I say Epidemic – You say Fear Mongering

By Ted Bruce

Debates on public health issues are a staple of life. Unfortunately, they often involve a false dichotomy. Those promoting individual choice argue that public health advocates are “no fun” trying to create a “nanny state” by banning all those tasty treats and indulgences like cheap happy hours and supersized pop. On the other hand, those seeking regulation may too readily use scare tactics in support of their arguments. I’ve been known to demonstrate this tendency myself. For example I may have been a bit over the top in arguing that those in favour of the new alcohol regulations in BC think that there’s nothing wrong “with a couple cheap double rum and supersized cokes after work to set you up for the drive home from work”. Who needs evidence when you can undermine your opponent with an “insightful” analysis like that?

When we get beyond the rhetoric though, these debates are critical as they force us to bring evidence to bear on an issue and help to educate the public about the need for important public health measures. A good example at the moment is the current debate on electronic cigarettes and whether they are actually a good thing because they may help some people reduce their addiction to tobacco. It is actually a critical issue and is becoming a well informed debate with better evidence and clearer arguments on both sides.

What we sometimes forget, however, is the importance of stopping long enough to recognize our past accomplishments and highlighting these. By demonstrating the value of population health interventions we can better help people understand the need for public health policies. This is especially important when pejorative statements like “nanny state” or “government paternalism” are used to counter public health evidence. The image of public health is an important commodity in winning the public over to effective interventions. In the electronic cigarette debate, actions to restrict electronic cigarettes may move quickly because of the credibility of public health that comes from the tobacco story we tell. The Canadian Public Health Association’s campaign on the greatest public health accomplishments is a good example of building trust in public health.

A recently released report by the Fraser Institute on obesity in Canada has been slammed by many in the public health community.

The importance of celebrating our successes and using these in shaping a case for public health interventions was brought home to me by the recent Fraser Institute report on obesity in Canada. They analyzed a very selective data set on weights to suggest that there is no need for public health interventions that they describe as “government paternalism” – yes they invoke that language to shore up their case – to deal with what they argue is not an epidemic of obesity. (It is worth noting that in the report they also characterize Canadian anti-smoking efforts as an “increasingly draconian war on the tobacco industry”.) There are many available critiques of the Fraser Institute report discrediting many of the arguments they put forward but an important one was by the Canadian Public Health Association and the Dieticians of Canada. Notable in this response is the comment on the success in combating obesity and the need to do even more.

It would be easy to rant about the Fraser Institute report being biased. It is important to critique their arguments and evidence to show where it is wrong. But as importantly, we must reinforce the successes of population health approaches to build confidence and trust in the voice of public health. Rhetoric is loud and can hide the evidence the public
needs to consider. Public health builds a credible voice by speaking out on its successes and demonstrating its value. It is this credibility that helps the public take the time to examine the evidence and draw sound conclusions. Sometimes it is important to brag a little.

Ted Bruce– Ted Bruce is the past-president of the PHABC

Further Reading:

Obesity is a Public Health Concern | Dieticians of Canada – News Release | April 28, 2014 | http://www.dietitians.ca/News-Releases/2014/ObesityPublicHealth.aspx

12 Great Acheivements in Public Health | Canaidan Public Health Association | http://www.cpha.ca/en/programs/history/achievements.aspx

Obesity in Canada: Overstated Problems, Misguided Policy Solutions | The Fraser Institute | April 28 2014 | https://www.fraserinstitute.org/research-news/display.aspx?id=21119

In the News:

Canada’s obesity ‘epidemic’ exaggerated and the health risks overstated, Fraser Institute says | By Sharon Kirkey | The National Post | April 28 2014 | http://news.nationalpost.com/2014/04/28/canadas-obesity-epidemic-exaggerated-and-the-health-risks-overstated-fraser-institute-says/