent powers.  The rules are complicated and the moves made by unseen hands.  What we want to do here is take our arm and sweep it across the board, wiping it clean and starting over (metaphorically, of course).  We are asking fundamental questions about public health, what it is, what it’s for.  And it’s not just US public health.  We have readers on every continent (except maybe Antarctica).  Public health knows no borders.  So while there may be different views as to whether health is a Right or not, and I think that’s worth discussing, we aren’t interested here whether it is a Right under the US Constitution.  It’s not a legal question but a question about what we think our mission is in public health.  And when I say “we” I am including anybody who sees themselves as engaged in or interested in or working in public health.  I don’t care if you are the head of a hospital, a nurse, a homemaker, a teacher, a doctor, an engineer, a laborer.  If you have something to contribute, that’s the point. And most people who are genuinely concerned about public health will have something to contribute, even if it is agreement or disagreement with what someone else said.

Panning for gold in this muddy river will take time and patience.  We might go around in circles (although I hope they are at least ascending spirals) as we try to clarify our thoughts, examine proposals for their consequences, argue about basic concepts and words.  It’s hard work and frustrating.

But someone needs to do it sometime. Soon. Why not us, why not now?

4 thoughts on “Public health: how to join the conversation

  1. I’ve been working on something, but many people who read blogs don’t really like to reply because its just the way they are- the public health community (from my view) is generally older and if they even READ blogs its not for two-way communication- that why there’s conferences and CC:. Is it possibly an archaic view or are people just too busy to bother with this when they already have 15 hours of work to fit into their 8 hour work day?

    I came to the pump handle from Confined Space when it shut down, and that was a problem there as well-I think internet anxiety is a real issue for alot of ‘new'(or older) blog readers; it’s easy for my generation because we grew up on the internet, but as you said “Comments people disagree with often draw responses” and most people who’ve been doing this for 30 years don’t want to hear what some random guy on the internet.

    I encourage people to post anonymously and ignore any responses if you please, but at least get your voice into the discourse(I had a professor once who was obsessed with saying if you control the discourse you control the message…I don’t think she was right, but definitely onto something;))

    You’re right tho, with an administration who will at least pay lip service to the issues, and is ready to throw out another $800bil for ‘something’ we’re probably already late on this-every public health organization probably already has a plan but 500 different plans may suit some, but we’re all about the many. At the same time though, as rage said, “It has to start somewhere. It has to start sometime. What better place than here, what better time than now?”

  2. This is a great idea, and thanks for giving voice to this conversation. I’ve gotten a start on my contribution, and will be posting the full essay on my blog.

    I think the “what is public health for” is clear enough. Public health is important because it’s hard to have industry or agriculture or art or literature or entertainment or public discourse or law or education or hundreds of other things that are necessary for civilized life, if you’re ill, dying or dead, or have to expend an inordinate amount of time to stave off being ill or dead. The harder question is what should public health look like to accomplish this goal.

  3. I finally have some time to submit a contribution to this conversation. I’ve been thinking and talking about “commodification” of public health over the years and the current economic meltdown brings me back to it. It seems that one of the problems that led to the collapse of the housing bubble was derivatives that were based on nothing more than bundled paper. When the first of those began to unravel, and banks which had held them began to fail, the whole edifice began to tumble. This isn’t a direct parallel to commodification of public health or public goods like clean air, but it seems to stem from the same impulse to create ways to generate profits out of nothing tangible. The “” bubble was famous for this a decade ago. The idea was that the “market” would eventually sort out the winners and losers and find the optimal solution that met people’s needs.

    The current plan to “cap and trade” air pollutants has this quality, I think, in that it proposes a way for a public good to be commodified and given “exchange value” that the market will eventually optimize in terms of improved air quality. This is completely in tune with orthodox economics, of course, and today’s Boston Globe has an op-ed touting this and urging the Obama Administration to get on with it. The authors say such a system will “begin to reveal the cost to reduce emissions and provide the price signals for doing so that our economy urgently needs.” They describe this as tortoise approach as opposed to the “hyperactivity of the hare.” My own view is that this tortoise is leading us right over a cliff.

    One place where this particular approach will be debated is the Copenhagen Conference of the Parties in December 2009, where the successor to the Kyoto Protocol will be hammered out. The U.S. role in these discussion over the past decade or more has been to propose “cap and trade” solutions as the fundamental mechanism for cutting greenhouse gas emissions. Without a countervailing “hyperactive” approach, such as a stimulus package that seriously ramps up alternative and renewable energy technologies, the Obama Administration will simply be perpetuating a flawed mechanism. We in public health can contribute to this conversation and have begun the process (see, for example “Healthy Solutions for the Low Carbon Economy” at We’re going to need to engage at a high level if this will have any effect on our Administration before December. We have organizational and institutional mechanisms to do this, and we need to continually activate them.

    I’m going to stop here, but I have also been thinking about the startling commodification of cancer treatment (and individualized therapy) and the incredible increase in costs of care over the past decade. All this proceeds while obvious opportunities for primary prevention are foregone. I’ll try to put some of that in a future post.

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