As you probably know by now, I do this newsletter as part of a tandem project with Nate Holdren, one of the aims of which is to develop a concept or theory of social murder adequate to explaining, in general, the role of capitalism in shaping population health, and in particular, the COVID-19 response. As part of this, Nate has been encouraging me for awhile now to do a post on what exactly public health is. This post is going to be one approach to this idea, an attempt to explain what public health is, but in a peculiar and hopefully interesting way.
Of course, public health is a lot of things — a public service, a complicated federalized bureaucracy, a private academic discipline, a vibe, an ideology, a loose constellation of methods. I have seen the serviceable analogy that medicine is to the individual body as public health is to the social body. What I want to address, primarily, is this interesting characterization along the lines of “individual vs. collective” orientation. The heuristic dualities here break down into public vs. private, collective vs. individual, social vs. biological, and so on. I want to propose something a little bit different: that the “individual/collective” framework actually flattens out the different levels of structural organization within which complex social phenomena play out.
Capitalism and the population distribution of disease or debility are both emergent properties of human social interaction and organization; they emerge, however, at a level above the individual, in the realm of the social or the collective or whatever you want to call it. This is absolutely different from a mindset orientated towards individual or collective phenomena, which is what people almost always mean when they bellyache about “individualism” getting in the way of public health (not hating, I’ve done my fair share of such bellyaching).
Population health is emergent at a higher level of social organization than the individual or groups of individuals — at the population level. Public health is, supposedly, the technocratic field that “manages” (but in actuality, usually ratifies) the population distributions of health and disease. “Social murder” can then be said to characterize the form of population health under capitalist social organization, what Tony Smith calls “dissociated sociality.”
Capitalism and population health are connected at this higher organizational level, the level of the social. Not only that, they are in contradiction. (Hopefully, readers of this newsletter do not need me to enumerate all the ways that the core capitalist imperatives of valorization and accumulation directly conflict with maintenance or improvement of population health.) Because I’m Hegel-pilled now, this has me thinking about what the dialectical resolution or product of this contradiction might look like, and on what level it might take place. Are global capitalism and population health both nested within (or put another way, the internal contradictions of) an even higher-level process? Some kind of planetary ecology? I don’t know, and I haven’t thought much about it, but I would like to think about it more.
To bring this back to a more concrete level, this helps me make some sense of how offensively futile I find a lot of the political/activist dimension of thinking about Covid these days. I could probably write an entire post about just this (which everyone would hate) but just briefly — “collective” is not a mindset, an attitude, or a belief. Yes, our individual actions ultimately constitute collective behavior; no, it is not as simple as yelling at people enough or posting enough infographics with asterisks at the bottom about how our individual actions of course must be grounded in a collective mindset. Behavior is structurally constrained; collective behavior emerges at the collective level
This helps me make sense of how futile I find a lot of individual-level, personal-responsibility activism around COVID. Yes our individual actions “make up” the collective behavior; no, it is not as simple as yelling at people enough or posting enough infographics and hoping that people change their behavior. I kind of think that this is intervening at the wrong structural level, that the toothpaste can’t go back in the tube — behavior is structurally constrained in meaningful ways that aren’t overcome by simple acknowledgment.
Hoping that you all aren’t too mad at me, I’m gonna leave it here and go eat dumplings. I hope you’re all having a lovely weekend.