Advocacy is Not Always Popular

By Dr. Trevor Hancock

Public health is political – always was, always will be. Ideologically, we believe in the collectivity, in using the power of the state to manage, control, tax, enforce and even punish (we do all these, for example, with respect to tobacco control, perhaps the most lauded public health success in the past 50 years).

Whether we are trying to control tobacco and alcohol use, unsafe food system practices, unhealthy working conditions, environmental pollution or junk food, we are going to irritate powerful ideological and thus political opponents; both those who believe in individual freedoms more than in collective responsibility and those who believe in unfettered free enterprise.

Nothing new in that: In the 15th century, Carlo Cipolla tells us in his 1976 book Public Health and the Medical Profession in the Renaissance, that the Health Officers for the Boards of Health complained about the hostility of the merchants, who in turn complained that their economic well-being was disrupted by the regulation of trade and commerce by the Boards, who were trying to enforce quarantines to control the spread of infectious diseases such as the plague.

It is not our role to try to be ‘neutral’ in these situations; we are not neutral, we are very clearly pro-health, which means we are very clearly opposed to health-damaging activity, no matter the source. If we are not biased, we are not doing our jobs. If we do not speak out in oppostion to policies, programs and practices harmful to health, be they from the public, private, non-profit, faith, academic or any other sector, we are not doing our jobs.

You only need to look at the recent policy positions of the Canadian Public Health Association to see such opposition in practice.

Opposed to minimum sentences

In favour of firearms control, opposed to closing the gun registry

Today twenty-eight medical, nursing, allied health and suicide prevention organizations and thirty-three professionals in the same fields, released an open letter to Members of Parliament in order to underscore the importance of the gun registry in helping to prevent domestic murders, accidents and suicides.

“For almost twenty years the Canadian Public Health Association has advocated for stronger gun laws including the licensing of all gun owners and registration of firearms because of their potential to prevent death and injury. We are seeing encouraging results from Canada’s progressive gun laws. Firearm related deaths in Canada have reached a 30 year low and of particular note is the dramatic decline in the misuse of rifles and shotguns, the target of the 1977, the 1991 and the 1995 legislation.”

Opposed to continuing support for the mining and expert of asbestos

CPHA calls once again on the Government of Canada to support the listing of chrysotile asbestos under the Rotterdam Convention, and as well urge the GOC to take actions to:

  1. Introduce legislation to ban the mining, use, and export of asbestos
  2. Cease funding the Chrysotile Institute

In favour of supervised injection facilities

CPHA commends and supports the Supreme Court of British Columbia’s ruling granting Insite, Canada’s first supervised injection facility (SIF), a constitutional exemption from the application of sub-section 4(1) and 5(1) of the Controlled Drugs and Substances Act (CDSA).

Clearly, the CPHA policy positions, based on public health values and evidence, are in opposition to declared federal policy and practice.  The Harper government, it has recently been revealed, has an enemies list – their word, not mine. Not an opponents list – an enemies list.

Well, if standing up for good public health policy and practice makes us not just opponents of the government, but enemies, so be it. We should all be on the list; I certainly hope I am on it, and will be offended if I am not! (see my letter to the Globe and Mail, July 18th)

Trevor Hancock crop_0

So are you on the enemies list? If not, why not?

Dr. Trevor Hancock is a Professor and Senior Scholar, School of Pulic Health and Social Policy at the University of Victoria

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One thought on “Advocacy is Not Always Popular

  1. Absolutely agree that public health is political and should be clearly pro-health. But it is then critical that we link that to a definition of health that is also political in its cognizance of the power dynamics between individual and collective. This dynamic is at the heart of almost all political debate but too often is not clearly articulated. As a result, in putting forward the “health” position we too often behave like absolutists doling out our “prescriptions” drawn from unexamined positivist assumptions.Let’s get political in promoting policies that enable individuals and communities to increase control over and improve their well-being.

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