The Scientific Look-and-Feel of Public Health
By Pierre Lemieux
An individual with a human brain can make the following value judgments: (1) maximum health is the most important thing in human life; (2) health must be as equal among individuals as physically possible; and (3) these two value judgments should be imposed on everybody. Once this is done, the most efficient means to pursue these goals can be scientifically studied, using both the medical sciences, economics (including, at the first rank, public choice analysis), and possibly other sciences. (I take a science to be a body of logical theories not disproved by observable facts.)
Of course, it will likely be found that the presence of two objective functions—maximize health and maximize equality—requires trade-offs. For example, some academics and government bureaucrats might have to eschew maximum health in order to equalize their health opportunities with ordinary people. But let’s ignore this complication.
As often, a comment in The Lancet, the venerable British medical and social-justice-warrior journal, can serve as an illustration: see Colin Angus, “Taking Public Health Policy Models Upstream,” March 1, 2020. Once value judgments like those above are accepted, the article does have a scientific look and feel. But, as far as I can see (and I am willing to be proven wrong if I am), it’s merely a look and feel. The medical sciences behind which it hides are of course scientific in any serious meaning of the term but they have nothing to say about how individuals make trade-offs on the basis of their preferences (or biases), how individual choices can be compatible in a social context, and how individual preferences can or cannot be aggregated in any sort of egalitarian way.
The article starts with the moral goal of “the reduction of societal inequalities.” The goal of reducing inequalities is certainly a value judgment that Professor Angus is free to espouse. The word “societal,” though, has no scientific meaning. It can be traced to a Minor Hugo, probably the pen name of Luke James Hansard, a utopian communist and follower of French theorist Charles Fourier. In 1843, Minor Hugo wrote:
Our monetary system, like that of trade, or any other societal occupation, is unfair from first to last.
The term “societal” does not convey anything useful that “social” doesn’t incorporate, except that it looks more serious, gnostic, more like scientific socialism. Still very rare (hence its alchemic value), the term really took off only in the 1960s, according to Google’s Ngram Viewer (see chart below). At that time, scientific students of society and the economy were and still are content with “social”—including in the scientific analysis of welfare economics and social choice. Interestingly, “societal” seems on the wane, but perhaps not in The Lancet.
Interestingly, “societal” is often used by corporations as a PR term to boast of their contributions to “society,” meaning mainly noisy and politically correct “stakeholders.”
The Lancet article also speaks of “economical, cultural, or environmental policies.” “Economical policies”? One might think that the author and his editors want to make tabula rasa of what has been learned before them, but looking scientific and obscure may be a better hypothesis. Later in the piece, though, we encounter the standard expression of “economic policies.”
A minor point also fuels an impression of confusion: the author seems to assume that “financial” and “economic” are synonyms when he mentions some “policies’ redistributive financial effects.” “Economic” normally refers to the use of resources while “financial” refers to claims on those resources—claims of which money is one sort. If the author thinks that economics deals primarily with money and Wall Street matters, he is mistaken, as reading Adam Smith or Jean-Baptiste Say (for example) would show him. Perhaps he should use “financietal”?
The medical sciences are true sciences that have much to say on physical phenomena—the biology of contagious pathogens, for example—but nothing on how individuals should make trade-offs between different good things, and very little on how they actually make them.
Academic figureheads of “public health” as we know it sometimes admit that it is a political movement more than anything else. In the fifth edition of his textbook Public Health: What It Is and How It Works (2012), Bernard Turnock writes:
In many respects, it is more reasonable to view public health as a movement than as a profession.
Similarly, the late Elizabeth Fee wrote, in her introduction to George Rosen’s A History of Public Health (2015):
Public health is not just a set of disciplines, information, and techniques but is, above all, a shared social vision.
The public health movement aims to use state force to impose its participants’ moral intuitions on everybody else—or, at best, to persuade some electoral majority to impose their shared values and lifestyles on minorities. No wonder why, when a real epidemic comes, public health is so underwhelming. Of science, public health only has the look and feel.