Stuff that I think about. Mostly books.

Tuesday, May 4, 2010

Dennis Raphael on Health Reporting (and Why It Sucks)

Dennis Raphael wrote, edited, or co-edited six (including second editions) books for my company. I have to disclose that he is thus responsible for a pretty significant chunk of my paycheque. That said, his recent blog post on health reporting is knocking me out with its awesomeness. It's no surprise that I'm generally dubious about the way health is talked about in the media, but Dr. Raphael has managed to say what I've been thinking for a long time, with half the words and twice the ire.

Raphael's work is focused on the social determinants of health - those non-genetic factors that are beyond our control but still impact our health in multiple significant ways. The idea that any part of health is beyond our control is one that the media consistently refuses to acknowledge. Mainstream media seems hellbent on perpetuating the lie that good health is a direct result of good behaviour, and that bad health is a result - and proof - of bad hehaviour. Magazines tell us to eat more vegetables and get more sleep; they don't tell us to address social and economic inequalities that lead to alarming gaps in general health and wellbeing amongst the Canadian population. Raphael does a pretty good job of hypothesizing why this might be so:

[W]hat are the implications for reporters – and their editors and publishers — suddenly pointing out that their last 1000 stories about fruits and vegetables, exercise, and tobacco use as the primary determinants of health were misguided at best and patently wrong at worst[?]

But if I may be so bold as to criticize the man who keeps me in tofu and gym memberships, I think he also could have addressed what seems to me to be a simple and obvious reason to keep up the lie: It means we wouldn't get to make fun of fat people anymore.

I'm exaggerating, but I'm also serious. If fat is considered to be the primary external indicator of poor health - and it is, erroneously - and if health is considered to be almost 100% under our own personal control - and it is, erroneously - then the despicable way people of size are treated by society, the media, and health care professionals is justified. And the way we treat fat people isn't just gross, it's a marketing tool. The diet and exercise industries take in billions and billions of dollars by telling us a) that it's bad to be fat, and b) that fat people could be Not Fat if they just Tried Hard Enough. Of course, Trying Hard Enough means investing time and money that many people don't have - not to mention the fact that weight loss has a success rate of under 10%. So we're trapped in an endless hamster wheel of body shame, unattainable goals, weight loss, weight gain, more body shame, and everybody makes a pretty penny.

I'm not sure what Dennis Raphael's views are on fat acceptance, but I think he'd agree that the almost one-track focus on weight as a determinant of health is not only misguided but dangerous. Maybe it would make a good book? Just saying.

By the way, if you just HAPPEN to find this interesting, you MIGHT just mosey on over to the CSPI website and MAYBE you'll pick up one or two of Dennis Raphael's books. I mean, if you want. Oh, and here's a picture.


  1. Actually I have written about fat!


    A review of Fat Politics for Canadian Family Physician

  2. Is that you, Dr. Raphael? If so - cool! Thanks for commenting! I've never read Fat Politics, but it's interesting that even fat acceptance authors tend to ignore social determinants. The link between poverty and obesity is talked about a lot in FA, so I'm surprised Eric Oliver didn't really touch on it.