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2008 Public Health Action Plan Update: Celebrating Our First Five YearsMaking Connections: The Conceptual Basis of Effective ActionBetty Sue Flowers, PhD In 2002, I was a participant in the early planning meetings and content reviews for A Public Health Action Plan to Prevent Heart Disease and Stroke. It is inspiring to see how much has been accomplished since then. And it is interesting to see the emphasis on the importance of the economics of prevention, since one of the key points I raised briefly in 2002 was the need to speak from within the economic myth or story that we all share. As a humanist approaching this work, I have been contemplating two central questions. First, what if we stepped outside the economic myth within which we lived when we addressed the economic aspects of heart disease and stroke prevention? The question I am posing is not the same as this question: why should we address the economic aspects of heart disease and stroke prevention? The answer to that question is self-evident simply because everything comes with a price tag. And price tags raise the question: if we pay for X or Y, what can we now not afford? I am not talking about the kind of cost-benefit analysis that leads us to choose to do some things before others. I am talking about a fundamental viewpoint from which certain arguments about public policy can be made. In addition to our personal stories, we also have big cultural stories that shape us. These cultural stories I call myths, not because they aren’t true — they are all true in their own way — but because we live with them unconsciously. In the west, we have four of these myths, although one is always ascendant. These are the hero myth, the religious myth — I remind you that by myth I do not mean untrue — the science myth, and the economic myth, which is the myth we are in now. Our medical practice works within the science myth — or the science culture of today, if you prefer. Anyone wanting to be a doctor gets a science education. The medium for this myth — or culture — is numbers, which is why it is an international story, although an elite one and therefore not the dominant myth of our culture. Originally, medicine — the art of healing — came out of the religious myth, not the scientific myth. In ancient days, medicine was in the realm of the sacred. The Iliad begins with Achilles sulking in his tent. But he is sulking because his prize has been taken away from him in order to appease Apollo who is raining his arrows of sickness on the Greek army. Of all the professions, medicine is still closest to the religious domain — at least, I often see chaplains in hospital corridors and never in an active role in the law firms or banks. Now we are in the economic myth, whose ideal is growth. More. Health care is a commodity — like almost everything else — competing in the marketplace with other commodities. An argument for good public health, if made as a “should” argument — we should care for our fellow human beings — falls within the realm of the religious myth and therefore outside the range of what many people can hear in our present global culture. This is not to say that, as individuals, we are not good or caring; it is to say that because public policy is made from within the economic myth, an argument based on goodness (the religious myth) or charismatic personalities (the hero myth), or even scientific evidence (the scientific myth), will not have much traction. Clearly, I am not talking here about the good people who make donations to hospitals, or the scientific advances that help us provide better treatment, or the changes we adopt within our own hospitals and treatment centers. I am talking about large-scale public policy action. What is the argument that has trumped all others in public conversation about universal health insurance, for example? Not “we shouldn’t do it” or “it can’t be done.” It is that “we cannot afford it.” Why is the economic myth so powerful?
For success in our campaign to reduce heart disease and stroke, we need two factors:
The second question I am posing is this: when we know the science, what stops us from making the needed changes at every level, from government policies to individual behavior? I could answer with one word—inertia—but that would not be helpful.
Page last reviewed:
August 8, 2008 |
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