Magda Szubanski
Magda Szubanski (Image: ABC iView)

What message are readers and viewers supposed to take from Magda’s Big National Health Check and associated articles, such as that from public health expert Dr Sandro Demaio at the ABC today, with the bizarre title “Why it’s becoming nearly impossible to be healthy in Australia”.

I’m not here to criticise Magda Szubanski (big fan, etc). And I know I’ve got my own baggage on all this, having been attacking the “nanny state” and “paternalists” pretty much since I arrived at Crikey. Using such terms, I recognise, is likely not the best way to win hearts and minds, so I’ll leave them at the door from now on.

That’s because there’s a lot to unpick and unpack here and it follows no set ideological path. In fact this is the ideological equivalent of crazy paving.

The message from Demaio is that individual decision-making on health is near meaningless. “It’s easy to think this is a failure of individual willpower, on a macro scale,” he says about Australians’ health. “When it comes to our personal health, the cards are stacked against us in Australia. At almost every point throughout our day, things make it harder for us to be healthy — and easier for us to increase our disease risk.”

Why exactly Demaio thinks “the cards are stacked against us in Australia” is unclear. Australians are the eighth-longest-lived people on the planet — 24 places above Denmark, which Demaio champions as an example to copy. We’ve just come through a global pandemic with one of the lowest death rates in the world.  Yet somehow the cards “are stacked against us”.

It’s true that for particular groups, such as Indigenous Australians, the cards are very much “stacked against them”, and it shows in their much lower longevity and poorer health outcomes. But the blanket claim that it’s impossible to be healthy in Australia — which an ABC subeditor, not Demaio, probably made — is absurd on its face.

To return to Demaio’s point, and that advanced by Liam Mannix in a recent article (also featuring Szubanski), individual choice is more or less unrelated to health outcomes — it’s all down to social and economic pressures, towards, in the words of Mannix, “our food and exercise choices — away from health foods and towards highly processed, highly profitable junk”.

“Some scientists are sceptical we are truly making ‘choices’ at all,” he intones darkly.

Let’s leave aside Mannix’s peculiar argument that suggests more exercise isn’t the answer because you just eat more, and concentrate on the message from both him and Demaio — that we’re all hapless victims of capitalism in the shape of food companies, or big sugar, or big soda, that render us incapable of exercising free will (although Demaio suggests “there are things we can each do at home to rebalance the deck of cards”, so plainly individual choice does work).

The only answer, they suggest, is government intervention to help people make the right decisions for their health. What are those interventions? Bans on advertising are mentioned by Demaio, but we know the standard line from the public health lobby — they want food taxes, restrictions on additives, better labelling along with curbs on advertising for products they disapprove of.

(There’s a welcome element of Marxism in all this, by the way: it’s the historical forces of materialism dictating our health, not the capitalist fiction of individual choice, and if not a revolution, then we at least need strong government action to help.)

But what is this interventionist, big government answer for? Better health outcomes, obviously. But who does that benefit, especially when Australians are already among the longest-lived people on the planet? The economy benefits: workers are more productive and take less time off for health reasons and they impose less burden on the taxpayer via the healthcare system.

There’s no overall economic loss from consuming less — that forgone expenditure will simply be redirected elsewhere in the economy, to other discretionary spending. More productive workers, healthier consumers, less demand on the taxpayer.

That is, this government interventionism is in aid of achieving the very traditional neoliberal economic ends of minimising government spending and maximising productivity for business.

This is the deepest underpinning of every public health expert and every health academic, most of whom would probably regard themselves as progressives fighting against predatory, exploitive capitalism: they are serving a neoliberal agenda.

Don’t eat too much, don’t drink too much, stay healthy, maximise your economic capacity and your role as a producer and consumer, for the good of the economy. It’s economic puritanism.

Except the grim truth is that so many of us eat too much, or drink too much, or take recreational drugs, or find other things to consume to numb ourselves, because we find late-stage capitalism so intolerable, because we find the demands to be a perfect worker and consumer and citizen and partner and parent and child too much, because we can’t see the point because the material and mental benefits of all that are illusory and transient.

Indeed, being told that if you don’t drink too much and don’t eat too much you’ll get an extra couple of years in your 80s is a thought that would fill some people with horror.

Where this all ends up is at the medicalisation of the basic problem of existence.

By the lights of the public health lobby, literally everything you do, every choice you make, is some kind of medical problem: you don’t eat the right things, you drink too much, you take drugs, you don’t exercise enough, your posture is bad, your mental habits undermine you, the way you parent is passing on problems to your kids, you’re not communicating well enough with your partner, you’re making people feel unhappy in the workplace with your language. The only solution is medically determined intervention to shape your choices to ends productive for the economy and society.

In the end what the public health lobby offers is no less bleak than the predatory world of capitalism that will sell you what makes you sick and flog you the cure over and over: a world where you are an eternal patient that needs to be treated, encouraged, nudged, cajoled and pushed to be the perfect economic and social unit. And you won’t feel the slightest bit better.

Do YOU feel better now? Let us know your thoughts by writing to letters@crikey.com.au. Please include your full name to be considered for publication. We reserve the right to edit for length and clarity.