Tag / social determinants of health

by crmayes

Don’t be surprised by Abbott’s comments about ‘lifestyle choices’

By Christopher Mayes, University of Sydney and Jenny Kaldor, University of Sydney

Prime Minister Tony Abbott’s claim this week that people living in remote communities were making a “lifestyle choice” that taxpayers shouldn’t be obliged to fund was not just the result of an unguarded moment. Rather, the phrase reveals an underlying view that social circumstances are the responsibility of individuals, rather than societies.

Commentators as well as Abbott’s top advisers on Indigenous affairs were quick to criticise the characterisation. Others suggested it was just another prime ministerial gaffe that shouldn’t distract us from the real issues.

Abbott is infamous for his gaffes and “dad jokes”, but this was not one of those moments. A day after he made the remark, the prime minister defended his use of the phrase on the Alan Jones Show.

“Lifestyle choices” was not a gaffe but a neoliberal mechanism of government that adopts a consumer logic to: i) shift responsibility for ‘closing the gap’ on to individuals; ii) trivialise Aboriginal ontological connection to land; and iii) ignore the effects of colonization, while “continuing settler colonial ‘logic o elimination’“.*

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by crmayes

Morally Indigestible Listicles: Food, Experts, and the Burden of Choice

Never Eat

The Sydney Morning Herald (via the Telegraph, London) has published another “no-nonsense-straight-shooting-science-based” listicle of the foods YOU SHOULD NEVER EAT AGAIN! These lists seem to appear at least once every week on some form of news website.

This current list is prefaced with references to recent British Medical Journal studies that turned upside down “everything we thought we knew about eating and drinking healthily”. Instead of saturated fats being “the killer”, it turns out carbohydrates are!

Put down that bacon & egg roll and get yourself a KFC Double-Down sandwich!

Surprisingly the article doesn’t question why these new claims have a stronger knowledge base than previous claims or how we can be sure that in a week there won’t be another “nutritional revolution” that will turn this all on its head and finger protein as Grandpa’s real killer.

Leaving aside the science-base of these claims – not to imply this is unimportant – what is most disturbing about these articles (and this article in particular) is the emphasis on individual food choices as the determining factor of health. “Expert” claims that “every bacon sandwich you eat knocks half an hour off your life” reinforce ideas that my heart disease or your diabetes are reducible to that sandwich or chocolate bar eaten six years ago.

When these factoids are spoken by folks in white coats during times of austerity cuts to health services there is a real danger of compounding already existing public health policy problems by pretending that structural influences can be addressed via a nice social marketing campaign or a Jamie Oliver TV show that teaches people how to cook, garden and “never eat those foods again”.

In the UK (where this article originated) David Cameron recently flagged that sick benefits may be cut from people who are obese and do not lose weight. The rationale for this idea is that obese people can lose weight simply by making “correct” and “healthy” food choices. However, according to Cameron, they aren’t making these choices because life is too good on benefits. Hence, cut the benefits and healthy food choices will be made.

While these listicle articles may be dismissed as “not too serious” or “a bit of fun”, they depend on and reinforce a moralistic and biopolitical perspective on the relation between food, choice and health. This perspective is often used to justify budget cuts to health services due to the expectation that health is simply a matter of individuals making the right choices.

In an article for Public Health Ethics, my colleague Donald B. Thompson and I argue that this perspective is morally and scientifically unjustified. Below is the introduction. If you’d like read the whole thing but the pay wall gets in the way send me an email.

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by crmayes

The Ethics of Spotify and the Social Determinants of Health

On March 16,  I woke to the news that Jason Molina had died. Molina’s struggles with alcoholism and associated health problems became widely known in 2009. It also became known that his family were struggling to pay his medical bills and that Molina did not have insurance.

Molina’s death is a singular event. It is unique. It is his death. But a feature bears comparison to the deaths of Mark Linkous (2010) and Vic Chestnutt (2009). All three died without health insurance and with financial difficulties. This scenario is not isolated to these three.

Artists like Molina, Linkous and Chestnutt were never chart-toppers, but during the 1990s they developed strong and loyal followings, including the likes of REM, Glenn Hansard, Tom Waits and others.  Despite gaining more exposure into the 2000s, this did not necessarily translate into greater sales or financial security.

A factor, not the cause, but a significant factor in the scenarios surrounding these deaths has been the rise of websites like Spotify or Grooveshark and the decline of musician income from record sales. Arguments about legality of these sites and their impact on the music industry go back and forth. Most consumers minds appear to be made up – there are 24 million users on Spotify, 6 million of which pay $5 or $10.*

My aim here is not to defend the music industry, but connect points whose relationship isn’t immediately apparent. I contend that the decline in artist royalties due to streaming sites is a social determinant of the poor health and life expectancy among artists. And this places an ethical obligation on consumers.

If consumers are only paying approximately $10 a month, but consuming more music than ever before, and artists** are only receiving 0.5-0.7 cents per stream while also living lives that are socially and medically insecure, then it is time to broaden the scope of questions from legality to ethics.

Spotify and other sites like it may be legal, but are they ethical? There is a lot talk about ethical sourcing of coffee beans or the conditions of workers in clothing manufacturers. This is important. But it would be a sad situation if this ethical concern was not also extended to those who produce the music that enriches and shapes our personal and social realities.

Many musicians of lesser fame than Molina struggle to secure basic needs such as medical care or permanent residence. This is part of mythos of the struggling artist, but it is also a reality that has been compounded by developments in music consumption via music streaming websites.

I am not suggesting that consumers necessarily need to stop using Spotify or other websites – although I am not excluding that option either – but they do have an obligation to ensure an equitable and just compensation to the artist. This could be achieved by hearing a song on Spotify and then buying the album directly from an artists website. I am sure there are many more imaginative approaches. But the point is that if we love a song or an album, then we should extend that love to the person that produced it.

* This fee isn’t for the music, but for the privilege of not having advertisements.
**By Artist I mean people who put their lives into their music. People who may have interim jobs but predominately depend on sales of records and concert tickets to live. I am not referring to hobby artists, people who have a profession and some artistic endeavor on the side.