This week finds me on the beautiful island of Rhodes. With the chilly October rain setting in at home, a week on the beach, soaking up the sun and doing nothing more taxing than penning a blog is blooming marvellous. Of course, in this era of 24/7 newsfeeds, I am aware that this quiet idyll does not reflect the general mood of the Greek populace. Economic calamity is stalking this nation and my contribution of purchasing beach towels and sun tan lotion is not going to satisfy its debtors. People are losing their jobs, livelihoods, pensions and hope for the future and angry citizens are currently making their feelings known a few miles down the road in Athens. As is often the case, you may be wondering what the Greek economic crisis and my holiday has to do with public health. Well, the missing piece of the puzzle is my holiday reading (stick with me, all will hopefully become clear!).
In the past few weeks, I have blogged about public health in the context of clinical medicine and it’s wider partner, infectious disease control. To the extent that it is actually possible, I think that we understand what needs to be done in these areas to keep a population healthy. There is always room for improvement, but these disciplines have been around for a while and with enough common sense and a continued push for a global response to preventable diseases, they should see us right for the foreseeable future. The trickier business for those of us interested in a population’s health and wellbeing is how to approach what is often politely (when compared to other terms…) referred to as the “soft stuff”. In the UK and other countries of a similar persuasion, we’re no longer dying in droves from dysentery and TB (although these diseases are still obviously of major global significance), but neither are we demonstrating good levels of mental or physical health. My holiday reading is a book that looks at why that might be the case.
The author Oliver James, has coined the term Affluenza, (1) as both the title and description of what he refers to in the book as a virus which puts a high value on acquiring money and possessions and looking good in the eyes of others. This increases our vulnerability to mental (and by association physical) health problems. He looks at this issue in different countries and cultures and finds Britain, America and Australia to be particularly virus ridden. This manifests itself as a drive to create an ultimately mythical land. There is an obsession with materialism and appearance ranging from hair products to houses, working longer and longer hours to keep up with the rat race and sustain a particular lifestyle, and hot housing children into an academic system where if they are not consistently top of the pile, they are considered failures. This causes already fragile self esteems to nose dive and the whole monstrous hamster wheel starts turning for the next generation.
The book is excellently researched and observed, but many of you will already be familiar with this view of our society – I have thought about similar issues in regard to health inequality in previous blog entries. What is particularly useful about this book and which has got me thinking as I soak up the rays on this beautiful island, is the vaccines against the virus that James offers at the end of each chapter. With the exception of the last chapter which looks at some aspects of how a political manifesto would address these imbalances, the vaccines are addressed at an individual level. They emphasize working out what is actually important to you, as opposed to: what social pressure is telling you is important; what consumerist and economic drive would like you to believe is important; what the academic and career ladder informs you is necessary; or even what your parents handed on to you in terms of values and beliefs. Now at this point, I realise that I sound a bit like a self help book, but if you can stand any sort of introspection at all, have a go at trying to divorce what you really hold important from all of the influences just mentioned (the confounder of course being that what you actually hold as important may very well overlap with some of these influences) – I confess that I gave up in favour of the beach when my head started spinning, but plan to return to it on a rainier day!
In terms of public health, I am fascinated by the idea that we could develop population vaccines against affluenza, protecting large numbers of people, as opposed to just the odd individual. Variations on this theme have already been posited in slightly different guises. Redistribution of wealth, education for all, a lifecourse approach (hit people with the healthy stuff whilst they’re still in utero) etc. These approaches all have value, but I think that they may fall short of the mark in truly achieving improved health and well-being across a population. My main reason for this reluctant pessimism is because we still approach this problem as though it were a disease with a simple causal pathway and a solution – old school public health where a one size fit was pretty effective and individual differences of minor import. This malaise is as complex a conundrum as ever presented itself and needs vaccines that understand far more about how individuals make up a population, and the difficult practical and ethical implications of implementing interventions. As many of the English. population have recently thrown their hands up in horror at the (I would argue not unreasonable) suggestion of adding fluoride to the water supply, I can only imagine the response to suggesting a combination of a policy change, a social marketing package and an educational approach, designed to protect a population from the ravages of consumerism – back to the PR drawing board with that!
As is only too obvious, I am just beginning to develop an understanding of how or if, these population vaccines might be fashioned and I would welcome any input on this subject. Whilst here in Greece, I have had two further further thoughts related to this matter: Is fast economic growth really a sign of a thriving population? I am not an economist and have no idea if Greece would be better off defaulting from the Euro or not, but the current state of play is pretty dire. Secondly, for this individual at least, a bit of time off on a not irregular basis is an effective vaccine in ensuring good mental and physical health and I am very happy to advocate for this to be included in any programme or policy manifesto!
References
1. James O. Affluenza. Published by Vermilion, 2007
Pop(ulation) Culture 