Sweden <--> Ohio: Student

Wednesday, March 07, 2007

Public health is about choices. It's about making some choices easier than other choices. It's about making those bad choices more expensive in some way, less desirable, and the 'better', healthier choices more attractive, easier, and less expensive.

It's about making value judgments about what's good and what's bad. It's judging bad choices from good choices and trying to make those bad choices harder, make the good choice more likely. It's about controlling behavior through limitation of choice, application of rewards and increasing punishments.

It's patriarchal, authoritarian, and puts those who 'know better' in powerful positions over those with less power, less knowledge, less authority, and less empowerment.

Through the application of knowledge, power, and money over those who are poor, needy, uneducated, and with different goals... we attempt to make those lives better. Unwillingly. We don't ask the permission of the patient for treatment.

We treat, and in our arrogance we hope that we're right.

Because being wrong would be much more than just a mistake - if authority is used without consent, and is wrong - what separates that action from abuse, neglect, or even torture?

We make choices for other people on the aggregate level - and for most of those people we make the right choice. Their lives are healthier, longer, and of greater quality than if we'd not taken action. But for the minority few who aren't helped, whose lives are harder, who are hindered by our bureaucratic actions - what responsibility have we to them?

Do we have any? Or because the numbers are small, are they insignificant? Is it a balance? Do the numbers of good deeds outweigh the deeds of increasing pain? When is something wrong with the system? 80/20? 70/30? 50/50?


We need cultural answers to these questions before we can ask the larger questions about 'quality of life' of our doctors, or have conversations about assisted suicide with our family members.

We need these same answers if we're to address larger issues of public health (ignoring completely the concept of "health care") - adequate, inexpensive, and healthy food, comfortable, convenient, safe housing, reliable, affordable and easy to use transportation, education, and the existence of a variety of jobs and welfare systems for those who are unable to work.

I don't have answers as to how to create that cultural change, or how to answer the dilemma of public health with democracy, or even the answer to my ethical problem of desiring removal of the TV despite objections of my partner (my goal is greater health but my method is authoritarian - what's the solution?).


Thoughts on these questions are actively solicited. Anyone who has figured out a moderate 'third way' to these dilemmas, please speak up.

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