The tyranny of public health

Public health dominates political discussion today. Masks, vaccines, social distancing – these are the issues about which we now argue daily. Not economics or the increasingly volatile geopolitical situation, but public health.

And I’m not just talking about the Covid pandemic. Indeed, virtually all aspects of social and political life today are now framed through the idiom of public health. Problems we used to treat as political and social questions are now often presented as medical issues.

So critics of prime minister Boris Johnson do not simply question his political record – they also brand him a public-health problem. As one article puts it, ‘Boris Johnson’s dwindling authority [is] becoming a “public-health issue”’. Likewise, Donald Trump was labelled a ‘public-health threat’ by his opponents while in office.

Public health has become a principal means to attack a political opponent or a set of political ideas. In 2019, a group of medics even wrote a letter to the Guardian calling a No Deal Brexit a ‘threat to public health’. Other critics of Brexit called it a ‘confused concept that threatens public health’. As public health has become politicised, politics has become medicalised.

The pandemic has intensified this medicalisation of politics. There is now virtually nothing that cannot be conceived of as a public-health issue. Take racism. Writing in the Lancet earlier this year, identitarian academic Kehinde Andrews insisted that ‘racism is a public-health crisis’. In the US, the director of the Centers for Disease Control and Prevention, Rochelle Walensky, made a similar claim earlier this year. ‘Racism is a serious public-health threat that directly affects the wellbeing of millions of Americans’, she said. The CDC has since launched a new ‘Racism and Health’ web portal.

All this changes the very meaning of racism. Racial oppression used to be understood in terms of political, social and economic domination. Now it is understood in terms of ill-health. The racially oppressed are now as likely to be seen as patients in need of medical intervention as they are victims of political injustice. ‘Racism isn’t just unfair. It’s making us ill’, complains a Guardian contributor.

Likewise, anti-racist campaigners portray racism as a mental-health problem. Student supporters of the Rhodes Must Fall movement at Oxford University have claimed that they feel traumatised by the presence of the Cecil Rhodes statue.

Increasingly, the presentation of a social problem as a supposed threat to public health is a means to draw attention to it. That is why President Biden recently chose to condemn gun violence as a public-health epidemic. Unable to present a critique of violence and crime in moral terms, he decided to offer one through the language of medicine.

Virtually every dimension of life has been reframed as a matter of public health. ‘Homophobia is a health issue’, argues one academic. Gambling is, too. So are climate change and war. Even boredom has been categorised as a threat to public health.

The most fundamental of existential conditions are now being reduced to medical problems. Take public-health advocates’ focus on loneliness, which the charities Mental Health Foundation and Age Scotland call ‘the public-health challenge of our time’. When the very normal condition of loneliness, which millions of people face daily, is transformed into a medical condition, then something is going seriously wrong.

Loneliness is a predicament that requires the engagement of friends, families and communities – not doctors. Yet it is now being turned into a target of public-health intervention. By recasting a challenge facing a community as a medical condition, public-health advocates transform people into patients and dehumanise the human condition.

The public-health lobby reduces complex emotional experiences to quantifiable units. This allows public-health technocrats to claim that loneliness is a ‘comparable risk factor for early death as smoking 15 cigarettes a day, and is worse for us than well-known risk factors such as obesity and physical inactivity’. In doing so they establish loneliness as a legitimate justification for public-health intervention, just like smoking or obesity.

The politicisation of public health would be less of a problem if it only helped people to live healthy lives. But that is not its function. Public health is now about moral regulation and, as we have seen during the pandemic, political control. When almost anything can become a target for public-health intervention, the very distinction between health and illness is eroded. People are encouraged to regard themselves as patients in need of medical support, rather than citizens capable of overcoming any adversity they might face.

Public health used to be a sensible project. It used to be about protecting health and life. But now it has become a means to regulate people’s behaviour and lifestyles. And governments are now drawing on its moral authority to enforce their will on society. In its current politicised form, the ideology and practice of public health is a direct threat to freedom and democracy. Rolling back the influence of public health on politics is one of the most important tasks facing us today.

Frank Furedi’s 100 Years of Identity Crisis: Culture War over Socialisation is published by De Gruyter.