Category: Ashley Fox - Part 2

With Mayor Michael Bloomberg leading the charge, NYC geared up last week to implement a bold new policy experiment to combat the obesity epidemic, banning the sale of certain sugar-sweetened beverages over 16 ounces. However, the move was dealt a death blow on Monday by a New York Supreme Court judge who concluded that the ban was “arbitrary and capricious” because of its unevenness in that it “applies to some but not all food establishments in the city,” and “it excludes other beverages that have significantly higher concentrations of sugar sweeteners and/or calories.”

President Obama’s surprisingly wide margin of victory and the gain of several democratic seats in the Senate was an important win for national health reform, women’s reproductive health, and for economic policies that buffer the social determinants of health. Most recently, Obama can add Florida to the count of states that chose him over Romney. But does this sweeping victory constitute an endorsement of Obama’s policies, or does it simply reflect changing demographics as many pundits have suggested in their election post-mortems? To attribute votes for Obama from minority voters to identity politics alone is overly simplistic because it confounds descriptive representation with substantive representation. Obama lost among seniors, white men and white married women voters. Apparently, Romney/Ryan’s threats to privatize Medicare did not dissuade elders from voting against their own interest.

At the same time as millions of people raced to buy Mega Millions tickets in the hopes of striking it big last week, the Supreme Court was taking a gamble with the lives of millions of Americans in their deliberation over the constitutionality of the individual mandate that is the cornerstone of Obama’s signature health reform law. The coincidence of the health reform hearings happening at the same time as the biggest mega millions pot in history got me thinking about the ways that health insurance more closely resembles the lottery thanbroccoli as Justice Scalia suggested in one of the hearings.

As a health leader/advocate, I submit that, ironically, the 2012 political agenda should NOT be focused on health at all. For instance, we should NOT be talking about insurance coverage of birth control. In spite of being an untiring advocate for sexual and reproductive rights, I believe that this dialogue is a highly distracting and divisive wedge issue. We also should NOT be talking about the health reform. Again, the public is torn over what to make of this complicated legislation. Instead, I propose that the 2012 presidential election should focus on what it is already largely focused on, which is economic inequality.

The choice between advocacy for long-run structural change versus implementing immediately remediable action that may fail to address underlying health determinants has been described as a choice between public health nihilism versus public health pragmatism.[i] Pragmatists emphasize immediate solutions to pressing public health problems such as education and behavioral modification strategies. Nihilists argue that these constitute band-aid solutions that fail to address the deeper, social and structural issues that give rise to health inequities such as economic and social inequalities in society.

The neoliberal right has exploited the debt crisis, as it did the economic crisis, to further its agenda of retrenching the hard won health benefits of workers and the meek and apologetic left, only too happy to oblige, has shrunk from defending these rights. This tactic, described as the “the shock doctrine” by Naomi Klein in her New York Times best selling book, exploits public disorientation following collective shocks such as wars, terrorist attacks, or natural disasters to institute economic reforms that would ordinarily be too unpopular to pass democratically. Unfortunately, the neoliberal right is only too familiar with this thesis. Klein cites Milton Friedman, father of neoliberal economics, as saying, “only a crisis, actual or perceived, produces real change.” Worse still, the debt debate, as with the economic crisis, has reduced our choice set to two options: bad or worse. Either employees face mass lay-offs or they must accept…