Public Health and the Triumph of Irrationality

Coming to a lawn near you…

It’s been inspiring to see how the nation has pulled together to stop the spread of COVID-19. It’s also been puzzling, however, in that it’s so out of character with the attitude Americans have otherwise taken to issues of public health. According to a recent article in the New York Times, cancer killed almost twice as many Americans in 2020 as COVID, and heart disease killed more than twice as many. That is, heart disease was the leading cause of death in the U.S. even during the most lethal period of the COVID epidemic, and cancer was second. Twenty-one percent of the deaths in the U.S. in 2020 were from heart disease and 18% from cancer, as opposed to only 10% from COVID. My point here is not that we should have been less concerned about COVID than we were. My point is that if we care so much about public health, why are we doing next to nothing to reduce the death toll of these two far more lethal threats?

Take heart disease. Not only do we know what causes it and how to prevent it, prevention is far easier than is the prevention of COVID. The causes of heart disease are things such as obesity, poor diet, smoking, excessive alcohol consumption, stress, and lack of exercise. It would be relatively easy to tackle these problems. We could outlaw the sales of jumbo-sized sugary drinks, limit legal amounts of sugar and fats in processed foods, outlaw smoking, establish legal limits on the sales on alcohol, and mandate short supervised exercise periods in workplaces. 

Americans are generally hesitant to impose what many have traditionally taken to be excessive legislative measures to protect public health. There was enormous support, however, for the legally-mandated extended lockdown measures and mask requirements to protect people from COVID, so why is there so little support for more moderate legislative measures to protect Americans from these greater threats to their health? The attempted ban on jumbo-sized sugary drinks was so short-lived that most people no longer even remember it. We’ve done a great deal to limit smoking in the U.S., but even with those measures it continues to be a huge threat to public health. If we can shut down businesses to protect people from COVID, why can’t we shut down the tobacco industry to protect people from the ravages of smoking (which affects not only smokers, but everyone in close proximity to them, not to mention imposing enormous costs on the healthcare system)? Bars and restaurants can, in theory, be held legally liable for serving alcohol to obviously inebriated customers, but in practice that law is seldom enforced and we have no legal limits whatever on the sales of alcohol in retail outlets. 

Obesity makes people more vulnerable to death not merely from heart disease, but also from COVID, but while we are going to unprecedented links to protect people from dying of COVID, we’re doing nothing to protect them from becoming obese. In fact, we are arguably encouraging obesity by our quiescence relative to the amounts of sugar and fat typically found in processed foods and grotesquely exaggerated restaurant portion sizes. According to Sheldon Rampton and John Stauber, a study by the Center for Science in the Public Interest done way back in 2000, found that “a mushroom cheeseburger with friend onion rings at TGI Friday’s contain[ed] about 1,800 calories and the same amount of fat as five strips of bacon, four chocolate frosted donut, three slices of pizza, two banana splits, and a Big Mac combined” (see Trust Us, We’re Experts: How Industry Manipulates Science and Gambles with Your Future, p. 66).

And what happened to the President’s Physical Fitness Award, later renamed “The President’s Challenge”? The award was initiated by Lyndon Johnson and designed to encourage Americans to be more physical active. It was discontinued, however, in 2018. 

Other countries take action to promote good health among their citizens. I moved to Denmark on a Fulbright fellowship in 1990 and ended up living there for eight years. Denmark launched a public service campaign in the early ‘90s to get Danes to eat less fat. The spokesperson did brief television spots where she was shown scraping butter off bread and rolls and wagging her finger accusingly at the viewer for having spread it on too thickly. 

Where are our anti-fat public-service commercials?

Denmark also promotes physical exercise among its citizens, and it does this despite the fact that exercise in the form of bike riding and hiking is a firmly entrenched cultural practice. Danes can be moralizing and one of the things about which they tend to moralize is the importance of fresh air and exercise. I can’t count the number of lectures I received from well-meaning Danish friends when I occasionally admitted that had not been outside or gotten any exercise for a week or more. 

Interestingly, not only do Danes have a longer life expectancy than Americans, their mortality rate from COVID is approximately half the mortality rate in the U.S. (i.e., 1% as compared to 1.8% according to statistics on a Johns Hopkins website). 

Cancer also claimed far more lives in the U.S. last year than did COVID, yet we’re doing almost nothing to prevent it, despite that there are measures we know would be effective. We know that glyphosate, an active ingredient in Monsanto’s weed killer Roundup, causes cancer. We’ve known that since 2015. Why is it still legal? Monsanto has been forced to settle thousands of lawsuits out of court (that’s what companies do to avoid any public record of liability) by people who’ve been able to argue persuasively that they’ve gotten cancer from exposure to Roundup. In fact, they’ve even been successfully sued by people who have gotten cancer from exposure to Roundup. A federal appeals court recently upheld a $25 million verdict against them. And yet glyphosate is still legal!

Glyphosate isn’t the only known carcinogen that’s legal. Formaldehyde, saccharin, nitrites, vinyl chloride, acrylonitrile, aflatoxin B1,and polychlorinated biphenyls, to name just a few, are also legal. I’ve chosen Glyphosate, however, because an experience I had recently serves as a great example of the point I want to make in this article. I passed a neighbor, while I was walking my dog, who was spraying his front lawn with Roundup. I’m generally reluctant to tell other people what to do. It occurred to me, however, that my neighbor might actually have been unaware of the dangers of Roundup, so I paused, smiled at him and then, with an expression of neighborly concern said, 

“Do you know that stuff causes cancer?”

“Yeah, but it’s the only thing that will take care of these weeds,” he responded and then retuned to spraying the area directly below the light on the walkway leading to his front door. 

The man was deliberately dousing his yard with a known carcinogen simply to get rid of weeds! Is it conceivable that he’s actually more afraid of weeds than of death from cancer? That hardly seems likely. The thing is, cancer is a more amorphous threat. It’s generally a result of repeated or prolonged exposure to a carcinogen. It’s rarely an immediate threat. It’s usually something relegated to an indeterminate future. 

The same thing is true with heart disease. We all know that obesity, smoking, poor diet, lack of exercise, etc., can lead to heart disease. The thing is, that threat isn’t immediate. It’s long term. You don’t drop dead as a result of eating one mushroom cheese burger, or drinking one jumbo-sized soda. You won’t drop dead because you haven’t yet joined a gym. You can always do that tomorrow, just as you can cut down on your consumption of alcohol, or of sugar and fat, or quit smoking — tomorrow. 

The situation with COVID is different. It’s an immediate threat. Immediate threats are something Americans can understand. We’re very short-term oriented. It’s arguably irrational, however, to prioritize the short term over the long term. Short-term gratification can end up causing horrific long-term suffering. A weed-free yard may elicit the admiration of one’s neighbors, but that’s going to be cold comfort on the cancer ward. The allure of junk food and the couch is generally more compelling than the allure of steamed vegetables and the gym, but we’re likely to regret having given in to it too often when we discover we’ve ruined our health.

It’s encouraging to see how Americans have come together to stop COVID. Why can’t we come together to stop heart disease and cancer? Are we incapable of appreciating that they are actually greater threats to the lives of most Americans than is COVID? Are we simply collectively incapable of long-term thinking? 

(This essay originally appeared in the 12 May 2021 issue of CounterPunch.)