Tuesday, April 24, 2012

"People Do Have Choices, But They Exercise Them Mainly Under Social Influences"

Dr. Lester Breslow, a pioneer in the field of public health, recently passed away. He was 97. Here's an interview with him from 2003:

An Interview with Dr. Lester Breslow, American Journal of Clinical Nutrition, November 2003

Here he discusses individual responsibility vs. societal responsiblity:
Throughout much of his work, an emphasis on individual initiative in health behavior change is evident. Breslow believes that an overemphasis on individual responsibility instead of societal responsibility leads to “victim blaming.”

"In the report on Health Needs of the Nation for Truman in 1952,” he said, “we delineated the issue quite clearly. People make choices. You and I can decide each day on positive health behavior or negative [health behavior], though most [behaviors] become ingrained in us as habits. Such decisions are not made nor habits developed in a vacuum, but in a social context in which we live. If people live with smokers, smoking is more likely; if people live with exercisers, they tend to exercise. Social factors, advertising, availability, are all determinants of each individual’s choices. As public health workers, we should make it clear that people do have choices, but they exercise them mainly under social influences.”

At the end of his book Health and Ways of Living, Breslow specifies that social action is necessary to influence health-related behavior decisions — social interventions will be more practical and efficient than individual ones. “An example of that,” he said in the interview, “is the successful tobacco smoking control program in California. A great effort of volunteers, public health, and medical people was instrumental in passing legislation as an initiative. A tax of 25 cents per pack is for specific hospital, medical, and other services, with 20% for interventions encouraging people not to smoke. The program involved a very broad network: school, work, health department, state, community organizations, [and] media. Projects spreading the word in neighborhoods, as well as use of mass media, were quite effective. The whole milieu about smoking was being changed, reversing the general tolerance of it. In government offices, smoking was prohibited, in workplaces and in restaurants and bars smoking was also prohibited. So there is progress to making smoking unacceptable.”
Here he addressed whether laws that limit individual freedoms are justified:
In conducting social interventions, there is the potential for conflict between personal autonomy and the common good. Is it right to make laws on personal health choices when such decisions can improve the health of the whole society? Some have referred to this as “health fascism,” an observation that drew laughter from Breslow. “Such laws can appropriately be passed when individual behavior is a hazard to someone else,” he said. “For example, secondhand smoke kills people and causes disease. Laws may be passed to protect people who may be exposed in the workplace, such as flight attendants. Yes, it is appropriate when one’s individual behavior imposes a risk on other people.
I liked the secondhand smoke example. Can you think of another?


Claudia said...

Another example is guns. People don't want gun laws even if its for the common good. We'll go through more loonies like Loughner before things change.

Bix said...

Guns is a good one. I had to look up Loughner. He's the guy who shot Gabby Giffords?

I've been held up at gunpoint. It's a terrifying experience.

caulfieldkid said...

Actually, I'm not sure guns fit. Or their mention at least brings up the difficulty in drawing the lines.

There is a direct correlation between smoking in front of someone and their health risks. But what about smoking away from others? It still puts a strain on the health care system, leaves some children w/o parents (due to early deaths), and businesses with lower productivity etc.

If we broaden the scope to include those type of secondary causes, then you have a lot of things that fit under the umbrella. I believe this is where guns* would fit, as would obesity and alcohol (excluding drinking and driving - that would be more akin to second hand smoke).

If we flesh that out some more, how about things like granting illegal aliens health care? Is that not done at the cost of those legally in the system? Should we allow some unnecessarily risky behaviors like riding motorcycles? Maybe there should an equation that assess risk of social costs versus the individual benefit. I guess that would be something similar to an actuary.

I will say this: I firmly believe in the "your fist ends where my nose begins" principle. I'm just trying to point out that determining where that is, exactly, can be difficult sometimes.


*The reason I would put guns in that category is because they can be/are used for things other than shooting/killing people. But you can certainly argue the risks of having firearms among the general public out weigh their (supposed) benefits. I wouldn't make the argument, but I wouldn't call you crazy if you did.

Bix said...

Well, Shaun, I agree with you that it isn't cut-and-dry. I do think assault weapons, these semi-automatic things where you don't have to stop to reload, should be banned. I think the purchase and use of other types of guns should be regulated, background checks, waiting periods, gun-safety courses, that kind of thing. Why do we have to jump through so many hoops to get a drivers license but not a gun?

Ronald said...

Luckily this is a food blog since you are opening up a can of worms with the guns discussion. I don't like violence but I do think I should be able to defend my fists when someone throws their nose at it.

caulfieldkid said...

Honestly, I don't have strong feelings about gun control (I don't own assault rifles/hand guns etc.). I just thought that it did bring up the issue of personal liberties vs. social costs/risks.

It's not an easy issue. I often find myself conflicted on the matter. I have libertarian leanings, but I also see that we are not automatons. How do we draw these lines?

I don't smoke, so it's easy for me to say, "There's nothing good about smoking. The only sensible thing to do is make it illegal." But I bet there are some smokers that would disagree with me. Do I really want to go down that road?

There are two extremes: A "Wild West" where anything goes and you have to fend for yourself (Anarchy), and "The Nanny State" that controls all things (think Minority Report/Brave New World etc.). Some how we, as a society, have to come to a consensus on things that approximates a balance between personal liberty and the social good.

Some things are black and white. Using melamine as a filler in food (human or pet food) is not okay. That one is easy. There is a direct correlation between someone trying to profit at the cost of someone else. Other things are not so black and white. Should we ban certain types of "junk food?" I'm not so sure.

All of that is to say that I find his statement("Yes, it is appropriate when one’s individual behavior imposes a risk on other people.”), when unqualified, fallacious. That's too broad. If pressed he might have qualified the statement; I don't know.

Maybe I'm just being a contrarian.