2 ms·

The joke is that we are actively going down this path in the US.

by sobellian 8y ago

wahern 8y ago
We've been on that path since long before the advent of modern medicine. The rate of diabetes and diabetic complications is so ridiculously absurd among rural communities and among the poor precisely because those communities live in the old culture of "<shrug> he's sick, what can we do?". Those communities embraced interventions like vaccines because they were easy, cheap (or more often than not free), and didn't require changes to lifestyle. Lifestyle interventions are the preferred mode of the bourgeoisie precisely because the poor are unable or outright unwilling to make those changes.[1] The easy wins are over. Now we need to move the real mountains: hearts and minds of the larger population. This is a new fight. The regressions we see are a regression to the mean. But don't forget about or underestimate real wins, like cigarette smoking. That's a radical cultural shift with a tremendous impact to public health and public finances, especially when you consider that through the 1980s and 1990s you saw the same conservative reactions (i.e. spiteful retrenchment) that you see these days wrt to today's social policies. [1] Consider the flavored "tobacco" ban in SF. From a public health perspective there's very little to be gained. But the social elite were arguably more invested in that campaign than in earlier campaigns to reduce actual tobacco use precisely because it's fundamentally a lifestyle issue. And the irony that the elite are for legalizing marijuana but increasingly restricting vaping... don't get me started. I don't want to equivocate the poisonousness fatalism of the right with the zealousness of the left, but it's important to try to keep an objective perspective. Public health is a marathon. And if we let the perfect be the enemy of the better we'll all lose.

2 ms·

The joke is that we are actively going down this path in the US.

by sobellian 8y ago

The joke is that we are actively going down this path in the US.

wahern 8y ago
We've been on that path since long before the advent of modern medicine. The rate of diabetes and diabetic complications is so ridiculously absurd among rural communities and among the poor precisely because those communities live in the old culture of "<shrug> he's sick, what can we do?". Those communities embraced interventions like vaccines because they were easy, cheap (or more often than not free), and didn't require changes to lifestyle. Lifestyle interventions are the preferred mode of the bourgeoisie precisely because the poor are unable or outright unwilling to make those changes.[1] The easy wins are over. Now we need to move the real mountains: hearts and minds of the larger population. This is a new fight. The regressions we see are a regression to the mean. But don't forget about or underestimate real wins, like cigarette smoking. That's a radical cultural shift with a tremendous impact to public health and public finances, especially when you consider that through the 1980s and 1990s you saw the same conservative reactions (i.e. spiteful retrenchment) that you see these days wrt to today's social policies. [1] Consider the flavored "tobacco" ban in SF. From a public health perspective there's very little to be gained. But the social elite were arguably more invested in that campaign than in earlier campaigns to reduce actual tobacco use precisely because it's fundamentally a lifestyle issue. And the irony that the elite are for legalizing marijuana but increasingly restricting vaping... don't get me started. I don't want to equivocate the poisonousness fatalism of the right with the zealousness of the left, but it's important to try to keep an objective perspective. Public health is a marathon. And if we let the perfect be the enemy of the better we'll all lose.