The White House outbreak: How to criticize irresponsible leaders without getting stuck in the illness blame game

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This post is a part of our Bioethics in the News series

By Sean A. Valles, PhD

In a twist of fate, there was an outbreak of COVID-19 at a White House celebration of the nomination of Amy Coney Barrett for the Supreme Court of the United States. This elicited a wide range of reactions to seeing a gathering of opponents of strict COVID-19 control measures being hurt by the very pandemic they have downplayed. While others have worried about the moral philosophy of taking pleasure in others’ suffering, or the hypocrisy of evading rules one publicly espouses, I have a different worry. A poll shortly after the White House outbreak found that a majority of respondents believed that Trump had acted “irresponsibly” in how he had handled his personal risk of infection from people he interacted with. While I do not worry about the president being blamed for his illness, I do worry about the wider cultural practices of 1) victim-blaming by attributing a person’s illness to their personal moral failure, and 2) insisting that health is a matter of individual choice. While the distinction might not seem important at first, I will argue there is an important difference between victim-blaming the ill and holding leaders accountable for setting bad examples with their conduct and other leadership failures. The first kind of blame is toxic in a society, and the second kind of blame is an important part of a well-functioning democracy.

President Donald Trump in the Oval Office nominating Amy Coney Barrett to the Supreme Court
Image description: President Donald J. Trump and First Lady Melania Trump pose for a photo with Judge Amy Coney Barrett, the President’s nominee for Associate Justice of the Supreme Court of the United States, her husband Jesse and their children on Saturday, Sept. 26, 2020, in the Oval Office of the White House. Image source: Official White House Photo by Andrea Hanks.

Blaming people for their ill health is a strategy with an awful track record. It doesn’t do any good for the people subjected to “you’re too fat” messages. It doesn’t do any good for survivors of sexual assault or domestic violence. When directed inward, we self-blame for failing to do enough de-stressing self-care, rather than directing our blame to more appropriate targets like the needlessly bad working conditions or economic insecurities that make us stressed in the first place. Repeated messages that “sickness is the result of individual moral failure” also reinforce stigma. Stigma is a nasty phenomenon, with a “corrosive impact on the health of populations” and is particularly bad in cases of infectious diseases like COVID-19 because it actively encourages people to hide their infection, which is obviously bad for them and for others who interact with them.

A second problem with blaming people for their ill health is that ethics of blaming individual behavior reflects a misunderstanding of how health behavior works in the first place. Seemingly individualistic choices like diet, condom use, smoking, alcohol consumption, etc. are not made independently. We choose such things in roughly the same way we “choose” our religions or the languages we speak at home. Yes, each of us can choose to practice an entirely different religion (or lack thereof), and each of us can learn and use a different language in the home. Some of us do. In all of these cases, though, the vast majority of us don’t venture too far from a combination of what we learned while growing up and the cues we get from the people we interact with. We eat the foods familiar, convenient, and affordable to us. We adopt the values and beliefs (including trust in aspects of the scientific endeavor) of our communities, etc. Individual choices exist, but they exist within larger social contexts that have powerful but subtle effects on our choices.

Each of our everyday behaviors related to COVID-19 exist in a complex ecosystem of influences. Mask wearing and other social distancing measures have become intensely politicized and tied to masculinity. Masks and other health behavior measures also create new inconveniences and financial expenses. Social pressures also vary vastly from one setting to the next—in one store there are prodding questions and judgmental stares for wearing a mask, at an adjacent store there are similar pressures on those who don’t wear a mask. How we move our bodies and (un)cover our faces within these intense social pressures is not simply an individual choice.

Take the case of one of the attendees of the party at the White House, University of Notre Dame President, the Rev. John I. Jenkins. He did not wear a mask at the indoor/outdoor party, shook hands with attendees, and otherwise did not follow the standards he had imposed on members of his own university. He knew better and did not do better. Many of us have likely also gone against our better judgment to fit the incautious social distancing norms of a setting. Whether it is the university president or the university student, this is indeed hypocritical, and irresponsible in a sense. But, such blame is aside from the point, and more importantly it contributes to the sort of harmful cultural practices mentioned earlier—especially victim-blaming and stigmatizing the ill. Pointing out hypocrisy and the assigning of blame for individual health behavior distracts from the far more damaging thing Jenkins and the other leaders at the White House party did. As cultural leaders, they undercut efforts to build new norms, like public mask-wearing, the habit of greeting people without needlessly touching hands, etc.

We ought to blame Trump, Jenkins, and many other leaders who attended that party. We ought to blame them for failing in their relationships to the people they lead. That is a devastating form of irresponsibility. And it is very important to separate that kind of blame and irresponsibility accusation from the destructive form of blame discussed above: blaming people for having irresponsible relationships with their bodies/health.

The “personal responsibility” blame game has been the go-to talking point of conservative governors as they use their power to obstruct or dismantle public health measures. “You shouldn’t have to order somebody to do what is just in your own best interest and that of your family, friends and neighbors,” according to Alabama Governor Kay Ivey. Scolding people about “personal responsibility” during a public health crisis is a strategy based on how one wishes the world worked and not how it is actually working. Along similar lines, abstinence-only sex education doesn’t work (“teenagers: be sexually responsible by just not having sex before marriage!”), and neither does “just say no to drugs” education. Jenkins was at least right to point out that his behavior was a failure of leadership. As many of my colleagues in population health science say, we need to build a “culture of health.” That will require leaders suited to the task, and we ought to blame them when they fail in that leadership. Just skip the personal health blaming.

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Sean A. Valles, PhD, is an Associate Professor with an appointment in the Michigan State University Lyman Briggs College and the Department of Philosophy (where he is also Associate Chair). His research spans a range of topics in the philosophy of population health, from the use of evidence in medical genetics to the roles played by race concepts in epidemiology. He is author of the 2018 book Philosophy of Population Health: Philosophy for a New Public Health Era. He is also co-editor (with Quill R. Kukla) of the Oxford University Press book series “Bioethics for Social Justice.”

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, November 5, 2020. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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More Bioethics in the News from Dr. Valles: We Need Healthier Schools, and Student Activists Are Stepping Up; Recognizing Menstrual Supplies as Basic Health Necessities: The Bioethics of #FreePeriodsTrump’s Attempt to Reignite the Coal Industry Is Another Health Policy BlunderPolitics and the Other Lead Poisoning: The Public Health Ethics of Gun ViolenceClimate Change and Medical Risk

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Trump’s Attempt to Reignite the Coal Industry Is Another Health Policy Blunder

This post is a part of our Bioethics in the News seriesBioethics-in-the-News-logo

By Sean A. Valles, PhD

The recently abandoned effort to pass the American Health Care Act (AHCA) was a massive blunder for the Trump administration, failing in its effort to “repeal and replace” Obama’s signature Affordable Care Act, despite Republican control over the House, Senate, and the White House. Less attention has been given to the Trump administration’s second major health policy reform. On March 28, Trump signed an executive order initiating a reversal of Obama-era clean energy plans and seeking “an end to the war on coal.” It was presented as an economic policy reform and an energy policy reform, but it is also a health policy reform since it will have drastic effects on U.S. health.

A short blog entry does not allow me to do justice to the incredible range of ways that coal power plants harm our health. For those interested, Epstein et al. (2011) survey the issue: Coal is one of the leading sources of mercury emissions in the U.S., with horrific effects such as neurological damage in developing fetuses. Meanwhile, much like breathing cigarette smoke, the mix of particles emitted from coal power plants causes increased rates of heart disease, asthma, bronchitis and a host of other diseases.

1024px-Detroit_Edison_Monroe_Power_Plant
Image description: a photo of the Detroit Edison Monroe Power Plant. Image source: Wikipedia

Obama’s Clean Power Plan, already delayed by legal challenges, was designed to hasten the process of replacing U.S. coal power with other energy sources (natural gas, wind, etc.). That replacement process had already been underway because of old-fashioned capitalist market forces. Natural gas recently surpassed coal in U.S. power plants because natural gas is getting cheaper, and renewable sources like wind power are also cutting into the coal market. Meanwhile, manual laborers across the country are finding themselves displaced by new technologies, so even a stable coal industry would offer a diminishing number of coal mining jobs.

The Clean Power Plan was projected, by 2030, to save 1,500-3,600 people from dying prematurely, prevent “90,000 asthma attacks in children,” and prevent “300,000 missed school and work days” (among other benefits). Coal is already struggling to economically compete with other fuel sources, but is even more expensive than it looks if one factors in the harmful side effects it brings into our world: “Accounting for the damages conservatively doubles to triples the price of electricity from coal per [kilowatt hour] generated.”

It is telling that the economists who have defended Trump’s executive order avoid addressing the health data above. Stephen Moore and Nicolas Loris both insist that coal power has gotten much cleaner. Neither of them acknowledges how much harm coal still does, nor how much death and illness the Clean Power Plan would have averted. Loris tries to change the subject, claiming that the Clean Power Plan was really about carbon emissions and climate change, not “pollutants known to harm human health and the environment”. But, climate change causes health harms too, such as the (worsening) heat waves that aggravate cardiovascular and respiratory diseases (see my previous post for Bioethics in the News).

We do not need to choose between caring about health vs. caring about coal industry employees whose jobs are at risk; we should do both. The U.S. safety net leaves much to be desired, but it at least offers: job retraining programs, coordinated by the Department of Labor; access to temporary housing for those who lose their homes, coordinated by the Department of Housing and Urban Development; food assistance for the families that will go hungry, provided by the Department of Agriculture. But… Trump plans to drastically cut the budgets of all of those agencies. And, as if to remove all doubt that his declarations of concern for coal workers are hollow, he specifically wants to eliminate the two federal agencies tasked with improving the economy in struggling coal-producing regions: the Appalachian Regional Commission and the U.S. Economic Development Administration.

We are at a tipping point in U.S. health. The most recent CDC data show that our national life expectancy is actually decreasing, while other countries’ expectancies are rising. Meanwhile, new data on the strengths and limitations of healthcare in the U.S. show us that the benefits of health insurance coverage are ethically essential, but frustratingly limited in their power. Insurance coverage protects people from getting unfairly trapped in medical debt after an unexpected illness, but just having access to doctors and medicines doesn’t automatically make people healthier.

Our health is the cumulative effect of our everyday lives: the food we eat, the air we breathe and so on. It is unethically deceptive and cruel for the Trump administration to advertise dubious economic benefits of reviving the coal industry while there is an abundance of evidence that doing so will cause unethical harms to the millions who will be increasingly left to breathe more soot and eat more mercury. As many of my neighbors in the Great Lakes region already know, mercury deposits from coal have left many of our local fish too contaminated to eat more than occasionally. Adding insult to injury, Trump wants to eliminate the Great Lakes Restoration Initiative that is now working to decontaminate the lakes (a rare program with bipartisan political support at the local and national levels).

Trump earned plenty of criticism for bungling his first major legislative effort, the AHCA healthcare reform bill. The bill infamously tried to slash Medicaid spending by $839 billion over the next decade, the safety net program which—among many other benefits—“covers the costs of nearly half of all births in the United States.” (Note: some rumors are true; yes, the U.S. infant mortality rate is more than double the rate in Sweden and, yes, Cuba is also beating us by a healthy margin). Even his own party refused to rally behind the bill. Trump’s second health policy is his effort to reignite the coal industry with an executive order. But, the U.S. remains a representative democracy and your local legislators have the power to step in and, well, legislate. By all means, tell them what you think of Trump’s second health reform policy.

Sean Valles photoSean A. Valles, PhD, is an Associate Professor in the Lyman Briggs College and Department of Philosophy at Michigan State University. He is a philosopher specializing in ethical and evidentiary issues in contemporary population health sciences.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, May 11, 2017. With your participation, we hope to create discussions rich with insights from diverse perspectives.

You must provide your name and email address to leave a comment. Your email address will not be made public.

More from Dr. Valles: Climate Change and Medical RiskPolitics and the Other Lead Poisoning: The Public Health Ethics of Gun Violence

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