5 quick-fire reasons why I have a problem with the public health approach reported in the New Zealand Herald today under the headline: ‘Attack on obesity starts before life’:
1. The studies were based on animal experimentation (sheep) and there are still many questions about how or whether the findings of these studies translate to humans and human environments. It is therefore way too early to use these studies as a basis for public health policy (this is leaving aside the ethics of animal experimentation that involves starving and/or force-feeding pregnant animals).
2. The relationship between obesity and health is highly contested and we should question the very idea of public health interventions aimed at obesity prevention. The study of obesity, the findings of those studies, their representation in the media, and their application into public health policies are all influenced by anti-fat bias – the socially constructed notion that fat is bad and that fat people are ‘lazy’, ‘greedy’, ‘stupid’, ‘out of control’ and ‘unproductive’. Anti-fat bias results in stigma and discrimination for fat people which is itself a health risk. For example, fat people report frequent dieting with both physical and psychological effects, avoiding recreation in public spaces, and forgoing health care because of the attitudes of health providers towards their fatness. Variations in body weight should be understood as part of natural human diversity, and identifying and addressing anti-fat phobia should be a public health priority.
3. Public health policies specifically targeting women as reproducers and mothers to improve population health are discriminatory on the basis of gender. Such policies are a continuation of a long history of reproductive injustice that has resulted from the reduction of women to their reproductive organs, the elevation of the interests of fetuses over pregnant women, and the responsbilisation of women, particularly mothers, for social and health problems. This in turn has justified, and continues to justify, the surveillance, regulation and control of women’s reproductive bodies including for example restrictive access to contraception and abortion, and policies and prosecutions aimed at foetal protection.
4. Public health policy focused on changing individual behaviour is influenced by neoliberal ideology that seeks to justify reduced state involvement in and responsibility for the population’s health and wellbeing by responsibilising the individual for health. This is unjust - it masks and maintains vast and persistent social and health inequalities and other relations of power eg. racism, poverty and gendered social roles, that create the conditions for and determine poor health. It is no coincidence that the ‘attack on obesity’ by targeting women’s dietary choices before and during pregnancy is our dominant public health strategy at a time when solo parents welfare entitlements are being reduced; when affordable, safe, warm housing is difficult to secure; and when many families are experiencing food insecurity.
5. Public health interventions targeting individual behaviours frequently translate, not into increased social support, but rather blame, guilt and punitive sanctions on those who fail to improve their health regardless of their material realities and social contexts. Not only is this unjust, it also fails as a public health strategy because it risks disengaging people from health and social services. Women are especially vulnerable to anti-fat bias in health services and are already subject to increased surveillance and intervention because of their role in reproduction, particularly women marginalised by their socio-economic circumstances and due to racist systems of oppression. The potential to disengage those women who could most benefit from health and social services is thus high and poses a significant threat to women’s and their children’s health.
(Related reading: Werewolf article: Policing Pregnancy, by Alison McCulloch)