Puritanism and Public Health

Public Health campaigns have targeted tobacco, booze and increasingly fatty foods. For most public health advocates it is a strictly scientific and medical business designed to encourage an healthier population. There is little wrong with that aim, one might think. There are of course limits as public health is always a balancing act against individual liberties – what is the right balance between a nation with healthier lungs and the freedom of smokers? However, there are also far more disturbing streams in the public health discourses, ones that echo a kind of Victorian puritanism. This manifests in moral judgements of individuals, instead of focusing on criticising social trends. By moving away from a focus on social trends, public health discourses loose whatever progressive power they once had.

Public health’s puritanism runs deep. The World Health Organisations (WHO), the worlds foremost public health institution, definition of health has something other worldly about it: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The later half of that conjunction is what was in mind in the founding of the NHS – disease being on of Beveridges 5 giants. However it is the completeness element of this definition which reveals the inner religiosity of the WHO. It may have well written ‘a state of heavenly bliss’, for such a state of health doesn’t appear possible in human life. It is no wonder that a certain religious zeal has attached the public health, even if its intentions were good.

This religious zeal appears more and more puritanical, the more it attempts to create a moral narrative of blame around individuals. We are of course used the stigmatization of those who might drink in the morning, or smoke in a public place, or do either, anywhere, anytime to excess. But it is perhaps in the war against fat that this stigmatization is strongest. It is easy to see how being fat would be a moral failing given our quasi-religious definition of health above. Similarly to not living a pious life, you are a morally reprehensible if you don’t follow the one true path to a toned stomach.

The stigmatizaton of overweight people – or fat shamming – is a highly politicized issue already. Feminists critcise the way it draws on and exacerabtes existing pressures for women to ensure their bodies conform to the chauvanistic standard. Socialists and others of the left criticise the way fat shamming criticises working class people for not knowing how to cook healthy middle class meals, and this is particularly true when it comes the parents of overweight children. However, links with puritanism are less often made. It is important that we recognise that not only does such puritanism obscure sociological causes and effects such as those highlighted by feminism and socialism, but also that it does so precisely because it shifts emphasis onto individual morality.

The return of puritanism under the guise of public health is an unwelcome regress. We have been able to comprehend social problems as being beyond the matter of an indivudal’s worthiness of paradise, whether that be heavenly or healthy. Public health is important, as are its aims, and some of its policy recommendatons are justifyable. The smoking ban, though perhaps a little heavy handed is perfectly justifyable in principle. There are surely some public spaces which one should be able to visit without inhaling smoke (thought the current UK ban probably goes too far in my opinion). The problem comes when such policies encourage stigmatization of a group, particularly when that group already suffers from other kinds of oppression. For example, minimum pricing laws will only affect the poor, an already highly stigmatized group, and reinforces the notion that drinking is a problem amongst poor communities, but that the wine at a middle class dinner party is not.

In order to safeguard against the ever creeping presence of puritanism in public health campaigns we should adopt an explicitly religious sentiment with a sociological twist into the public health discourse: “there but for the grace of a series of loosely connected socio-economic trends go I.” Perhaps then we might remember the point of public health campaigns which is to improve the lives of those who suffer in our society. It would also serve to reconnect public health with other politics of oppression, like feminism and socialism. Public health discourses are designed to enhance freedom – not be pressure gages for our own prejudiced, authoritarian, puritanical judgements that we had been learning to keep in check.