Blind spot of academic political philosophy: not recognising health as a political incentive and healthy longevity as a political goal

This post is the continuation of The Open Lifespan answer to Jonathan Floyd’s political philosophy organising question: how should we live? Preparations post and takes up the story where the earlier one ended.

On the other hand, the reason I gave it a separate, focused title is that this is also a standalone, and I think quite relevant, piece in terms of the political philosophy Open Lifespan is aspiring for.

Introducing Health as a political incentive NB style, examples

As mentioned earlier, Floyd introduces 2 behaviourist measures to judge, justify success of existing (or past) political systems: plainly put, the more disincentives to political insurgence and crime a system enables the more successful it’s going to be.

‘minimising inequality, by way of a more social or egalitarian set of policies, minimises crime’

p169, Is political philosophy impossible? Jonathan Floyd

So less crime according to Floyd is the behavioural expression of the political preferences of people who do not commit crime due to the egalitarian policies implemented by the institutions of the political system they live in. Notice the negative, indirect aspect here, the inference is that if you do not commit crime it means you approve the system more.

My main suggestion is that ‘public and personal’ health considerations are as much a political incentive (or disincentive, see later) already today and due to increasing life expectancy are increasingly become so in the near future.

First, let’s see if we were to treat ‘health’ in an orthodox Floydian normative behaviourist  way as a dependent political variable, like insurrection and crime, what would we get? 

We would get something like the less disincentives to be unhealthy a political system provides the more successful it’s going to be. And orthodox, narrowly political NB methodology require us to think of political unhealthiness as a response to political principles expressed by reigning institutions. Let’s try to think of an example (example #1) and since both Floyd and me are living in the UK, where there’s NHS, the embodiment of ‘universal’ health care, maybe we can think of something concerning this data from last year:

‘The number of patients waiting for an operation on the NHS has reached 4.3 million, the highest total for 10 years, official figures show.

Growing numbers are having to wait more than the supposed maximum of 18 weeks for planned non-urgent surgery such as a cataract removal or hip or knee replacement.’

NHS operation waiting lists reach 10-year high at 4.3m patients Guardian

Should we think here that we have 4.3 million people, representing ~6.5% of the total UK population, as a political mass ready to rebel against the system? The system keeps them unhealthy by making them wait for long, isn’t that a political fuel? Maybe. Should we maybe think of those UK expats living in Spain, enjoying less waiting times and better food as a political expression of being disincentivized by the UK health care system, that needs be actually factored into NB’s way of selecting the best political system?

Actual political parties are trying to use the ‘health care’ card all the time to appeal to the electorate, but never (please give me counter-examples) as central arguments in their political toolkit. This might have something to do with thinking about health as not a primarily political thing. To me this is the same problem I see amongst political philosophers too chronically underestimating the political relevance of health issues.

Let’s see more examples of the politicization and mainstreaninization of health, some of them might seem ridiculous but am offering them here nevertheless to provide potential pointers towards extending NB to include the topic.

Example #2: consider the Brexit process and its effect on the (public and personal) health of the UK population and the NHS consequences. I assume it will be something that plays out in the longer term but will affect the political preferences of a lot of people. Consider this cite from the editorial of the current New Statesman:

Brexit has absorbed the energy and resources that should have been devoted to the economic and social renewal that Mrs May once promised. Life expectancy is now falling, income inequality is rising and violent crime is surging.  

New Statesman

Let’s go transatlantic with Example #3: I don’t know whether we have empirical research  on this (would guess no, will search later, but eminently doable) but I can easily imagine that back then there were health-focused people (Democrats) who have not voted for Obama because he was a smoker. So they might have observed this and thought: if this guy is still smoking then he is not the best candidate to promote public health as what he does presents health danger not just to him but to his human environment, family, whatnot. And I imagine there might have been health-focused people (Republicans) who have not voted for Trump because he loves junk food. So they might have observed that and thought: here is somebody who promotes an obviously unhealthy lifestyle and popularises an activity (Obama as I recall was much more secretive with his smoking habit, acknowledging it’s problematic status) that led to already bad public health consequences.  

Please note with this example, that this does not lend itself easily to the orthodox Floydian type of NB method he calls institutionalism which puts the political effects of institutions on the behaviour of groups of people on centre stage. But I think this focus relates to how Floyd missed to recognise the political relevance of single trends see earlier post. On the other hand with including health here as political motivation we are pushing NB to extend its position and research agenda. This is how it can be turned into a collective academic enterprise.

Example #4: The potential political consequences of overmedicalising blood pressure readouts: Last year the American Heart Association came up with much stricter guidelines regarding hypertension: According to these guidelines hypertension starts at 130/80 mm Hg and Stage 1 hypertension is between 130-139 systolic and 80-89 diastolic. Values between 120-129 systolic are now counted as elevated, while diastolic under 80 might still be counted as elevated if systolic is in the 120-129 range. Most BP machines available now will give a firm green rating to a 125/81 reading for instance, but this is supposedly now in the yellow. The political point am about to make is statistical: with these guidelines more than 50% of the US population are now considered to be at a health risk by the dominant professional organisation/institution. Can guidelines representing top level state yellow warnings like these, handed out to the majority of the citizens, lead to political disincentivization on part of the affected, as opposed to help as the guidelines supposedly were aiming to do so?

And the US is I believe counts as an SLD according to Floyd. Just like the UK. This case of ‘overmedicalisation’ is way more complicated than just one example can suggest (there are further examples, eg. similar thing is happening with pre-diabetes guidelines) and hope I can allocate enough time latter to handle work out a position compatible with Open Lifespan.

Example #5: just giving here the headline, the link and a brief cite with no further comment on how political this situation can be: Americans Are Going Bankrupt From Getting Sick

According to a survey published this month in the American Journal of Public Health, nearly 60 percent of people who have filed for bankruptcy said a medical expense “very much” or “somewhat” contributed to their bankruptcy. That was more than the percentage who cited home foreclosure or student loans. (The survey respondents could choose multiple factors that contributed to their bankruptcy.)

Americans Are Going Bankrupt From Getting Sick The Atlantic

I hope I have provided some interesting examples for an eager normative behaviourist political philosopher (or maybe even for a mentalist one) to make them think a bit more about the political aspect of health issues in general.

Finishing this section with a quick note concerning the concept of ‘Public health’ and while I have avoided to use it: it is a mixed bag concept, but I don’t have time to deal with it now.

Improving health in general and improving healthy longevity is part of the same continuum and express the same political incentive

Going back to NHS surgery waiting list example #1 above, most of those 4.3 million waiting for surgeries deemed to be non-urgent by public policy but certainly more urgent by their personal policies, are over 60 as all 3 of those problems above (cataract, hip, knee) typically affect older people and increase with age. Concerning cataracts a fresh news from today, just showing the headline: NHS England restricts patients’ access to cataract removal and the and subheading: ‘RNIB says ‘shocking’ rationing severely affects people’s ability to lead independent lives’

These people just as well think of these delays, as an expression of a deeply rooted, institutionalised ageist policy. An ageist policy that is nevertheless very prevalent in social-liberal-democracies too.

Here we have reached a central political component behind Open Lifespan philosophy, which can be thought of as a generalised (possible upper limit) form of healthy longevity philosophy. It is that better health care and increasing healthy longevity are just simply the 2 sides of the same coin, or to use a more quantitative and statistically accessible phrase, pushing healthy longevity is the last effort that has not been maximised yet as part of of improving general health, so longevity is part of the health continuum, sitting at the long tail of it. Going back to the coin analogy, so far we have just mainly seen one side, the heads of the coin (the coin was biased), the ones related to improving infant, childhood mortality and fighting off infectious diseases (latter present an ongoing challenge though), but we are just starting to see health coin tosses ending up showing us tails, the far side of health (care) that is working on improving late life mortality and contributes to growth in increasing healthy life expectancy too. In this respect please consider what I said about the modal age of death in Martha Nussbaum’s problematic first capability: what is ‘the end of a human life of normal length’? Part 1.

From this OL point of view, advancing (advanced) biomedical technology for the improvement of human health, and making it a central political goal is the same thing as fighting against deep rooted ageism, and making it a central political goal. Ageism is the most universal and least battled amongst all of the big discriminations out there, a true final frontier for egalitarian approaches. Please see detailed argument in Fighting aging and fighting ageism: two sides of the same coin?

Stretching normative behaviourism: Why should be crime a more political thing than health or ill-health?

Let me finish this post by asking the NB orthodoxy (which at this point is Jonathan Floyd himself, the founder): Why do we think that crime is a more fundamental behavioural variable/measure of political preferences than health/ill-health behaviour?

It seems that insurgence/rebellion/revolt with its amply documented history is a prima facie political thing to do and study as such, but why crime, if not health?

According to the reasons provided above actions, opinions, voting preferences expressive of health preferences are just as political as behaviour related to crime or lack of crime.

Maybe the the focus is not there yet, but I believe there’s already ample data to look into the (perhaps fairly contemporary) history of politics to dig out relevant health related data and come up with a modified theory of what polity is.

To be continued…

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