The Perversity of Public Health

I’ve been thinking about health quite a lot recently, and wondering what “being in good health” means. And I suppose that to me “good health” means something like being strong and active. Sick people, suffering from some disease or other, are usually weak and inactive. I’ve hardly ever been sick during my lifetime, and most of the periods of sickness were confined to my youth, when I would come down with things like measles or mumps or tonsillitis, usually contracted while at school (I never seemed to get sick when not at school).

“Health”, it seems to me, should in principle be measurable. And a week or so back I was proposing measuring the health of hospital patients by measuring how active they were (with diagnostic e-cigarettes). So I supposed that on entry into a hospital, road crash victims would be confined to bed, and doing nothing, and being subjected to intensive nursing care. But as they gradually recovered, and broken bones healed, they would gradually become more active. They’d sit up in bed. They might be able to begin to feed themselves. They’d talk. And read books. They’d generally become stronger and more active. Eventually they’d get up and walk around on crutches (possibly as far as the hospital gates, where they could smoke a cigarette). Shortly after that, they’d be released from the hospital to go home, where they might continue to need to receive some care or assistance from friends or family until they were fully recovered.

And when they were fully recovered they’d go back to drinking and smoking and eating fast food, and playing football and skiing and swimming and driving their Ferrari at 180 mph along motorways…

…which is when they become road crash victims once again, and complete the cycle from sickness to health and back again.

While they’re sick or injured in hospital, they’re in the care or doctors and nurses who restore them to health as far as they possibly can.

But once they leave hospital in good health again, preventive medicine – in the form of Public Health – acts to try to prevent them getting sick or injured again. And it increasingly does this by restricting or banning activities which are likely to make people sick or injured. Hence smoking bans, alcohol restrictions, and so on.

But the odd thing about smoking bans is that smoking is one of the activities that is least likely to result in sickness or injury, in the short term (and probably in the long term as well). The same applies to eating fast food. And the same also applies to alcohol, drunk in moderation.

It’s doing things like playing football and skiing and swimming and driving Ferraris at 180 mph that are most likely to cause immediate injuries which result in premature death or hospitalisation.

So why aren’t all sports restricted or banned? There would be a lot fewer broken bones, torn ligaments, and premature arthritis. Why aren’t swimming pools and beaches closed? Why isn’t motor racing banned, and road speeds limited to 20 mph everywhere, including motorways? Why isn’t foreign travel banned, in order to prevent people acquiring transmissible diseases like malaria or cholera or ebola?

Rather than engage in high risk sports, swimming, racing, and travel, shouldn’t people be encouraged to instead engage in low risk activities like sitting in pubs drinking beer and smoking cigarettes? That way they won’t end up in hospital quite so quickly.

Why does Public Health seek to restrict or ban the least dangerous activities rather than the most dangerous ones?

And if Public Health are concerned with preventing people getting sick or injured, is it because people spend far too much of their lives in hospitals? There are 137,000 overnight hospital beds in the UK. The population of the UK is 65 million people. So at any one time only 0.2% of the UK population are confined in hospitals. And over an average lifetime of 80 years someone can expect to spend an average 0.2% of 80 years – or 2 months –  in hospital. And given 224,000 nursing home beds in the UK, they can expect to spend less than 3½ months in a nursing home. That is, they spend in total about 0.7% of their lives being cared for by other people. That doesn’t seem to be very much of a burden at all.

After a lifetime of smoking, drinking, driving, and travelling to foreign countries, this 70-year-old has so far spent just one single night in a hospital bed. And that wasn’t as an emergency admission after a road accident or cholera epidemic.

Final thought: Don’t healthy people always like to dice with death by doing things like motor racing, skiing, mountaineering, surfing, or scuba diving? Isn’t life always gambling with death?

About Frank Davis

smoker
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20 Responses to The Perversity of Public Health

  1. garyk30 says:

    There is no gambling about ‘Death’.
    Death is a 100% certainty.

    ‘Public Health’ seems to be all about ‘them’ deciding how ‘you’ should be allowed to die.
    ‘Public Health’ seems to be all about ‘them’ deciding when ‘you’ should be allowed to die.

    ‘Public Health’ is all about them deciding how much, or how little, freedom you should have in deciding how you enjoy your life.

    Public Health is just Tyrany by those that deem themselves Elite and our Betters.

    We should rebel against those that insist on deciding which pleasures we are allowed to have.

  2. RdM says:

    We should rebel against those that insist on deciding which pleasures we are allowed to have.

    Agreed! And how to, most effectively, or at all?

    I still think it may be worth writing to politicians… although this would need to be most carefully thought out. All the evidence and references necessary yet clearly and simply inexorably laid out.

    The Mayor, the councilors, the President or Prime Minister, the opposing party heads, etc.
    The Health Minister, about the subversion that has been going on under his or her watch.

    An inchoate, incomprehensible or confusing (to the ‘other’) unreferenced emotionally blurted ‘smokers manifesto’ on a blog (and there have been others, at least one book and an easily found college article, have a look!) will not do it… in my humble opinion.

    But perhaps all these little posts will add up…

    What is a Manifesto?
    https://en.wikipedia.org/wiki/Manifesto

    When I was at art school, I found my favourite reading materials outside the prescribed texts.
    There were manifestos of art movements, all historical now.

    Things need to be clearly stated, arguments defined, proofs demanded, all brought very public.
    You need to think of your audience.
    I’m struggling with this; I find it difficult to write, myself.

    Perhaps it will happen eventually!
    But in the meantime, how many have to suffer?

    Just drinking thoughts at 1:30am here, 2:30pm UK, 9:30am EST, no one in the SDB to talk with!

    Oh, well! ;=})

  3. Twenty Rothmans says:

    Unlike PHE, I do things. I export a commodity. This brings in funds from overseas, so that I can pay taxes, which pay for PHE and so that they can indulge themselves on overseas conferences and holidays on FX I earned.

    PHE produces nothing. Were it not for government (i.e., *your*) funding, they would not exist. If bin collectors, Tube drivers or Ford factories go on strike – look what happens. Nobody would notice if PHE went on strike. Nobody would notice if they were taken out and shot. That’s not strictly true – I would because my ears would be ringing.

    Consider how dangerous the lives of the men who first took to the sea and the air were. They are still risky activities (although commercial flying is really expensive when you crash, so there is a powerful incentive to make it very safe. This is driven by money, not safety.).

    An assessment of my risks looks like this, in order of danger:
    Motorcycle riding
    Motorcycle taxi/tuk tuk in BKK
    Light aircraft flight
    Age
    Parasailing
    Alcohol
    Smoking
    Car driving
    Sailing

    What does your profile look like? Anybody have smoking at the top?

    PHE will hector me about two of these, yet they are not the most dangerous factors. I will pay them to do it to me. With the exception of age, they are voluntary activities that give me pleasure. Tobacco and age are the only ones that might give me some time to get my affairs in order.

    It takes a certain amount of retardedness to get into PHE. They honestly think that if they proclaim something, others will listen. If people do not, there is something wrong with the audience, not them, and they’ll roll our power-hungry MPs into it. We pay for them, also.

    If I am at home smoking crack with a couple of prostitutes and suffer a cardiac arrest, why is this different to me keeling over doing the gardening? Why is it anyone else’s business? Who can judge that a crack-fuelled orgy is less honourable a way to peg out than grafting a camellia?

    A former Australian PM signed out in a very auspicious way: https://en.wikipedia.org/wiki/Billy_Snedden Lad.

    • RdM says:

      “while having sex with an ex-girlfriend of his son”

      An ebullient international impresario friend related to me about having suffered a stroke in the middle of sex on a Pacific island, recovering, learning to talk again, seemed well recovered, irrepressible as ever… gay as could be. Some live, some die … life goes on.

      • Twenty Rothmans says:

        The French call it la petite mort, I think. It seems that Billy left the ‘petite’ out.
        He has legendary status back home.
        If she’d had some poppers with her, he might have stood a chance.

        “An ebullient international impresario friend ”
        -> speculates wildly

    • Joe L. says:

      An assessment of my risks looks like this, in order of danger:
      Motorcycle riding
      Motorcycle taxi/tuk tuk in BKK
      Light aircraft flight
      Age
      Parasailing
      Alcohol
      Smoking
      Car driving
      Sailing

      I’m curious why you think smoking is a riskier/more dangerous activity than driving a car. Alcohol, as well, for that matter (unless you drink yourself into a blackout frequently, then it might be debatable).

      • Twenty Rothmans says:

        Hi Joe,
        I seldom ride in a car. In my 20s, it would have been up the list and again in my late 30s on the Autobahn. Therefore, I take a car to/from airports mainly, and it is relatively – but not completely – safe.

        > unless you drink yourself into a blackout frequently,
        I do my best. I’m under no illusions that I drink dangerous amounts of alcohol. Similarly, I know that smoking is bad for me. It carries the very real risk that someone will go apeshit on you if you don’t give him a cigarette. It happens a lot in cities.

        • Joe L. says:

          Thanks for the reply. I now understand your list is ordered by your perceived risk of each activity as well as the amount of time you spend participating in each activity.

          However, even though you rarely ride in cars, I still believe your risk of injury/death from riding in a car is greater than that from smoking.

          Apart from the occasional cigarette burn, smoking has never been scientifically supported as a cause of injury or death (otherwise there would be more than the current total of zero death certificates which list it as a cause of death).

    • Frank Davis says:

      “In order of danger”. Does that mean most dangerous first? Or last?

      Having come off a motorbike, and known others who did as well, that would count as dangerous to me.

      But having a great grandfather who drowned off Mostardos on the coast of Brazil when his sailing ship was lost, I think sailing is dangerous too.

      Smoking would be last on my list, as the least dangerous.

      • beobrigitte says:

        Having come off a motorbike, and known others who did as well, that would count as dangerous to me.
        Indeed. I became the youngest sibling that way.

        Skiing is dangerous, too. Michael Schumacher was kind of lucky
        http://www.express.co.uk/news/world/816454/Michael-Schumacher-latest-health-news-update-progress-ski-accident-head-injury

        I’d have cars at the second place. When I was 10 a class mate was killed by a car and the number of RTA deaths in my microcosm has drastically increased since.

        There is a hell of a long list of dangerous things that cause REAL deaths. No fictional 20 – 40 “lag phase” lies needed.

        • Twenty Rothmans says:

          I would not count Schumi as lucky. But I guess you’d have to ask him, and he cannot answer,
          A few friends perished in car/abseiling/diving accidents, but not many, We really did think that we would go to war, I am unsure about you, Frank.

      • Twenty Rothmans says:

        Sailing recreationally bears some risk, nothing like sailing professionally. As skipper, if I don’t like it, we drop sail and GTFO. Happened many times.

        But in two months I’ll be dicing it with Australian drivers on their shitty B-roads and a month later flirting with death on Thai motorways.

        Erase these two and smoking is at the bottom of my list, too.

        So what’s on your list, Frank?

        I hope that tea is. It’s revolting :-)

        • Frank Davis says:

          I can’t think of anything much to go on a list, but tea would be the least dangerous of all,

        • nisakiman says:

          When I was driving semis interstate in Aus back in the ’70s, I had a guy cold-call one day selling life insurance. When I told him what I did for a living, he said that most insurance companies wouldn’t touch interstate drivers, although his did. The premiums were very high, though, second only to professional racing drivers, he said. Needless to say, I demurred. That of course was in the days before tachographs and when you got paid trip money rather than a salary (more trips = more money, but more driving hours and less sleep); and when the Hume highway was a narrow, twisting road; the combination of which resulted in accidents waiting to happen. The rate of attrition was quite high back then. Is the Hume freeway all the way now? There was still a rickety old wooden bridge at Gundagai when I first started driving that route:

          Thailand really is a dangerous place to drive. One of the highest road death rates in the world, I believe. The Thais seem to think that as long as they have an amulet hanging from the mirror, then they are both immortal and invincible. They have no concept of roadcraft, and no understanding of the dynamics of driving, such as braking distances and how they are affected by wet roads, or the time and space required for an overtaking manoeuvre. Yes, Thai roads are lethal. I do drive there, but I adopt a super-defensive driving style. The level of stupidity you see on Thai roads beggars belief.

          I’d agree that riding a motorbike is probably top of the list, wherever you are.

          The work I do probably comes second on the list, as I work with a lot of sharp and potentially dangerous tools which produce clouds of fine particulates known to be carcinogenic. If I get lung cancer or COPD, it’s far more likely to be caused by my work environment than by my smoking habit. Plus what I do involves a lot of heavy lifting and carrying.

          But apart from that, (and drinking and smoking), I don’t really do anything risky anymore. I must be getting old…

  4. RdM says:

    “Isn’t life always gambling with death?”

    Exactly!

    And giving life and giving death are both possible in this human existence.

    That’s a bit of a paraphrase from a quote in a chapter heading of a book I’m reading, The Making Of The Atomic Bomb, by Richard Rhodes (25th Anniversary Edition) – a fascinating history… of far more than just that, through two world wars, the context, discoveries, personalities, outcomes.

    Scientists and politicians, desires for openness vs secrecy, it’s a whole saga.

  5. Clicky says:

  6. waltc says:

    On the futility of writing to politicians, our Mayor DiBlasio (who’s still deciding whether to tear down the statue of Columbus in Columbus Circle or rename Roosevelt Island on account of the Japanese internment) just signed all five anti-smoker bills approved by the city council, among them raising the minimum pack price to $13. And still, I believe when bills are proposed, it’s important to write if only for one’s conscience and “for the record.” Similarly, and perhaps more important because it might change minds of the General Public and make smokers aware that they’re not alone, it’s also i portant to write letters to the editor when anti-smoking articles are printed.

    • Joe L. says:

      Similarly, and perhaps more important because it might change minds of the General Public and make smokers aware that they’re not alone, it’s also [important] to write letters to the editor when anti-smoking articles are printed.

      I agree that it’s important for the reasons you provide, but it can only have an effect on the general public/other smokers if your ‘letter to the editor’ gets published, which isn’t very often in my experience. I must admit this has completely depleted my motivation to write letters to editors.

      The internet equivalent are comments on antismoking articles, and while I still post them occasionally, we’ve all seen our dissenting comments magically disappear without warning, not to mention the comment sections of said articles are usually swarming with antismoking astroturfers who drown our voices in a sea of repetitious unsourced lies and hate.

      Any resistance is obviously better than no resistance, but it’s hard to not get discouraged about the effect our individual voices have in print.

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