Individualistic v Collectivist Public Health Policy

I read an article today that made me wonder about the approach that the Malaysian government takes to public health. No doubt, we are a relatively new nation and we have a long way to go when it comes to comprehensive, accessible health regulation, but perhaps that's a good thing. It allows us to start with a clean slate.

Now, starting with a clean slate is difficult when it comes to legislating on matters of public health because of how medicine is constantly evolving and how public health threats are constantly mutating. In the words of Justice Windeyer in Mount Isa Mines Ltd v Pusey (1970) 125 CLR 283: "Law [is] marching with medicine, but in the rear and limping a little." (at 395) In my view, this will always be the case, no matter how much we legislate and critique and debate about it. But all that legislating and critiquing and debating will ensure that we limp along as closely as possible to the galloping hooves of medicine, instead of ending up running helter-skelter, all a shambles and weighed down with socio-political sloth, forty or fifty years late.

The article 'To Boldly Go...', by John B. McKinlay and Lisa D. Marceau in the American Journal of Public Health (2000) on the whole is an article about the public health approach in the United States and whether it successfully tackles health issues arising in the 21st century. The authors spoke about two main views: the mechanistic or medical science view, which is individualistic in nature (such as is used in the US) and the holistic health promotion or salutogenic view, which is collectivist in nature (such as is more prominent in Europe). (at 27)

Before I state my views on this matter, it is probably best that I explain what the above views actually encompass. The medical science view is one that is focused on medical research and health education, seeking to educate the individual on what he should do to improve his own well-being and prevent his own premature death and onslaught of avoidable chronic non-communicable diseases such as obesity and heart disease. This approach is individualistic because it places the burden on the individual i.e. the individual bears full responsibility for his own ill-health.

This is contrasted with the holistic view or the collectivist view, which looks towards health promotion policy and much of the burden off the individual. Examples of collectivist health laws, for example, are laws that prohibit the export and import of narcotic drugs for non-medical use. These laws tackle the problem at the core and encompass socio-economic and environmental factors, amongst others. Yet another example (this one involving alteration of the built environment) is that of regulation to reduce the number of fast food joints in residential areas. Such legislation has been shown to positively affect the public health epidemic of obesity.

So basically, I'm just wondering how Malaysia tackles problems like this, and in the course of my research hopefully I can learn of some examples to discover whether we are too one-sided in our approach to health legislation and see where and how changes can be made to create more balanced, more accessible public health legislation. As someone highly interested in health care policy, I can say quite frankly that I'm not wholly on one side or the other. I advocate taking the best parts and principles of both the individualistic medical science view and the collectivist holistic view and merging them together. There is no doubt that in many circumstances, the exercising of wiser personal choices can lead to better health and avoidance of heart disease, liver disease etcetera, but the role of the state still exists and in fact is becoming increasingly important in this day and age, where influenza sneaks behind corners and obesity slaps us in the face. Both of these views CAN and SHOULD work together. The time has come for Malaysia to step up to the health legislation platform and make a stand.