Many of the members of HES are engaged in the metamedica of public health. However, what is the future for public health when our understanding of genetics makes medicine and pharmacy an increasingly tailored, individual-centred activity? Once we know that a particular drug therapy is only effective for particular individuals, and we are all different, is that the end of 'public health' as we know it?
I am not sure about this. Whenever someone says 'we are all individuals', I recall the lines from the Monty Python film The Life of Brian. Brian gives an impassioned speech to the crowd gathered outside his window.
Brian: "You're all individuals."
Crowd: "Yes, we're all individuals."
Brian: "You're all different."
Crowd: "Yes, we are all different."
One Man: "I'm not."
To me, that is something of the nature of Public Health. It has always been about individuals together. The influenza epidemic in 1918 can be seen as a single event, but equally it is a series of individuals all being affected by influenza. It is at the same time an individual experience and a collective issue. And the same is true of the modern threats, of obesity or cancer, and of failures in the supply of water or of starvation. Health is both an individual and a collective experience.
To define something as 'public health' is not, at its heart, a medical action. It is a political action. To say that influenza, or obesity or cancer, or clean water or food supply is a matter of public health is to change it from an individual problem to a political problem. Further, to move from the individual to the public, political claim is also to require a solution. It is a statement about equality and equity. Together we acknowledge this problem and the need for a collective solution.
And so in the new public health chapter that opens with greater understandings about the individuality of medical and health problems, the political activity that is 'public health' remains at the fore. It remains the pursuit of ensuring that health and well-being are provided for all regardless of their genetic predispositions. It is a matter of ensuring that there is no discrimination through the observation of genetic difference. It is about ensuring that drug and other therapies continue to be pursued for all. We do not stop seeing obesity or cancer as a public health issue because we know that it is highly individual in its character, because in great part the public health aspect of these diseases and conditions is the access to healthcare and the development of responses to the problems.
If anything, as we understand the individuality of disease, the need to maintain a 'public health' is paramount, because an appeal to the 'public health' is an appeal in the public interest. The public interest concerns, at its heart, the recognition that individually we are concerned, quite naturally, with our own individual interests and, instinctively, at best with the interests of our families and those who are our immediate neighbours. The public interest ensures that we are forced to look beyond our immediate, personal world to see our connectedness with other people. This is not simply an enforced altruism. It is in our own best interests that we treat the interests of others as equally important as our own interests. If we do not, then what claim do we have on other's resources when we are in need?
And this is where the Law of Public Health takes a form and shape. Law, and the Rule of Law, is also the vehicle of the public interest. Its claims to fairness and justice are not merely rhetorical claims. Courts, lawyers and the machinery of Law do not have to subjugate themselves to the interests of the powerful. Law creates its own narrative, its justificatory story-line about how justice appeals in each claim to its justificatory authority. Indeed, Law is the only response to the almost inevitable exasperation in modern democratic society when confronted by the sight of injustice and inequality, of unfairness and the victory of greed and oppression - 'what can we do about it?' What we can do is reclaim the Rule of Law.
The Rule of Law - the active pursuit of the fairness and justice claims of Law, worked out, in particular through robust, impartial and rigorously observed procedural Law - is centrally important to Public Health. The Rule of Law ensures that the political activity of Public Health, locally, nationally and internationally, finds fair and just translation into policy and action. It is the only real mechanism that enables individuals to call the political and economic classes to account.
Of course, I am not claiming that Courts and Lawyers are not themselves part of that political and economic class. Clearly they are. Often, procedural, substantive, and remedial Law is manipulated to ensure that the interests of the political and economic classes are not only protected and furthered, but are given a veneer of normative respectability through the blessing of the Law. But at the same time, because Law needs to use a language of fairness and justice in order to create the veneer, it leaves itself open to account in its definition of 'fair' and 'just'. That is the opportunity for the political activity of Law. That is the moment when the inequalities that require us to recognise a need for 'public health' can be raised; when the shout for fairness and justice can be heard above the clamour for self interest.
When Sir Joseph Bazalgette engineered the sewerage system in London, or Dr John Snow saw the waterborne nature of cholera, they were engaged in the political activity of public health. When we vaccinate or engage in health promotion campaigns, when we research and identify a new threat to people's health and well-being, we are engaged in political activities. Public Health Law is equally political. It is about ensuring that individuals, regardless of their economic voice, enjoy the universal aspiration to health and well-being. It is the vehicle for ensuring that we all can equally respond "yes, we're all individuals."
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