Pragmatic Revolutionaries Needed in Public Health

Pragmatic revolutionaries are needed to solve two of the most vexing problems in public health: tobacco dependence and obesity. David Sweanor is making this case in tobacco policy and Hank Cardello is making the parallel case in food policy.

So what do pragmatic revolutionaries look like in action? The textbook case would be the AIDS activists of late 1980s and 1990s, when HIV and AIDS were ravaging the communities affected. The medical and public health policy establishment moved slowly and ineffectively. Activists rallied with a strategy of pragmatic revolution. They protested against policies of CDC and FDA that served to slow progress and stigmatized people with AIDS. They confronted a pharmaceutical industry that they saw as putting profits ahead of the lives of their community.

But at the same time they mounted theatrical protests to foment revolutionary changes in these institutions, they quietly negotiated with them for the changes they were demanding. They helped to shape testing and prevention policies at CDC. They paved the way for accelerated access to new drugs at FDA. And they negotiated for a voice in drug and vaccine development with the pharmaceutical industry. HIV infection is now a manageable chronic disease.

Baby steps in the direction of pragmatic revolution are emerging in tobacco and food policy.

Sweanor makes the case for seizing the opportunity that electronic cigarettes offer in the Canadian Journal of Respiratory Therapy. He says:

Intelligent policy development can allow us to contain the risks of unintended consequences while moving as fast as possible to make today’s cigarettes as obsolete as the automobile technology of 50 years ago.

Likewise, Cardello has been been spotlighting the opportunity to engage, as well as challenge, the food industry to solve the excess of obesity. He says:

Food activists should take a bow and congratulate themselves for generating high levels of awareness for America’s obesity epidemic and for helping drive demand for lower-calorie, better-for-you products. But the knee-jerk urge to demonize business, an all-or-nothing attitude toward how to address a problem, and the public-image, legal, and regulatory warfare that inevitably follows accomplish nothing. We should all be fed up with that.

“If you change the way you look at things, the things you look at change.” — Wayne Dyer

Click here to read the commentary by Sweanor and here to read one of the commentaries by Cardello. Click here to read an essay on the false choice between public health and private liberty.

Revolution #9? Photograph © FredArt / flickr

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