The puritanical public health movement

For eight weeks in 2011, four public health researchers – three from the Cancer Council, one from the University of Western Australia – watched 792 music videos aired on Australian television. They recorded all the mentions of alcohol, tobacco or illegal drugs.

The results were published in the journal Alcohol and Alcoholism in September this year. About one-third of the music videos referenced drugs. The vast majority of those references were to alcohol.

Here the full horror is unveiled: “references to alcohol generally associated it with fun and humour”. Only 7 per cent of the music videos that referred to booze presented alcohol in a neutral or negative light.

The paper argued music videos mentioning alcohol positively should be classified differently and regulated out of the morning timeslot.

But more broadly, the implicit claim of this research is there is something wrong with our culture: not just “the culture of drinking”, but culture in general.

Society associates alcohol consumption with fun, humour and celebration. According to the researchers, that association is “insidious”. One might add: pretty accurate.

This minor paper tells us a lot about the spreading ambition of public health activism.

The modern field of public health started with campaigns against ignorance. Educational programs were designed to inform the citizenry of the health consequences of their choices. The messages were simple. Smoking is bad for you. Keep fit. Eat more vegetables.

Such benign information provision is a thing of the past. Now public health is a great social project. It desires nothing more than a complete rewiring of our preferences and a rewiring of the culture which it assumes formed them.

It’s not just that the study of public health is deeply paternalistic and patronising. Nanny state accusations have pursued the field for decades. And no wonder: the Rudd government’s Preventative Health Taskforce even recommended the Government regulate the portion size of restaurant food.

But nanny state doesn’t quite capture it. Public health is an imperial discipline, dragging in everything from cultural studies to urban planning. And it does so all in the service of an increasingly ambitious program to reshape society and prioritise health above all other moral values.

Take the most fashionable adjective in public health right now: “obesogenic”. This pseudo-medical term describes an environment – usually physical, but sometimes social and cultural – which encourages over-eating and under-exercising.

Under the obesogenic flag, public health activists seek to colonise debates over housing sprawl, economic policy, public transport, childcare, house size, telecommuting, infrastructure spending, consumerism, and sustainability. Even law and order has been dragged into the public health domain: high crime rates mean parents don’t let their child walk to school which means those children get fat.

Here public health becomes less a medical concern and more an umbrella social critique. As one book, Obesogenic Environments, puts it, obesity is first and foremost a social problem. Certain obesity-encouraging practices have become culturally embedded. We eat out more. We drive instead of walk. It is the self-appointed task of public health activists to change those embedded practices; that is, “promote healthier choices”. Town planning has to change. Tax policy has to change. Infrastructure spending has to be reprioritised. Our preferences have to be redirected.
With its grand social crusade, the public health movement has come full circle.

Temperance activists in the late nineteenth and twentieth century talked as much about social practices as alcohol consumption. The major American temperance lobby was called the Anti-Saloon League. Saloons weren’t just bad because they were where the drinking happened. They kept men away from their families, and encouraged other sinful behaviour.

In Australia temperance activists lashed out at everything. In 1896 the South Australian politician King O’Malley described barmaids as “the polished fangs of the stagger-juice rattlesnake… angels of mercy luring men to their own destruction”. Several states banned barmaids. One major avenue for female employment – and the economic independence it brought – was closed. Poor old barmaids were merely collateral damage for the monomaniacs obsessed with stamping out booze.

In the same way, today’s public health movement is willing to jettison many other values in its quest to rewire society.

The hard-won conveniences of modern life – cars, restaurants – are obstacles to a better world. Popular culture is “insidious”, simply because it reflects our own beliefs back at us. Choosing what we eat and drink is not a right, it is a prison.

Public health is groping towards a full-blown political philosophy. Sure, it speaks the language of medicine. But it is more ambitious and vague than that modest field. The paper on music videos is a ham-fisted attempt to give cultural studies a scientific patina.

Like the puritans of the past, the public health movement is flailing against a society and economy it believes is deeply unwell.