The Final Stage Of Public Health

The WHO goes full 'you do you'

The World Health Organisation just went full ‘you do you’ on public health.

Earlier this week, addressing the mountain of respiratory virus cases across Europe, the WHO’s regional director for Europe, Hans Kluge, said: “no one knows your risk like you do yourself…we all need to use our own judgement when taking steps to protect ourselves, and others around us, based on an individual assessment of risk.”

They tweeted it out:

While this has been the informal approach to managing covid for a couple of years now, it is jarring to see an institution that sets the tone for global public health say it so openly and without fear of reproach.

Kluge said people should make their own decisions about wearing masks, staying at home and indoor air:

He did not reprimand governments for scrapping mask requirements in healthcare settings, or for making it financially (and socially) difficult, if not impossible, for people to stay at home and not work when sick. He didn’t put any onus on businesses to clean their air.

He said this was all up to us as individuals.

As if the air we breathe can ever be an individual choice.

We can’t understand how we ended up here without understanding the creeping, insidious influence of libertarian, laissez-faire economic principles and ideology over our world.

Without understanding that most overused and boring word — neoliberalism.

I’m sure most are familiar, but a brief explanation. Neoliberalism is the description given to the economic policies most of our governments enact: privatising essential services (transport, health, postal), deregulating business, slashing tax and cutting spending on social programmes in the name of financial competence. This framework, the neoliberals say, is the route to growing, competitive, healthy economies and societies. It also happens to make a few people stunningly rich.

Alongside this economic worldview, however, neoliberalism also promotes a specific set of social relations that are just as important for understanding our world today. Neoliberals demand that we view each other in competitive, not cooperative terms, and insist that we have no responsibility towards people we don’t know. Neoliberals see individuals as consumers, not citizens. The role of government, they say, is to protect free markets, not to protect people.

Neoliberalism’s view of social relations was best voiced by former British prime minister Margaret Thatcher when she said: “there is no such thing as society. There are individual men and women. And there are families. People must look to themselves first.”

One of Thatcher's primary goals was breaking up the unions. Of course she hated them. They are organised expressions of society that enable the pursuit of collective action. They were and are the antithesis of the atomised, individualised society she craved. Their power in the 70s and 80s was an obstacle to free markets and low tax. Most annoyingly for her (and the growing band of neoliberals including Ronald Reagan that were winning power across the west), they were effective. They demanded a fair share of employer profits, and they got them.

The neoliberal vision of society was, then, contingent on the crushing of the unions. Which, in most places and for most professions, they duly did.

Thatcher’s sentiment was a radical one in the 1980s, but it set the tone for the decades that follow. The world is now fully crafted in the image of the neoliberals, economically and socially.

When this world crashed up against a new airborne virus, a disaster was foretold.

By advising an ‘individual assessment of risk' Kluge is simply, dangerously, applying to public health the same ideological principles that have long dominated other aspects of our lives. The de-engineering of society away from the collective and towards individual concerns and interests.

A de-engineering that, in health terms, is catastrophic, because health can never be a property of the individual. It is always a property of the collective.

This is never more obvious than in a pandemic, and the last few weeks have once again made this stunningly clear. Covid infections in the US have surged to two million per day, the second largest wave of infections nearly four years after the pandemic’s start, with similarly large waves across Europe.

This is what ‘you do you’ has brought us, what neoliberal public health has brought us, and will continue to bring us: atomised pockets of individuals and families attempting to stay safe, while governments pursue herd immunity, which is nothing more than the transposition of a neoliberal, free market economics approach to a virus. Remember, under neoliberalism, it is not the role of government to keep you safe. If markets can’t or won’t do it, that necessarily means it’s not worth doing. To intervene would be to pervert the natural, and correct, course of things.

Surrounding all of this is the big lie that we can have individual health without collective health. A big lie we are sold constantly. This superfood, that superfood, eat this to avoid cancer, sleep like this to live forever, Brad Pitt’s age-defying diet!

The big truth is that environmental and social conditions are the overwhelming determinants of health: the toxins in the air with breathe, the forever chemicals in the food we eat, the plastic in the water we drink. We can only buy the food we can afford, and to which we have access. We can only sleep in the neighbourhood we can afford, and for as long as the time we have between essential matters of survival allows.

All of these things are determined by our politics, our economics, and our social relations. Not by our choices as consumers.

The same goes for planetary health.

If two million infections a day four years into a pandemic is the biological outgrowth of neoliberalism as applied to public health, climate breakdown is its physical outgrowth.

All the recycling and carbon offsetting of our flights in the world has not, and will not stop, climate breakdown. Think you can create a climate safe community where you can escape fire and flood and drought? On what planet?

Whether viruses, plastics, chemicals or climate changing pollution, we are all exposed.

Everything is contingent on everything else.

We can’t choose the air we breathe.

There is only one planet.

And somehow, some way, we’re going to have to take it back from the neoliberals.