of humans as near-powerless victims of life have not only stoked irrational health panics but have helped to create an unhealthy attitude to health and illness in our society.
First, it means that there is a tendency to medicalise many of our problems, to redefine personal issues and characteristics as medical afflictions requiring professional intervention. Thus, everything from childish mischief making to shyness can now be labelled as a syndrome or a disorder, and drugs or treatment prescribed. This process of medicalisation has the effect both of relieving people of responsibility for their lives (how can those suffering medical conditions be blamed for the symptoms?), and of making them even more obsessive about health issues.
Second, as Dr Michael Fitzpatrick – GP and author of The Tyranny of Health – has argued, these trends have created a climate in which it is now deemed perfectly normal for us to be ill rather than well, and where health has been turned from something we took for granted into the goal of life for which we must self-consciously strive:
In the recent past, health was regarded as the normal state of affairs and illness was considered an exceptional departure from normality, a transient state through which the patient passed… At the same time, illness has lost much of its stigma and even confers a series of socially approved identities – ‘person with HIV/AIDS’, ‘cancer survivor’, ‘sufferer from stress’, ‘victim of bullying’ – confirmed by patient organisations, celebrity sponsorship, soap opera story lines, autobiographical accounts and other forms of media coverage.3
Who is responsible for bringing about this unhealthy state of affairs? It is common to blame outbreaks of irrationality and health panics on stupid members of the public, now sometimes known as ‘the worried well’, who are whipped up into a moblike frenzy by ‘the meejah’. The media certainly play a key role in setting the public mood. But it is important not to underestimate the extent to which these problems emanate from the top of society downwards – starting with the government and the political class. They have done more than anybody to worry the well.
Since the panic about a SARS epidemic gripped the world in 2003, the New Labour government’s policy towards issues such as bioterrorism or SARS in the UK has been based on the principle of ‘organised paranoia’. That memorable but little-known phrase was coined at the time by Geoff Mulgan, then the head of the powerful Downing Street Performance and Innovation Unit. Mulgan was speaking at a conference entitled ‘Panic Attack: interrogating our obsession with risk’, organised by the online magazine spiked at the Royal Institution in May 2003. He had a wry little smile on his face when he used those words. But he definitely was not joking.
Mulgan suggested that, through elevating this organised paranoia into a principle informing policy planning, the government hoped to become better at spotting new risks such as SARS, BSE and bioterrorism ‘before they become evident’. But how exactly do the seers and oracles of Whitehall hope to identify a potential risk before it has even become visible? By gazing into a crystal ball, perhaps?
Almost, it seems. The modern political equivalent of the crystal ball is the ‘what if?’ scenario, and this is increasingly becoming the stuff of policy-planning discussions on both sides of the Atlantic, especially post-9/11. It means that policymakers dream up fantasy disasters (what if a terrorist infected with SARS crashed a petrol tanker into a nuclear power station?), and then try to plan to deal with these hypothetical crises.
The reaction to SARS became a powerful symbol of what is wrong. Here was a new but relatively minor epidemic that, in a sane society, would demand a serious response from the medical and epidemiological authorities.
In our apparently less-than-sane society however, officials from the World Health Organisation (WHO) downwards treated SARS as a cross between the Black Plague and a bioterror attack, quarantining entire cities and damaging whole economies. Meanwhile people across the world could be seen walking around wearing useless paper masks, a sort of modern equivalent of the medieval amulets used to ward off evil. The SARS panic turned into an outstanding example of the cure being worse than the disease, the panic causing more damage in the real world than any fantastic ‘what if?’ scenario is likely to.
Mulgan’s remarks should serve to remind us that the suffocating safety-first spirit of the age comes from the top down. Major political academic and scientific institutions now appear to be obsessed with risk management/avoidance, and infected with the outlook of organised paranoia. The worst fear of those in authority is now to be accused of not taking sufficiently stringent precautions to ward off some potential, or even hypothetical, threat to public health.
The watershed in this came with the BSE/vCJD crisis of the 1990s. The authorities were widely – and arguably unfairly – blamed for not doing enough to foresee and forestall that disaster for British farming. The Phillips Report into the disaster advised that the government should in future adopt a strict ‘precautionary approach’ at the hint of any potential public-health problem. Even though the apocalyptic predictions about a vCJD epidemic on which the Phillips approach was based proved entirely unfounded, the precautionary principle has been institutionalised in government policies ever since. It essentially dictates that a lack of hard evidence about a possible risk is no excuse for postponing official intervention and public-health warnings.
The impact can be seen in something like the government-backed Stewart Inquiry of 1999 into the safety of mobile phones, which established that there no evidence of a health risk – but then concluded that, regardless of the evidence, we should all adopt a precautionary approach to using the things anyway. In 2005, the official UK Food Standards Agency launched a high-profile PR campaign around the alleged risk posed by the Sudan 1 food dye. The presence of traces of the banned colouring in some processed foods (so minute that anybody would need to eat a supermarket full of the stuff to suffer so much as a stomach ache), became the pretext for ordering the recall of millions of pounds’ worth of perfectly edible food. Every expert knew there was no real risk of harm to public health; one put the risk of eating some of the contaminated processed food on a par with smoking one cigarette in an entire lifetime. But they went ahead and banned it anyway, threatening shopkeepers with prison for selling safe food, just as a precaution.
The authorities’ hope is that taking pre-emptive action will reassure the public and forestall future health panics. The result, however, is often the precise opposite. In the risk-conscious climate discussed above, overblown precautionary measures only confirm many people’s suspicions that there is a real problem. And self-conscious government attempts to show that it is doing something can only lead to escalating demands for it to do more.
It is possible to see how this works itself out in relation to the avian-flu issue as it has developed in the UK over the past couple of years. For its part, the New Labour government has tried to hold the line against hysteria and appear reasonable, issuing a consistent ‘don’t panic’ message. But it has been repeatedly outbid by opposition politicians, experts, campaigners and media voices accusing it of complacency or a cover-up, and demanding more and more precautionary measures. In this, it lies at the heart of government policy on everything from food dye to mobile phones, and by emphasising the need to reduce risk. Now, fearful of being accused of not intervening enough to prevent a potential threat to public health (almost the most serious charge a politician can face these days), the government’s response is to up the ante further, to try to demonstrate that it is fully prepared.
There have been many official appeals to remain calm and attempts to put the risk of bird flu in perspective (such as the chief scientist’s assessment that, even if avian flu did infect our poultry population, the odds of anybody in Britain contracting it would be about 100 million to one). But these would be far more convincing if they were not accompanied by reports of the government’s plans to deal with a hypothetical devastating pandemic. These measures include plans to close schools, reportedly to keep the predicted number of deaths among children down to 50,000 instead of 100,000 (that should reassure the parents); plans to dig ‘plague
