In the last newsletter ("An Inconvenient Truth: Politics, Economics, and Ethics"), I argued that it is our responsibility to speak scientific truth to political power out of consideration of professional ethics and of the mission of public health – social justice.

I would like all of us to see that C. Wright Mills had public health leaders and researchers in mind when he wrote (in Dissent, 1955): "The intellectual ought to be the moral conscience of his society, at least with reference to the value of truth, for in the defining instance, that is his politics."

There is greater attention being given to factors "upstream" from traditional public health practice, evidenced by "the social determinants of health." However, too many articles about them fail to take account of the political and economic factors that largely determine them. The way public health research is funded, assessed, rewarded and published isolates it from having positive effects on the social determinants of health.1

By limiting analyses of societal health to its social determinants, we play into the hands of those who enforce the status quo to block all progressive efforts, a process well described by Noam Chomsky: "The smart way to keep people passive and obedient is to strictly limit the spectrum of acceptable opinion, but allow very lively debate within that spectrum - even encourage the more critical and dissident views. That gives people the sense that there's free thinking going on, while all the time the presuppositions of the system are being reinforced by the limits put on the range of the debate."

So long as that debate remains epidemiological, the status quo is protected, for as Albert Einstein noted, "the significant problems we face cannot be solved at the same level of thinking we were at when we created them." For medicine to realize its promise, Rudolph Virchow wrote (1848), "it must enter into the larger political and social life of our time; it must indicate the barriers which obstruct the normal completion of the life cycle and remove them." In his idealism, he saw medicine as "a social science, and politics nothing but medicine on a grand scale."

My idealism requires me to argue that our politics is bad medicine on a grand scale, virulent in obscuring the causes of the inequities that deny us social justice. As John Dewey wrote in "The Need for a New Party" (1931), "Politics is the shadow cast on society by big business." Against that we must fight with the equity inherent in our democracy and in those liberties whose exercise protects and promotes democracy.

The first truth is that the liberty of a democracy is not safe if the people tolerate the growth of private power to a point where it becomes stronger than their democratic state itself. That, in its essence, is fascism - ownership of government by an individual, by a group, or by any other controlling private power.
-- Franklin D. Roosevelt (message to Congress, 1938)

We Americans need to realize that our desire for wealth, manifest in the for-profit corporation, concentrates not only wealth, but the power to control our government and determine our politics, a power that must be reserved to The People democratically in order to preserve the republican government promised by our Constitution.

Recent political events may make my ideals seem hopelessly impractical to achieve, but I’ll continue promoting them in the very interest of hope. As Andrei Sakharov said (interview, 1973), "There is a need to create ideals even when you can’t see any route by which to achieve them, because if there are no ideals then there can be no hope and then one would be completely in the dark, in a hopeless blind alley." So for a liberal, the hope is always that The People will develop the political acuity necessary to realize the promise of America now being squandered, and that we are still the America where, as De Tocqueville noted, events "can move from the impossible to the inevitable without ever stopping at the probable."

Each of us promotes social justice by doing the right thing – telling the whole truth: Right in principle, right in practice.

By John Steen, Consultant in Health Planning, Health Regulation and Public Health