The original concept of public health was to deal with outbreaks of and prevent spread of infectious diseases. This included advice on quarantine, and treatment. Useful advice included sanitation of water and other basic (as would be regarded today) hygiene.
The jargon of public health includes terms like “epidemic” which is entirely suited to a contagious disease, which can spread from person to person. Conditions, which can spread in this way, are suited to measures, which suggest ways people can change their behaviours to reduce spread.
In some regards public health has been a victim of its own success. Since the 1918 Spanish flu, each subsequent flu epidemic has seen fewer deaths and far less impact overall. Thanks to better sanitation, better nutrition and overall improved living conditions, the western world no longer has epidemics of infectious diseases.
In the 1960s public health started tackling smoking. This has been successful to the extent that smoking has been in decline for half a century. But the binary approach of “smoking bad, not smoking good” does not apply to other aspects of health. In particular, chronic lifestyle related conditions (75% of the disease burden in western countries) do not respond to the same approach as infections.
So when you hear about an epidemic of obesity or type two diabetes, remember that you cannot “catch” these conditions. The actions of others will not affect what happens to you. What happens to you is solely determined by your own actions.
There is another problem with “population health”. Statistics are fine when applied to a population but meaningless when applied to the individual. An Australian Institute of Health and Welfare (AIHW) report claimed that if Australians lost three kilograms the impact of obesity would drop substantially. I was interviewed about this on Today Extra.
Collectively a national weight loss of 72 million kilos is significant. However a person who is five kilos over weight will not live any longer by losing three kilos. They might drop a dress or pant size and feel better (which is fine) but there is no actual health benefit. Likewise for someone who is carrying 50kg more than ideal, losing three is a good start but will also make little difference if that is where it stops.
Thus the public health claim that losing three kilos will make a difference highlights the disconnect between “population” health and that of individuals. Losing three kilos will make little difference to most individuals even though collectively it makes a statistical difference. In turn this is why the type of thinking that was useful in stopping the spread of TB is useless in stopping obesity. How much an individual may need to lose to be of significance to them varies from person to person.
And that is before we consider that public health advice for the last 35 years has been to eat low fat, which has been a major contributor to increased obesity. Yet public health refuses to acknowledge its error or apologise.
In the same report the AIHW notes that obesity is second to tobacco in terms of its impact on heath and longevity. Yet public health in Australia continues to oppose E-cigarettes, which are 95% less harmful than regular cigarettes. New research from the USA shows again that it is more useful than other stop smoking aids.
There is a quote from Groucho Marx which says that politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies”. Sadly we could say today that Public health is the art of looking for epidemics, finding them everywhere, diagnosing the causes incorrectly and applying the wrong remedy. The only addition would be they do it all whilst screaming for more funding.
Your health is in your hands. What you choose to eat each day, how much exercise you do, how much sleep you get, and how you manage your stress are up to you. Yes it is helpful to get input from others and vital to be questioning. But ultimately your health is your responsibility and the results will be a reflection of the decisions you make.
This article first appeared on www.drjoetoday.com