Power in public health

Power is one of those big, ambiguous concepts that come up over and over again in politics, geography, and international development. One can not truly understand the world and how it works without spending a good while thinking about how large the role of power is.

I have read a great deal about power in the last few months. In fact, I wrote an essay on the interplay between power and security in development. It is clear that rationality is only a small part of the process of policy making. Self interest has a strong tendency to overrule rationality, which is why it is so important to acknowledge who has the power to  influence decisions made on behalf of nations, or large global organisations and corporations. How they use their power to influence policy is equally important.

The common definition of power is that it is the ability of one person/group to make another person/group do something they would otherwise not do. How this is done varies however and often the use of power for this purpose is not obvious to those being influenced or made to do something.

I was reading about the role of power in health policy while sitting in a café in Edinburgh. It occurred to me how much goes on in the world that we never even realise. In the half a year that I have been studying at the University of Sheffield I have read countless articles and books that have been incredible eyeopeners for me. Power is something I was vaguely aware of, but did not really understand until now.

One thing I have come to see is how dishonest and insidious the actions of the most powerful in society are. That’s not to say I was completely naïve and blind to it, I simply had not realised how extensive the problem is.

In Buse, Mays and Walt’s Making Health Policy there is an incredibly interesting discussion of the different kinds of power. Two of them really jumped out at me.

1. Power as Non-Decision

This is a method of sorts where those with power are able to trick people into believing they have choices, when it fact only the choices that are acceptable to the powerful are made available. This can be done for instance by drawing the public’s attention away from important issues by emphasising other issues. Such as by using the media to drown sensitive subjects with discussions of other, less urgent ones.

As an example of this they mentioned the tobacco industry and its influence on the World Health Organisation. In order to draw attention away from non-communicable diseases that could potentially have been caused by smoking, such as cancer, they used their ‘influence’ to direct the public’s focus on infectious diseases.

It made me think about the Millennium Development Goals. They have been criticised heavily for being too narrowly focused on infectious diseases and other health issues that are mainly a concern in the poorest developing countries. Meanwhile public health issues in many middle income countries, and even developed countries, are largely neglected.

While diseases such as HIV/AIDS and malaria are important, what is more urgent is to provide quality health care to all. With strong health systems these diseases are much more easily tackled and more people can be approached with preventative measures. In most cases a strong health system requires that the state take action and increase its public spending. This goes against the claims of neo-liberalists that the free market is the only way forward. A greater focus on state intervention, public spending and…god forbid…a bit of socialist welfare, is not in the interest of the global elite.

So is the purpose of this skewed image of the global health priorities a way to draw the focus away from the real problem? That the system simply isn’t working? I wonder. Meanwhile they have convinced everyone that they are doing something great, something so good, that few even question whether it is at all effective. This way they can throw lots of money at particular issues and make themselves feel like they are doing something…while avoiding making the hard decisions that are more likely to lead to real change, real long-term change.

2. Power as Thought Control

The media is not only used by the powerful to divert people’s attentions, but also to shape their thoughts and influence their values. As they put it in Making Health Policy:

Lukes argues that A gains B’s compliance through subtle means. This could include the ability to shape meanings and perceptions of reality which might be done through the control of information, the mass media and or through controlling the processes of socialization.

As an example they mentioned how widespread and popular so-called ‘alternative medicine’ has become. The market is drowning in all sorts of ‘medical’ products that no one has been able to prove to even work. The purpose is to make money, and if people get hurt in the process, who cares? Right?

It is not just alternative medicine though, it is everything. A large part of the media does not care whether the information they spread is factual. They want to sell, and controversy sells. Would Andrew Wakefield’s claims that the MMR jabs cause autism have become so widely accepted if it were not so much easier to sell papers that say “DANGER DANGER” than ones that say “no, everything’s fine actually”? Wakefield’s claims have never been confirmed and it has even come to light that he was making lots of money from it.

This is where the issue of authority comes in. People are quick to accept the authority of doctors and scientists because they believe them to have superior knowledge. Most of the time they do, and I honestly believe that the vast majority of them are doing their best to make the world a better place. But it also means that it’s fairly easy for the less honest to get wrong and even harmful information out there. Especially when backed by powerful people with lots of money who have a vested interest in deceiving people into spending more money. Fortunately the good guys do their best to make it right, to correct the information, to fix it. It would be easier however if they did not have to fight a largely corrupt media world which is more interested in news that sell than news that are true.

Who can we hold accountable for this?


6 Comments (+add yours?)

  1. Kristinn
    Mar 10, 2011 @ 13:22:41

    “Who can we hold accountable for this?”

    Me. I am to blame. Sorry.

    On a more serious note; great article. This is perhaps really a discussion about human nature and human intentions, needs and tendencies.

    Do we let our personal interests, our in-group interests, our national interests or our global interests lead the way…?

    Power is tool people use to further their interests, but power can also be used to influence what people perceive as their interests.

    It’s complicated, so I have decided to become a fanatic Christian. Would you like to join my church?


  2. Kristinn
    Mar 10, 2011 @ 13:28:45

    ..”_a_ tool people use”, even.


  3. kalldoro
    Mar 10, 2011 @ 13:33:43

    Yes, Christian fanaticism is the answer to everything! Count me in!

    This whole issue is just so interesting because people want to believe that economy is run in a “rational” way, that the market is free of human influence, and that the government is some kind of separate entity above everything. They aren’t, everything is run by people, and people are flawed and selfish.

    It makes me wonder how much of what we think we know is actually just fabricated by the ones with all the power. Fortunately we have the internet today, so every day people are more influential in spreading the information the media ignores. However, the internet is also overrun with people who are stupid and ignorant, so finding anything worthwhile can be quite the battle.


  4. Kristinn
    Mar 10, 2011 @ 15:11:06

    As a name for my church, I’m thinking: “Holy church of latter day narrow-mindedness”.

    Does it work, do you think?


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