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?

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Eastern Europe

This is the Lithuanian Eurovision song from this year. It’s awesome. It’s also remarkably smart and it makes me feel ashamed of myself and my country. Check out the lyrics:

You’ve seen it all before
We ain’t got no taste we’re all a bore
But you should give us chance
Cause we’re just victims of circumstance
We’ve had it pretty tough
But that’s ok, we like it rough
We’ll settle the score
We survived the reds and 2 world wars

Get up and dance to our Eastern European kinda…
Get up and dance to our Eastern European kinda…
Get up and dance to our Eastern European kind of funk!

Yes Sir, we are legal we are, though we are not as legal as you
No Sir we’re not equal no, though we are both from the EU
We build your homes and wash your dishes,
Keep your hands all soft and clean
But one of these days you’ll realize Eastern Europe is in your genes

Get up and dance to our Eastern European kinda
Get up and dance to our Eastern European kinda
Get up and dance to our Eastern European kind of funk

(emphasis mine)

Every year we here in Western Europe go on about how the Eastern European countries send crap songs to Eurovision and then only ever vote for each other and how they are spread out all over Europe as migrants and that they’re ruining Eurovision. It’s disgusting and it needs to stop. They tend to vote for each other for the same reason we tend to vote for each other (the Scandinavian countries are the worst!): because they like the music! Their music tends to not appeal to us and our music tends to not appeal to them. It’s as simple as that.

Also, I need to stop talking about us and them. We’re all just people and we have as much right as everyone else to enjoy our music, feel sympathetic toward the people/nations closest to our own and not be prejudiced against just because of where we come from.

I work at a nursing home and my coworkers come from all over the world: China, Japan, Thailand, Sri Lanka, Spain, Canada, Brazil, Lithuania, Poland, etc. They are all wonderful people! They work hard, they are funny, they are kind and they are just as awesome as the Icelanders I work with. I’ve always been very positive toward migration and immigrants, but after working there I have learned that even I am and have been incredibly prejudiced and I’m working on that. It really hit me especially one day when I heard that one of the girls from Lithuania had been crying because she’d had a difficult phone call from home. It made me think that I’m moving to England in the fall and it’s going to be difficult. It’s not different for her or other migrants and we need to show them more consideration.

Eastern Europeans are not our slaves, they are no more criminally inclined than anyone else and they are not here to steal our jobs or live off our welfare system. They are just people searching for a better life and they are welcome to do so as far as I am concerned. I’m proud to work by their side.

School, parties and links!

So school has begun. I have a feeling that my schedule this semester is going to be kind of mad. I have two research projects, one for sociology and one for geography. The geography one is a group project and next month we’re going on a 5 day research trip to Vestmannaeyjar. Before then we have to prepare pretty much everything. Then I have three other courses (criminology, sociological theories, and image interpretation and remote sensing). So I won’t have time to slack off. Rest assured, I will definitely be slacking off anyway. I’m stupid like that.

Tonight I am going to a crazy tequila/singstar party. I’ve bought some Strongbow and white wine and I intend to enjoy myself immensely. How can I not? I will be surrounded by crazy slasher chicks who have no sense of shame. We have been known to discuss necrophilia, watch gay porn, and play Supernatural drinking games. We’re insane.

Then tomorrow I have to start packing. I have to clear out my apartment before Thursday and I’ve hardly begun. See? I’m slacking off already.

I have to go get ready, so here are some links to interesting stuff.

BartCop’s letter to republicans.

I’m sick of the way you try to destroy the whole concept of government. You’ve tricked the people into believing that government can’t do anything right, always being careful to exclude the army because you love your bullets and bombs but you’ve so destroyed the public’s ability to reason that they don’t even think of interstate highways, the space program, the national parks program, etc. Government is always great when it’s doing what you tell it and inevitably corrupt when it isn’t. Fuck you.

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Pfizer Agrees to Record Criminal Fine in Fraud Probe.

“When a drug is marketed or promoted for non- authorized, so-called off-label uses, any use not approved by the FDA — as was the case here — public health may be at risk,” Associate Attorney General Tom Perrelli said at a news conference in Washington.

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1/4 of teenage girls suffer physical violence, 1/3 sexual violence in relationships.

One third of girls age 13-17 have been forced or pressured into “unwanted sexual acts”, and a further one quarter have suffered physical violence by their boyfriends, according to a study by Bristol University and the NSPCC. A smaller number of boys reported being pressured or forced into sex or suffering physical violence in a relationship.

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FDA Draft Report Urges Consumption of Fish, Despite Mercury Contamination.

The Food and Drug Administration is urging the government to amend its advisory that women and children should limit how much fish they eat, saying that the benefits of seafood outweigh the health risks and that most people should eat more fish, even if it contains mercury.

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Interview with the author of Autism’s False Prophets, Paul A. Offit M.D.

It’s a statistic that’s quoted at parents constantly, almost casually: the rate of children diagnosed with autism in the United States corresponds directly to the increase in childhood vaccinations that’s taken place over the past ten years. Here’s the problem: it’s not true. Not only is there is no statistical correlation between the rise of autism and an increase in vaccinations, but twelve separate studies have shown absolutely no difference in autism rates between vaccinated and unvaccinated populations.

And here’s a bit of funny just because I love Zachary Quinto so much.

HOSTAGE: A Love Story with Zachary Quinto from Zachary Quinto