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At the turn of the century: which values should drive public health?

At the turn of the century: which values should drive public health? The need to build community autonomy in public health Gavin Mooney Social and Public Health Economics Research Group (SPHERe), Department of Public Health and Community Medicine, University of Sydney, New South Wales There is a need to debate the values that do and those that should underpin public health. In particular, there is a need to challenge the extent to which the values of public health advocacy and public health practitioners dominate too much in public health. Often, it seems there is an untested assumption that the objective of public health is health maximisation. What values underlie such an objective? Whose values underlie it? Two of my concerns are that, first, it is public health professionals’ values that are driving this and, second, there is so little challenging of the health imperative. Those of us in the public health movement – and I deliberately call it a ‘movement’ – run the risk of being seen as elitist zealots. There is, I believe, a real danger of public health falling into the quantification imperative from which clinical medicine suffers, fed by an obsession with data and evidence which are so often a product of what is quantifiable rather than what is important. Especially in Indigenous health, we are learning lessons from 2000 VOL. 24 NO. 2 the past about not attempting to impose solutions. We have a long way to go as a public health movement to do something that will be of genuine use to our Indigenous brothers and sisters. Where is the research, for example, which seeks to identify their cherished dreams for their health? More generally and fundamentally, there is a need to engage much more in social justice. At the turn of the century, we heard many ‘goodwill’ sentiments about the need for changed values, for adopting a more humanitarian face on many more aspects of social life. We entered the brave new world of this century and immediately the media were full of news about the biggest financial merger in history. The date has changed but not the universal greed that drives the capitalist world. Income distribution and wealth distribution and power distribution and health distribution – all seemingly inexorably linked – look no different. The values of the market become so pervasive that textbooks in neoclassical economics can read as if they pertain to a value free planet. Highly educated and articulate commentators write as if economics and neo-classical economics are synonymous. The market has nothing to say about social justice except in so far as its existence is seen as creating barriers for promoting a narrow market concept of efficiency. Can public health stand up to these forces? Can we do anything to redress the inequalities in health created by the massive redistribution of income away from the poor? Where is public health’s research into the income and health effects of the GST and tax reforms? Where is the genuine concern for working class health? More importantly, where is the concern for working class well-being? In terms of social justice, which of these ought to be present in the value base of public health? Yet more importantly, where is the concern to establish what working class people, indeed people more generally, want from public health? The lack of consultation is astonishingly elitist. We need to get out there, asking instead of assuming. Who are we to assume, to presume on behalf of others? However, consultation – which seems too often to be saying, “this is what we are going to do to you and we are telling you, OK?” – is not enough. Eliciting community values and letting these drive the public health enterprise is the way forward. Promoting the community’s capacity for autonomy instead of taking it away from them is the key. Public health has to be driven by concerns for social justice. Journal ‘moves house’ This is the last issue of the Journal to be produced by SUBStitution and I would like to thank Anne Burgi and her staff for all their hard work over the past two years. It has been a pleasure working with Anne and Barbara, and I have appreciated their prompt and professional assistance. The Journal will now be produced from the office of the PHAA National Secretariat and authors should submit their articles to Dr John Lowe, Editor ANZJPH, PO Box 319 Curtin, ACT 2605. John B. Lowe, Editor-in-Chief AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

At the turn of the century: which values should drive public health?

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Publisher
Wiley
Copyright
Copyright © 2000 Wiley Subscription Services, Inc., A Wiley Company
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.2000.tb00120.x
Publisher site
See Article on Publisher Site

Abstract

The need to build community autonomy in public health Gavin Mooney Social and Public Health Economics Research Group (SPHERe), Department of Public Health and Community Medicine, University of Sydney, New South Wales There is a need to debate the values that do and those that should underpin public health. In particular, there is a need to challenge the extent to which the values of public health advocacy and public health practitioners dominate too much in public health. Often, it seems there is an untested assumption that the objective of public health is health maximisation. What values underlie such an objective? Whose values underlie it? Two of my concerns are that, first, it is public health professionals’ values that are driving this and, second, there is so little challenging of the health imperative. Those of us in the public health movement – and I deliberately call it a ‘movement’ – run the risk of being seen as elitist zealots. There is, I believe, a real danger of public health falling into the quantification imperative from which clinical medicine suffers, fed by an obsession with data and evidence which are so often a product of what is quantifiable rather than what is important. Especially in Indigenous health, we are learning lessons from 2000 VOL. 24 NO. 2 the past about not attempting to impose solutions. We have a long way to go as a public health movement to do something that will be of genuine use to our Indigenous brothers and sisters. Where is the research, for example, which seeks to identify their cherished dreams for their health? More generally and fundamentally, there is a need to engage much more in social justice. At the turn of the century, we heard many ‘goodwill’ sentiments about the need for changed values, for adopting a more humanitarian face on many more aspects of social life. We entered the brave new world of this century and immediately the media were full of news about the biggest financial merger in history. The date has changed but not the universal greed that drives the capitalist world. Income distribution and wealth distribution and power distribution and health distribution – all seemingly inexorably linked – look no different. The values of the market become so pervasive that textbooks in neoclassical economics can read as if they pertain to a value free planet. Highly educated and articulate commentators write as if economics and neo-classical economics are synonymous. The market has nothing to say about social justice except in so far as its existence is seen as creating barriers for promoting a narrow market concept of efficiency. Can public health stand up to these forces? Can we do anything to redress the inequalities in health created by the massive redistribution of income away from the poor? Where is public health’s research into the income and health effects of the GST and tax reforms? Where is the genuine concern for working class health? More importantly, where is the concern for working class well-being? In terms of social justice, which of these ought to be present in the value base of public health? Yet more importantly, where is the concern to establish what working class people, indeed people more generally, want from public health? The lack of consultation is astonishingly elitist. We need to get out there, asking instead of assuming. Who are we to assume, to presume on behalf of others? However, consultation – which seems too often to be saying, “this is what we are going to do to you and we are telling you, OK?” – is not enough. Eliciting community values and letting these drive the public health enterprise is the way forward. Promoting the community’s capacity for autonomy instead of taking it away from them is the key. Public health has to be driven by concerns for social justice. Journal ‘moves house’ This is the last issue of the Journal to be produced by SUBStitution and I would like to thank Anne Burgi and her staff for all their hard work over the past two years. It has been a pleasure working with Anne and Barbara, and I have appreciated their prompt and professional assistance. The Journal will now be produced from the office of the PHAA National Secretariat and authors should submit their articles to Dr John Lowe, Editor ANZJPH, PO Box 319 Curtin, ACT 2605. John B. Lowe, Editor-in-Chief AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Apr 1, 2000

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