Western "Public Health": a Socialist Vanguard

The culture of "Public Health" is displacing the culture of "Medicine"

Modern “Public Health” primarily focuses on disease prevention and treatment, rather than on health promotion. “Public Health” relies on top-down, centrally planned interventions imposed on populations rather than individually optimized health promotion and treatment decisions. The “Make America Healthy Again” (MAHA) movement strives to focus on health promotion rather than disease treatment. Success in this enormous transformational endeavor will require a re-examination of the organizational, cultural, and structural drivers that have led to the currently dominant focus on disease.

One simplistic argument is that this modern focus on disease is the consequence of “capitalism” and the profit motive (as embodied by “Big Pharma”) distorting what should be a public utility (“healthcare"). While the predatory nature of many large pharmaceutical firms and their marketing arms is self-evident, they have become adept at exploiting a niche, a business opportunity, that emerged consequent to fundamental political and sociological trends towards centralized planning based on utilitarianism and socialist theories.

“Public Health” as defined by current Western two-year “Masters in Public Health” (MPH) training programs (that require no prior medical or biological training), theorizes that imposing healthcare management decisions on the population at large will achieve statistically optimal minimized average disease for all people.

In other words, Western “Public Health” is based on the political and sociological logic of socialism: equality of outcome rather than equality of opportunity, coupled with a form of medical authoritarianism in which “healthcare” interventions are imposed on the population in general, rather than developed and negotiated on an individual basis in a private physician-patient relationship.

Western “Public Health” shares a commitment to achieving equality of statistically optimized “minimal disease” outcomes across the overall population, rather than equality of opportunity to achieve health, and rather than optimizing health on a case-by-case basis for each individual citizen. As history has repeatedly demonstrated, when centralized planning and decision-making imposed on populations err in assumptions or interventions, the consequences are typically catastrophic due mainly to the scale of the imposed mistake. This is one of the key truths illustrated by the COVID “pandemic” debacle.

The modern practice of “Public Health” relies on big data, and primarily involves statistically isolating and defining measurable medical signs and symptoms associated with “bad” public health, and then identifying interventions that are demonstrated to move population-based statistical parameters towards “good” public health. In many cases, “good” and “bad” are subjective, and often myopically lack broader context.

In modern practice, these subjective determinations are made by an “expert” elite (that typically benefits from the priorities it establishes), separate and isolated from the general population- typically in the “ivory towers” of the academy- rather than subjected to any public deliberative democratic process. There are no referendums on injecting fluoride into public water systems, discouraging a meat-based diet or substituting seed oils for animal fats. It is no wonder that one consequence of modern “Public Health” has been the rise of various “health” priesthoods, such as now exist in pediatrics, cardiology, infectious disease, and epidemiology. This is the direct consequence of the logic of centralized planning and socialist philosophy (ends justify the means!) infiltrating the entire US national and global (WHO) healthcare enterprise. Central planning requires an anointed expert elite to guide and justify centralized decision-making.

These interventions are then promoted by various top-down mechanisms (governmental and corporate policies coupled with coercive judicial enforcement and propaganda). Often, these policies are enforced through mandates (notably vaccine mandates), insurance rate incentives, taxation (alcohol, cigarettes), as well as other methods of theft, violence and coercion, coupled to governmental, corporate, and social pressure.

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What drove this transformation from health promotion to disease treatment?

The Flexner Report - 100 years later

The Flexner Report of 1910 transformed the nature and process of medical education in America with a resulting elimination of proprietary schools and the establishment of the biomedical model as the gold standard of medical training. This transformation occurred in the aftermath of the report, which embraced scientific knowledge and its advancement as the defining ethos of a modern physician.

Such an orientation had its origins in the enchantment with German medical education that was spurred by the exposure of American educators and physicians at the turn of the century to the university medical schools of Europe. American medicine profited immeasurably from the scientific advances that this system allowed, but the hyper-rational system of German science created an imbalance in the art and science of medicine.

Before the Rockefeller-funded, “Flexner Report”-driven transformation of medicine, medical treatment was grounded in the logic of individualized health optimization and the principle of subsidiarity. Although not explicitly mentioned in the US Declaration of Independence, Constitution, or Bill of Rights, the principle of subsidiarity is a key subtext that runs through these founding documents.

The fundamental principle of subsidiarity is centuries old, was once a core tenant of both the Catholic church and many other Christian theological disciplines, and is written into the original charter of the European Union.

Subsidiarity is the principle of social organization that holds that social and political issues should be dealt with at the most immediate or local level consistent with their resolution. According to the European Union:

“the general aim of the principle of subsidiarity is to guarantee a degree of independence for a lower authority in relation to a higher body or for a local authority in relation to central government. It therefore involves the sharing of powers between several levels of authority, a principle which forms the institutional basis for federal states.”

When those raised in the classical liberal Western tradition speak of “freedom,” in many ways, they are referencing the principle of subsidiarity. The ideas of freedom and subsidiarity underpin the assumption that, in a “free” society, individual adults are presumed to be competent to make their own personal daily decisions so long as they do not interfere with the rights of other citizens.

The principle of subsidiarity forms the bedrock upon which modern “libertarianism” and “anarcho-capitalism” (as defined by Murray Rothbard) have been constructed. The principle of subsidiarity recognizes that optimal decision-making during periods of change occurs in a decentralized, locally-based manner. The principle of subsidiarity rejects the logic of large-scale, top-down centralized planning, instead endorsing decentralized bottom-up problem solving.

The principle of subsidiarity is grounded in millennia of experience with human social organization. Socialism, utilitarianism and centralized planning are modern political and social experiments that have repeatedly failed since their 19th century origins through to the present.

The principle of subsidiarity is fundamental to traditional Western allopathic and osteopathic medical practice. In that context, the local authority is the autonomous licensed physician and, even more so, the physician-patient relationship.

Subsidiarity: Restoring a Sacred Harmony

Abstract

The principle of subsidiarity is a bastion of Catholic social teaching. It is also a principle in the philosophy of the American Founding Fathers. In the USA, subsidiarity is ignored without a sense of the proper harmony between authority and responsibility. Human dignity and wise stewardship are compromised. Conscience protection becomes a concerning issue as highlighted by the conflicts arising after passing of the Patient Protection and Affordable Care Act. A reconnection of the patient to be steward of his health care is critical in addressing these issues. Third parties, including the government, business, and insurance companies, are firmly entrenched in health care, oftentimes with the result being increased cost and detachment of the patient from the stewardship of his or her care. Vitally needed is a return to the principle of subsidiarity in health care.

Introduction

The genius of the American Founding Fathers is their unprecedented success in implementing subsidiarity. The idea of independently sovereign states coming together to form a united nation is subsidiarity put into practice. Since the time of the initial European immigrants to North America, from the Quakers and Puritans of the middle and northern colonies to the Celtic and Cavalier cultures of the southern and western regions, the common conception of power was from the base upwards (McClanahan 2012).

That is, people saw authority first within themselves and their family and looked next to their local town then to the county and after to the state and finally, last of all and least importantly, to the federal authority. In our very own Bill of Rights, the 10th Amendment to the Constitution makes this belief clear. Namely, any power not expressly delegated in the Constitution to the federal government resides with the states or the people.

However, the deterioration of subsidiarity is evident in the United States today. The office of the presidency dominates modern political discussion while local politics is almost completely disregarded. The Supreme Court renders decisions (see Roe v. Wade, Obergefell v. Hodges) about all facets of life ranging from marriage to abortion.

The default response to societal problems today is centralization. Physicians must combat this response in order to maintain the sacred relationship between them and their patients. The principle of subsidiarity is instrumental in this effort. Specifically, reconnecting the patient with his or her health care is the fundamental solution subsidiarity offers for some of the greatest ills within the healthcare system today.

Many thanks to Dr. John W. Kieffer, then of Lackland Air Force Base, San Antonio, Texas, USA. I could not have said it better.

If we are to succeed in the endeavor to Make America Great Again, and to Make America Health Again, we would heed his wisdom and advice. Paraphrasing Shakespeare, the fault, dear citizens, lies neither in our stars, capitalism, nor “Big Pharma”, but in ourselves. As both physicians and as citizens, we must wean ourselves from the false idol of centralized planning, utilitarianism, socialism, a nanny state bureaucracy and a conflicted medical elite that seeks to optimize equality of outcomes, and return to a belief and commitment to the ability of free people to make their own decisions about how they live and their own health.

“I would rather be ashes than dust! I would rather that my spark should burn out in a brilliant blaze than it should be stifled by dry-rot. I would rather be a superb meteor, every atom of me in magnificent glow, than a sleepy and permanent planet.”

John Griffith Chaney (eg. Jack London). (born January 12, 1876 – died November 22, 1916)

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