Filed under: Health
Heather MacDonald argues that the idea that the health care system should focus on prevention is nonsense because
Prevention lies overwhelmingly within the realm of individual behavior, but our modern reflex of transferring agency from favored victim groups—in this case, millions of artery-clogged, waddling Americans—onto less-favored entities guarantees that we see the problems of Fat America as the failure of doctors to practice the right kind of medicine.
Well that’s sure wrong! Prevention lies overwhelmingly outside the realm of individual behavior. For instance, basically none of the foods we eat are prepared by our individual selves. We’re either eating meals that were cooked by a family member for our entire family, or meals that were prepared by a restaurant or cafeteria, or we’re eating snacks that were made by companies and sold by corporations. In rare instances, we may be eating a piece of fruit, or something we cooked ourselves from scratch, and in that case prevention really does lie within the realm of individual behavior. But that’s pretty uncommon.
To put it more clearly: the amount of healthy fruits and vegetables we consume is largely predicted by our socio-economic class. In what sense is this “in the realm of the individual”?
Similarly, how much exercise we get during the course of the day is pretty much determined by the transportation layout of the neighborhoods and conurbanities we live in, which, unless we’re named Robert Moses, we probably didn’t individually shape. How much particulate matter we breathe is determined largely by regional power generation and transportation choices and government rules. And so forth.
Ah, but there’s no way for society to intervene to make a purposive change in those sorts of things! Except of course for how public anti-smoking campaigns and taxes have slashed the rate of smoking to less than half what it was in 1965. Was that “in the realm of the individual”? Or how when France instituted a nationwide campaign to stop the rising rate of child obesity through school-based monitoring and exercise and diet interventions, it, well, stopped the rising rate of child obesity. At a level less than 1/4 that in the US.
Scotland is adopting the French small-town anti-obesity program, known as EPODE. But we can’t do that because…what’s the conservative/libertarian argument again? That Americans are stupider, less disciplined and naturally fatter than French people? Or something?
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