Long before coronavirus, the public health sector had inklings towards authoritarianism justified by the so-called science, just not the widespread public support.
The British general practitioner Michael Fitzpatrick wrote in his book two decades ago, The Tyranny of Health, that the medical profession is ‘at the cutting edge of the drive to extend professional regulation over personal life.’
As Fitzpatrick identified, one of the central weaknesses of the new public heath regulations of lifestyle was that benefits were often limited yet the costs were very substantial. An example he cites is cholesterol control. A ten per cent reduction at a population level of cholesterol levels amounts to barely a few months in the extension of life expectancy.
Little did the prophetic family doctor know that his warnings would become even more relevant over time.
Our leading medicos who have led our much-lauded response against Covid-19, namely Chief Medical Officer Brendan Murphy and Associate Professor Paul Kelly, are not from the public health establishment. They have taken wise decisions such as closing the border to China against the advice of the World Health Organisation and to the chagrin of Chinese authorities and critics such as NSW Greens MP Jenny Leong claiming such actions were evidence of the racist essence of Australian society.
They are also leading the charge to accept a certain level of risk and re-open the economy, but are dependent on state authorities to implement the advice.
But the current indications are that our state leaders, especially of the biggest states NSW and Victoria, have natural leanings to the authoritarian preferences of the public health establishment.
Experts from the public health department of the University of New South Wales for example, such as Professor Mary Louise McLaws, have suggested the current restrictions remain till the end of June to be truly safe.
The Premier of NSW, Gladys Berejiklian, demanded rugby league players have the flu vaccine compulsorily, despite the vaccine arising originally to protect the elderly and immunocompromised.
Within a few short years and in the midst of coronavirus fears, suddenly influenza is being billed in the same way as smallpox or rubella despite no new evidence supporting the necessity of widespread flu vaccination. The fracas over football players not receiving an influenza injection is a pointer that we are in danger of absorbing a public health version of morality, read tyranny, as the current era continues.
The public health establishment has an inbuilt tendency towards catastrophic predictions on top of a growing culture of lifestyle regulation. This includes trying to ban sugar, commanding exercise or finding new ways of punishing the dwindling pool of smokers. All such measures have a disproportionate effect on the poor, much like the current set of restrictions. Cleaners and waiters can’t log in to work meetings remotely for example.
The populations of the Western world are living longer, more prosperous lives than ever before. Life expectancy has increased by approximately thirty years over the past century. The killers of much of human history such as infectious disease, complicated pregnancies and poor nutrition are well under control.
Improvements in sanitation have dramatically improved the risk against gastrointestinal killers. The primary burdens on health systems are all diseases of growing longevity and prosperity, namely cancer, osteoarthritis, metabolic diseases and mental health.
Not unlike dentists for whom the improvement in dental care meant many have had to move into cosmetics, the tremendous gains we have made in treating disease mean public health has become more about exhortation of virtuous behaviour.
A good example in New South Wales is the lockout laws. Here was an example of public health over-reach driven by doctors who could not see beyond the potential patient in front of them. Doctors are poorly qualified to consider the myriad of costs at a social and economic level. Nor do most see the inherent value of individual autonomy and liberty, prizing health outcomes as the ultimate value. It is appropriate that experts are somewhat monomaniacal about their specific endeavours, which is why politicians and policy makers are required to balance competing interests.
An aspect of this current crisis, as identified by scientist Dr John Lee in this magazine, is that the speed with which we were required to act meant governments were never really in a position to compare apples with apples. Models clearly predicting the social, economic and mental health toll of widespread restrictions were not readily available.
This meant catastrophic modelling such as from Imperial College’s Professor Neil Ferguson held reign, despite our initial data being limited. It is rapidly becoming clear that Ferguson’s assumptions and modelling were woefully incorrect. He has since been forced to step down from his position advising the British government after being caught out in a salacious lockdown affair with a young lady with the wonderfully numerically-themed name of Antonia Staats.
Our own proponent of widespread lockdown, Norman Swan, was essentially the biggest local mouthpiece for Ferguson’s modelling.
The comments under the UK Telegraph newspaper exclusive exposing Ferguson were especially humorous; one stated that in the pretence of Ferguson’ voice ‘We had sex one hundred thousand times, but if it were not for the lockdown, we would have had sex five hundred thousand times’, a reference to Ferguson catastrophic prediction now proven to be way off the mark.
In the clamour to congratulate front- line workers, we should also acknowledge the less glamorous role of the public health soldiers, tracing, testing and measuring. An epidemic such as our current one is where public health comes to the absolute fore.
However, we should be wary of some of the wider underpinnings and history of the sector as it remains front and centre of national discourse.
Let’s hope that the downfall of Ferguson, albeit through a sex scandal, is a marker that the potential of an authoritarian, public health version of morality and social control will not acquire greater traction in the midst of our pandemic- scarred future.
Dr Tanveer Ahmed is a psychiatrist
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