Quick note here. I wrote this a few months ago and am still kind of workshopping it. But I was revisiting it today and I think this fragment is sufficiently developed to send out.
A little while ago, I wrote some posts about Goran Therborn and ideology: here and here.
As I was reading Therborn’s book, and writing those posts, I (Carrie Bradshaw voice) couldn’t help but wonder: what is the ideology of public health? (In the interest of limited time, I am not going to rehash Therborn’s analysis in depth here. You can go back and read my posts if you’d like to, but basically, following Althusser, Therborn argues that ideology “interpellates” different kinds of human subjects; ideology is a process that subjectifies you and also qualifies you for certain kinds of social roles and responsibilities.)
Who does public health “subject and qualify”? What kind(s) of subject(s) does it interpellate? Immediately, I think there are already two distinct ways to talk about this: the ideological processes of public health interpellate 1.) public health professionals and also interpellate 2.) “the public” that public health is addressed to. Bringing Therborn back in, he argues that ideology interpellates human subjects according to: ontology (what is), possibility (what could be), and normativity (what is good or desirable).
I’ll get right to an illustrative example: the concept of the “epidemiologic transition.” This is widely taught in public health programs; it is definitely part of the ideology of public health in the United States. The theory of the epidemiologic transition is that heavily industrialized countries, like the US, have basically conquered infectious diseases as important sources of population-level morbidity and mortality since the advent of antibiotics, the eradication of smallpox and malaria (here), and other developments occurring around the middle of the last century. The US, according to this theory, has passed through the epidemiologic transition such that now, the really concerning sources of morbidity and mortality in the population are chronic conditions — diseases typically associated with longevity, like cancer, or “lifestyle,” like hypertension or type II diabetes. (“Lifestyle” is in quotations because, while this is part of public health ideology, I do not endorse it.)
The ideology of public health as expressed in the theory of the epidemiologic transition tells public health practitioners what is (infectious diseases aren’t a meaningful source of population-level mortality but chronic diseases are), what could be (the “burden” of these chronic conditions will balloon due to the age structure of the population unless interventions to reduce them are taken now), and what should be (there’s a lot packed in here, nesting ideologies, but I think most public health professional’s sense of normative consensus here is basically free-market ideology reflected in the “lifestylist” paradigm that dominates public health — that members of the public should listen to experts and take approved steps to reduce and manage their risk. I don’t think most are conscious of this — to paraphrase Zizek paraphrasing Donald Rumsfeld, there are things we don’t know we know, and that is the structure of ideology).
This ideology has interpellated as subjects a generation of public health professionals who don’t think very well about infectious diseases as social problems, or in social terms, or even in population terms. The epidemiologic transition is a concept whose “truth” also materially structures public health as an institution in terms of funding and training opportunities. Cancer, physical activity, and cardiovascular disease are funding bonanzas; many grants are awarded to study these things (often maddeningly basic and redundant bullshit — we fucking know that things like poverty and living in a town without sidewalks are associated with poorer cardiovascular health), training grants are available to support trainees, and so on. Infectious diseases and the study of them are usually siloed away in a more bench-science discipline, and addressed at the molecular rather than social level. It would be moderately easy to get on a training grant as a PhD student to study the molecular mechanism of action of the COVID spike protein; it would be basically impossible to get on one to look at the social dimensions of COVID. This may be changing, I hope so.
The epidemiologic transition is one hyper-specific example. I think public health professionals are interpellated by a lot of other ideological processes — those corresponding to positivist science, those corresponding to small-l liberalism and the social role liberalism affords scientific information and expertise, certain types of practicalism or pragmatism. I’d love to write more about this at some point when I have more time. Boston University School of Public Health dean Sandro Galea’s book Within Reason is a perfect example of asinine public health ideology and the kind of expert subject it interpellates: overconfident and poorly read, naive and Pollyannaish about what science is and the ultimate truth of “the data,” dangerously ignorant about most issues of public import, unprincipled, condescending in this horrible transparent way that feigns concern and empathy (this is a rich people/academics thing generally but it is so loud in public health).
Public health ideology also interpellates “the public” on whose behalf it is supposedly intervening. My perspective on this is necessarily as someone interpellated as an expert, of course, but still I think I can evaluate this. But, I will do so in a subsequent post! Bye!!