Public Health is Bullshit

If a clinician treats tuberculosis with Paracetamol alone, they would be labeled an idiot. Tuberculosis is a disease caused by microorganisms. But also tuberculosis disproportionately affects people who live in poverty and undernutrition. Thus treating TB requires anti-tubercular therapy (ATT) and also nutritional rehabilitation. Paracetamol might help with the symptoms, but is not sufficient. The ATT kills the microbes while the nutrition helps the patient recover strength and life. People in preventive and social medicine would say “it is not enough to stop there. We need to also think about the social support of the individual, their housing, their family members, their livelihood.” If a clinician treats tuberculosis with paracetamol, they should be labeled an idiot because they’re killing the patient.

What then do you label a public health practitioner who treats the failing public health system with “publications” and incremental change? When the Titanic is sinking, what use is it to pour water out with a spoon? Karl Marx says “The philosophers have only interpreted the world, in various ways. The point, however, is to change it.” Karl Marx is right. Public health systems are failing millions of vulnerable Indians. Yet, public health practitioners are involved in describing how. They seem to spend no time in changing it. If at all they do, they do it like the clinician with the Paracetamol. The incremental change they affect is apparently useful, but actually harmful.

The worst part is that they are actively against radical change. They do not just discourage those who seek radical change, they stand in the way and sabotage such work. They create justifications for governments to focus on the trivial. They create “evidence” and recommendations that can be used by self-serving politicians to build a veneer of change. 

And then there is the self-aggrandizement. After doing absolutely shitty work under the label “public health”, there is a LinkedIn inspired congratulatory performance that public health folks engage in. They pat each other on their backs for having done “fabulous work”. This performance is not without consequence. There are powerful and rich people waiting for enabling more such work. It is in the best interest of everyone in the elite section to have public health be a performance of mediocrity and fundamentalism. To seek radical change is to be trouble for them.

Anyone who speaks about annihilation of caste is cast aside. You can question entrenched caste hierarchies in public health, but only in a publication. That is “discourse shaping”, you know? You shape the discourse through publications. And then what? The discourse becomes more and more politically correct, but the reality remains the same as it was. No power exchanges hands. There is no reparation. And no justice. Just verbal performance. 

They say Mathematics is the queen of sciences. Well, public health is the LinkedIn of sciences. For every op-ed that’s written about tuberculosis, there’s a person dying of tuberculosis. Op-eds don’t change how power operates in the society. And without changing the dynamics of power, one cannot change the dynamics of tuberculosis. Power has to be actively disrupted. And that requires being radical. And public health folks seem to hate being radical.

I’m not homogenizing the field of public health. Like there are several forms of feminism, there are several forms of public health too. And the moment I say that there’s a radical form of public health, everyone else would want to claim they’re in that too. Really? You’re radical? With your publication about how the learning environment in medical school shapes how doctors practice? Or your index on universal health coverage?

There’s an intense fear of judging in public health. Good judgement is a result of knowledge and critical thinking. If you cannot judge, what use is thinking for you? And when anyone judges work in public health for being bad, there’s a universal scorn. Like it is a felony to say that bad work is done in public health. Well, fuck you. Bad work, shitty work is done in public health by a lot of people. And if you’re scared to call it that, then probably it’s because you’re scared of being called out yourself.

Why should you be scared though? Public health is incredibly difficult. It is natural to fail in it. We should be suspicious of people “succeeding” in public health. For public health to succeed in its goals, the world has to be radically re-arranged. And such radical re-arrangement is beyond the hands of an individual. If we could all be comfortable with that idea, the idea that we have taken on a field of work where it’s impossible to succeed. Where the reward is in having dared to dream and having attempted the impossible. Where the victors are not judged by how successfully they did a tiny thing, but by how spectacularly they failed in a lofty goal. Perhaps that humility about the scope of public health might be what changes the field and makes it actually useful to people.

The humility to say that our work does not amount to anything. The humility to give up our mic and chairs in favor of those who are doing things that are far more useful. The humility to join hands with those who want a better world and are discontent with the way things are. The self-awareness to think about why incremental change is acceptable to us. The commitment to truth. The commitment to justice. The commitment to put justice above our own careers.

Perhaps that will save the field. But till then, public health is bullshit.