Ben McLeish - Public Health - Z-Day 2013

Zeitgeist Day 2013 - March 17th, Los Angeles CA Thank you, I come ... with great tidings of joy from the UK. They all say 'Hi' and they say they love you. [Applause] I'm going to broadly talk about public health, which has been touched upon actually very helpfully by Brandon, Jason and to some extent by Peter, as well. I call this 'Public Health: Historical and Modern Value Conflicts'. Of overriding importance to any society's security and integrity, is the integrity and development and flourishing of its own public health. This is true whether we define that society as a village community, a city, a nation, or the aggregated global population. As referenced here, 'public health' doesn't just mean physical health of individual humans within that collective, that being, broadly, the body's ability to cope with, and react to invasive infectional disease, and to build up a library of immunity, if you like, of known illnesses. On a wider level, the social level of public health should be considered as an aggregated immune response system of a society itself. On this level, 'public health' could be broadly characterised as the ability of a society to recognize, prepare for, and defend against larger survival and life-quality threats to its structure and to its population's own functional integrity. The broader system of public health integrity encompasses many interlocking levels, not all of them strictly medical or scientific even. Those that are medical include research and development of treatments known and existing ailments, preventive healthcare efforts such as check-ups on national or local levels, genetic research to predict family or group immunities or predispositions to certain illnesses, and the broad coordinated sharing of information about disease and communicable ailments, and so forth. Particularly with reference to common health threats, the modern science of epidemiology can be traced back to the emergence of the priority of public health as a broad issue in London around the 1800s. At this time, large urban populations began to amass and so the necessary safeguards for close-proximity living and health stability needed to be ensured for continuance of the rapidly growing cities. Epidemiology as a science, and public health as a priority set are implicitly modes of plurality [or] models of plurality; they exist as layers of societal logic based on environmental feedback and the goal of group stability. Their successful effects are the generalized improvement of all, not based on class or arbitrary division. Data is collected and contributed to by the many, for the many. Then there are the less direct medical factors of culturally promoted lifestyle, both of the dominant consumption habits and individual choices, which, as Brandon also said also comes from the society, and levels of exercise, the level of stress which is borne by the population, and so forth. On the more oblique levels are matters of healthcare policy, the value placed on availability of systems of public health and well being, and initiatives directed at solutions to health issues: housing, work environments and all, which are all essentially imbricated with the overall bio-psychosocial culmination of what becomes general public health. Of course, much of this collective support can be made totally redundant by a few economic and social premises which prioritise values in a manner contrary to the logic of shared and generalised systems. For example, if a society's economic factors have the effect of determining that the availability of health-enhancing treatments or non-stressful lifestyles are only available to a particular class, or set of classes, the groundwork upon which public health and epidemiology rests actually just falls at the first hurdle. Or, if a known impending danger to a society is ignored in favour of business interests, then there is no public health system at all, since any preventive responses or precautions are essentially rendered null and void by their non-implementation. This is actually true even if there is a general recognition that social health priorities are important. In fact, if you've been nodding your head quietly this whole time I've been speaking, thinking that this all sounds rather obvious, it's because there really isn't anyone who doesn't think that the arena of public health isn't in some way integral to the function of the logic of a society. The last general point here I want to make at the outset [is] true systems of public health integrity also differentiate themselves from, and are in fact, I think, set against the so-far dominant competitive market model of human social operation, as well as the dominant way in which we think about rights and entitlements for members of society, and those differentiate themselves in a few important ways. Public health is about a different kind of human right. We often hear talk of the freedom of the press, freedom of speech, freedom to assemble, freedom of dissent, and so on. The resulting impacts of optimal and successful public health actions are conversely freedoms 'from'. Freedom from disease, freedom from regular food poisoning, freedom from the early corrosion of your nerves through socially imposed stress, for example, freedom from violent attack by psychologically wounded individuals driven to dissonance with their society through unmet needs and value distortions. [Laughter and applause] Freedom from dying of cholera yesterday. These freedoms are marked by an absence of a negative retroaction, rather than an ability for a particular action to take place, like the freedom to assemble, for example, which you do so well in the U.S. with the freedom of speech zones. [Laughter] Sorry, we are the same. [chuckles] The effects of public health are felt in the promotion of an improved standard of physical and mental health. They are the results of preventive health. In this sense, the benefits can seem a little 'invisible' within public discourse, especially in a society that reinforces and rewards behaviour through a series of positives or 'if-then' scenarios: If you work, you will get paid. Work hard and you will get a raise, or maybe extra holiday or a promotion. Work extremely hard and wear suit everyday and you'll get the Republican nomination, and so forth. Avoid working hard, or well, and you would be forfeited your security. Break a society's rules and you'll imprisoned, and so on. Given these different criteria of results and priorities, it may not be that surprising that- and this is where I'm going to lose any free-market advocate who might accidentally be watching this video- but systems and social constructs which encourage public health and a generalised approach towards the promotion of functional life requirement are not achieved by the general free-market activity at all, ever. Nor are they encouraged or enabled by them. In fact, public health as a discipline arose precisely because the laissez-faire attitude to social operation, and the uncoordinated function of activity, limited- and even completely ignored- the ability to avoid health dangers. If the priority set is profit-based, or based on a particular power distortion generated by vested interest motivations, social interest is placed second; that is, it is not a factor at all. History shows an almost constant battle between the sort of slowly-emerging arena of public health and the inhibiting forces of poor public and academic education, a lacking awareness or understanding of various environmental effects by society in general, and of course, the ever-present business interests at the time. I'll borrow a few stories from Victorian England which is the era that actually birthed modern public health. The major plank in this era was the fight against the spread of cholera. So, the deadly strain of Asiatic Cholera came to Britain in late 1831 and caused devastation and death for many years after, bringing with it the riots that had accompanied... the outbreaks in Russia and elsewhere. British medical professionals had actually known about this new strain of the disease from reports that preceded its advance from its point of origin it had in Bengal, taking, as it did, about 15 years to spread across the Middle East and Europe, before finding its way onto a ship which docked at Sunderland port in North England. It is already this early in the story of the Victorian Cholera epidemics that we find one of many examples of the value war between established societal power, and the efforts of preventive healthcare and social immunity. At the time of the impending ... and expected epidemic, King William IV himself stated that he had "directed that all the precautions should be taken which experience has recommended as most effectual for guarding against the introduction of so dangerous a malady into this country." One of the precautions was a 15-day quarantine of vessels entering from the Baltic into Sunderland. This was a major threat to business and financial stability, of course, and the precaution ended up being watered down in a major way in practice by the rhetoric of the business community. Lord Londonderry, acting as the voice of the Business Community, stated- contrary to the alarm raised by the medical boards of doctors- that "Sunderland is now in a more healthy state than has been usual in the autumnal season." The actions of Londonderry, which eased cholera's road into England, spreading north to Scotland, south to Oxford, and then to London, wiping out some 52,000 people, were motivated and dictated by a value-system analysis which placed business with mainland Europe higher than medical safety. While the ramifications, and the mass-death and the flight from stricken areas were not expected by him maybe, and the disruptions to trade would have meant a vast impact upon Sunderland -which had 14,000 paupers out of 17,000 people- aah... you know. The point is, that it is widely agreed by historians that the business community love to distort the statements from the doctors, claiming the whole thing was a conspiracy, to cover up stolen cadavers for dissection by the medical community, and so on. We see at work here the sort of, social immune disorder born out of the necessity to conduct business over everything else. and, I did say there was about 17,000 people in Sunderland so, they only wiped out almost 4 times that whole city in the rest of the UK. We also see this pattern, and how it was actually defeated in the long march towards the ultimate development of a resistance to, and a solution for, the cholera pandemic. The going theory in the 1830s, which persisted as the general belief until practically the dawn of the 20th Century, was that many illnesses, particularly cholera, were transmitted by foul air -they called it a miasma- which had arisen out of rotting matter. It took the concerted and clever work of a man called John Snow, an anesthetist who lived in Central London, to uncover the analysis of death rate statistics provided to him by England's first official statistician, William Farr. That's how they really sourced the real cause of cholera and how is being spread, which today we understand the pollution by the cholera bacillus carried in the water supply, and not in fact the air, foul though it may have been, and indeed was. Snow actually noted that a violent outbreak of the disease centered around the communal pump in Broad Street, and his work with the local community. Actually they removed the handle from the pump, and deaths dropped, partly because of that, partly because everybody else who could afford it ran way, accidentally helping themselves health-wise. When years later, William Farr, now more convinced of this waterborne theory of cholera transmission, lobbied against the heavy interests of the London water companies- trying to correctly lay blame at that door for failure in hygiene and all kinds of other hijinx they played- he encountered the kind of resistance witnessed in Sunderland, and which has been seen constantly in the modern day as well. Farr's words are worth repeating, partially because he wrote with a panache not normally attributed to a statistician. He said, "As the air of London is not supplied like water to its inhabitants by companies, the air has had the worst of it. For air, no scientific witnesses has been retained, no learned council has pleaded." (I would say 'plead'; who am I to correct William Farr, however) "So the atmosphere as been freely charged with the propagation and the illicit diffusion of plagues of all kinds; while Father Thames, deservedly reverenced throughout the ages, and the water gods of London, have been loudly proclaimed immaculate and innocent." Here you see the comfortable shift of blame onto media of communication which, at the time, could not be bought or sold, that being the air. We even have that bitter hint by Farr, that the ruling companies occupy a position of almost theo-capitalistic reverence. Only after vast pressure by the population against a recalcitrant government, and uncooperative and censorious business community, and the construction of a whole sewer system under the supervision of engineer Joseph Bazalgette (who had kick-ass side burns you'll see), was the systemic integrity of public health in a position to actually combat a cholera epidemic. We know that, because in 1892 a massive cholera outbreak in Hamburg killed close to 9,000 people in 6 weeks. And yet in England, which was expecting it next, based on prior infection patterns, a small bat of cholera broke out, largely in areas not even covered by Bazalgette's system. This presented a sort of major watershed; it's one of the first moments in public health that we can see an event by its relative non-occurrence, its non-happening. The same sort of pattern has been since seen with the introduction of the occupation of midwifery which was decried by doctors as a threat to their job market, there you can see them being bad for the economy right there, and... [Laughter] the resistance to the introduction of hand washing by, amongst others, a wonderful gentleman called Charles Meeks, who- betraying the thought genes of class and social standing doctrines implicit in his day- said that "Doctors are gentlemen, and gentlemen's hands are clean." [Laughter] He was a doctor. [Laughing] (Holy shit!) Right up to the modern day we have a similar pattern, with the widespread prescription of antidepressants and anti-psychotics, particularly to children, to nudge them into line with the generalized dissonant atmosphere into which they're born. According to Dr. David Hilley, a noted psychiatrist, some 90% of school shootings in the US coincide with antidepressant treatment, to say nothing of the suppressed data by companies such as Eli Lilly on suicide levels related to serotonergic drugs. The collated adverse and unsustainable effects of stress, treated with profitable patchwork drugs, marks out our still-present... 'disconnect' between true public health prioritization and the actual operation of social health support resulting from our value alignments within that social operation. Today's interest groups are bigger, smarter, and worst of all in a way, they have more data about human behaviour, which means they can use that data to make advertising stronger, more subtle, and control public discourse in a more enlightened age than even during the more credulous times, when we as species knew much less about the physical, as well as the psychological world. I'd like to suggest the following small, very simple idea for improvement, to combat this ideological and bio-psychosocial misalignment. From primary school onwards, we teach public health education and public health history every year, as an educational constant. Home schoolers, relax and sit back down, you can do this at home as well. This module updates dynamically as new public health discoveries are made, and most importantly, we teach the failures as well as the successes of prior ages, and of our own, to inform the young of our fallibility, of the evolution of knowledge, particularly in the medical arena. Those failures should be taught, as just as important revelations to our way of thinking, as the positive discoveries themselves that we make. [Applause] The benefits, in my view, are a better readiness to update our mindsets when it comes to new information, being aware of prior corrected knowledge, and a positive side effect, of this particular educational move- this sort of pedagogical disposition, if you like- might just be the consequent diffusing of this nationalistic and insular view held by our respective nations that, their country is the best and that a certain nation is the greatest civilization that could be, and all the other steadfast attitudes towards the current zeitgeist. It's no accident, I don't think, that the nations which proclaim themselves as the greatest, which is pretty much all of them, the more they do that, the more out-of-date their systems seem to be, and the slower the evolutionary process is, and of course, the thought gene mechanism for that is "things are so awesome now, how can they ever get any better?". We build in the awareness: When it comes down to it, we as a species, no matter where we are situated, are only as good as our information up to that moment, and only as secure and free as the health systems and attitudes which align our well being with the environmental challenges we face, and those allow us to be, in their direct and indirect consequences, safe-guarded. Thus, the vast undiscovered country of as-yet-unknown knowledge ahead of us has the potential to alleviate, to enrich, and to better inform the great structures of stability and harmony, which are our consolation and the true life blood of our human tenure on this planet, both individually and collectively, if only we are ready to accept where they lead us. Many thanks. [Applause] The Zeitgeist Movement