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The structural aspects of public health

Public health has now become synonymous with how we cope with the pandemic. Though it is understandable that the focus is on containing the spread of the corona virus, it is important to remind ourselves of the underlying reality that renders COVID possible and potentially dangerous. The pandemic has exposed the systemic flaws of modern society, which can be summarised as (i) urbanisation, (ii) inconsiderate eating practices, (iii) lack of exercise in the form of longer-term, daily habits coupled with an ethos of physical wellness (iv) excessive confinement to closed spaces such as offices with heating or air conditioning.

  • Urbanisation has increased the density of human populations, while simultaneously downgrading the quality of their everyday environment. Cities are centres of pollution, meaning that one does not breath benign air. Cities combined with international trade make people oblivious to the realities of seasonal agricultural production, to the effect that they have no natural check on what they eat and when: for example, grapes grow towards the end of the summer and so a natural life cycle will prevent you from overdoing it by consuming them all year round. Furthermore, cities in a capitalist world that is single-minded about incessant growth impose rhythms that are detrimental to one’s overall stability, by sustaining pressure and engendering or amplifying anxiety.

  • Food is a complete disaster and the single most important cause in a vast number of chronic diseases. Just walk into a grocery store and take note of everything that is outright unhealthy: all processed foods, everything that contains preservatives or artificial flavours and colours, sweets, soft drinks, alcoholic beverages, chips, industrial loaf which is made with numerous dubious ingredients that contribute to its taste and texture… The list goes on. Then we have practices which lead to a degradation in the quality of otherwise genuine food, such as adding sugar in the preparation of meals, overcooking vegetables, using sauces which ultimately contain sugar/salt and questionable additives, frying the ingredients, overdoing it with substances that should only be taken in small doses such as by eating lots of fruits, and so on. One’s diet is essential to how they feel and how healthy they are inclined to be overall.

  • Lack of exercise is a more tricky case because you will find people who go the gym to work out. The key here is to think of training as a quotidian condition that happens continuously, not just one hour per some fixed schedule. Some gym-goers may be doing it properly, though a lot of people will indulge in bad habits, such as eating junk food and then going to the gym to entertain the illusion that they are burning off what they have just consumed. Exercise is about one’s longer-term condition. It is at its best when it contributes to stability, instead of the erratic heights and lows that the gym-going-junk-food-consumer endures.

  • Confinement to closed spaces results in poor air quality. Such spaces further compound the inherent problem cities have with what people breath. Whether it is office work, the gym, or a car with closed windows and air conditioning turned on, the recycling of one’s breath is always harmful, let alone the potential damage coming from the sudden changes in temperature when moving between indoors and outdoors.

Those are intertwined though we treat them separately to make sense of phenomena. They are all part of a wider system that encompasses production, consumption, and ownership:

  1. Production involves all techniques and methods that go into making the good. In the case of food, production is typically inimical to the presence and sustainability of ecosystems. It abuses animals to get their by-products such as milk or eggs, and it mistreats those which are intended to be slaughtered. It also endangers or exterminates bees, rodents, snakes, birds of all kinds, etc. Agricultural practices involve monoculture and the use of chemicals which ultimately contribute to the deterioration of the soil’s quality, which then reinforces the need for yet more chemicals to undo the damage of the previous ones, so the vicious cycle invigorates itself.

  2. Consumption covers everything from packaging, distribution, advertising, handling of waste. Most products on a supermarket’s shelf are wrapped in plastic. It is supposedly cheap to produce because its accounting does not factor in the damages to the planet. Advertising typically is downright unethical, for it is an exercise in misleading potential customers. Think, for instance, of a certain soft drink that purports to contain “zero sugar” yet remains as invidious as ever for everything else it has and does. Or consider how a major junk food defiler provider is incentivising kids to buy its garbage by packaging it with a toy. Or even take the seemingly innocuous claims about certain “superfoods”, which can easily lead one to believe that they can counter-balance their poor habits simply by eating those, while keeping everything else constant.

  3. Ownership pertains to the system of values that underpins this order. At its core is the distribution of control in a hierarchical structure that favours those at the higher strata. Layered on top of that is the sanctification of property rights for those in power, though not for property in general as that remains an easy pray for the state. The maximisation of profit follows therefrom as the meta-narrative that rationalises gathering increasingly more wealth and control at the top. Such is the conventional wisdom that profitability alone is considered a virtue in itself, expressed in the shared deceit on the desirability of year-on-year fiscal growth. The concentration of wealth in fewer hands is what enables so-called “economies of scale” and “horizontally integrated” management, which in turn feed into production and consumption patterns.

Couched in those terms, we have a political system and concomitant business incentives that have a direct effect on all aspects of personal well-being and on public health at-large. The establishment prioritises profits without considering the actual costs on people and the planet in general.

Duty towards others

Decision-makers are employing all means possible to focus minds on the ongoing vaccination programmes to limit the spread of COVID. One rhetorical device they use is that of putting the brunt of the blame on those who have not taken the jab and who, perhaps, have no intention of doing so. Vaccination is described as a moral imperative to safeguard the health of others, which rests on the kernel of truth that some vulnerable groups are in need of protection.

What is not being discussed is the underlying reality of people’s overall condition and the structural magnitudes contributing to it. The authorities have had no trouble imposing restrictive measures of all sorts. Those have, among others, resulted in mass impoverishment and bankruptcies, as well as the further erosion of labour rights for the lower parts of the income distribution, yet are combined with record profits for major corporate actors. All this is forgiven as the necessary cost of tackling the pandemic, or so the apologists claim. Yet the authorities, who are apparently committed to the valiant promotion of public health, have done nothing whatsoever to contain the distribution and availability of all the rubbish that masquerades as food nowadays.

Those who work all day and have no energy left to go for a proper walk, those who are forced into tight schedules and eat junk as a necessity in order to stay on time, those who are misled by advertisers into making choices that are detrimental to them, overweight and obese people, as well as those with relevant chronic diseases like type 2 diabetes, are all victims of an immoral system of the joint magnitudes of production-consumption-ownership; a system that has a vested interest in poor personal health and in squeezing the life out of every person, every animal, every natural resource it controls.

While a vaccine can help protect against a given virus, it does not address the underlying systemic causes, nor does it bring about a paradigm shift in how we think of food, the unity between the mental and physical states, and public health in their wider context as inherently political phenomena.

The rhetoric of social responsibility is insincere, for it does not consider its own implications and puts the blame wholly on private persons for faults that are not entirely their own. If you claim that all people have a duty towards others, then that means they possess the agency to fully carry on such a task in pursuit of the betterment of their own condition. And if that is so, then you must be prepared to deal with the consequences, such as those who are healthy openly opposing, say, overweight and obese persons on the premise that the latter group—those who also have the aforementioned moral agency—do not assume responsibility for their own health and so nor should the former. The argument applies equally to cases where such a fully capable agent realises that they do not need the government in order to realise their potential for taking care of their health and, a fortiori, are not obliged to follow the exhortations of some bureaucrat, public intellectual, or whatnot. In other words, the social responsibility bandwagon is a distraction from the persistent, system-wide problems. It risks turning groups of people against each other, while those at the top continue unencumbered with business as usual.

If you want to insist on the morality theme, there exists personal duty of a different sort: that of recognising the truth of the case and helping move things towards a different direction altogether that is respectful of humanity as a whole and all other life forms in a spirit of sustainability.

We all have the means to resist being mistreated by a status quo that has made fiscal growth its sole guiding principle. To take care of yourself is to make a minor revolution. Every little bit counts. It all starts from small beginnings, though commitment to it will have a cumulative effect. Be prepared to enact change. Stop eating sweets. Zero! No more soft drinks. Dispose of all junk food. Walk and be active. Strive for a balanced lifestyle that is consistent with natural cycles. You get the idea. Resist advertisers who want you to spend all your disposable income on stuff you do not need. Hold on to your possessions for as long as they last. In short, say “no” to those who profiteer from your bad habits and seek out knowledge on how to improve the quality of what you buy. Establish networks to promote your goals and support each other.

Once you assume responsibility and adopt a purposeful stance towards life, you will soon realise how everything is connected and that you cannot decouple health from politics, politics for economics, economics from social organisation. You will also understand on your own what else needs to be done to break the mould you currently find yourself in. Let the prevailing conditions serve as a reminder that we were in trouble long before the pandemic broke out and that the real solution, the one which guarantees that we have learnt from past mistakes and are thus prepared to act decisively, requires thoroughgoing reforms across the board.