Milton Friedman (1912-2006), Nobel Prize winning economist from University of Chicago, popularized free market economy. Friedman’s explanation of economics emphasized that the laissez-faire economic system helps poor people by the trickle-down effect, which economic growth flows down from the top to the bottom indirectly benefiting those who do not directly benefit from the policy changes. This economic theory advocates letting businesses flourish, since their profits will ultimately trickle down to lower-income individuals and the rest of the economy. Another teaching of Friedman is that only a crisis real or perceived, produces real change, and when that crisis hits the change that occurs depends on ideas that are lying around.
Advocates for trade deregulation claim that an ‘invisible hand’ – a systemic, emergent force beyond the control of any individual or section of the economy – will produce benefits that will enlarge the total ‘cake’ of the economy, allowing a trickle-down effect that reduces poverty and improves health. Globalization is seductive to many because it enhances material production while simultaneously shielding, muting and distancing the vast number of people who are disadvantaged by it. The emphasis on economic globalization has resulted in objections to taxation based on the premise that taxation is an unnecessary barrier to trade and to the creation of wealth that would otherwise ‘trickle down’ from the rich to poor (sans taxation).
In the 1980s and 1990s monetarism, public choice theory and neo-classical economics, was vulgarized and misused to justify simplistic small government policies. As for monetarism, it is essentially the belief that the freedom to make and spend money will finally address all our human needs, and that the public good is ultimately served by subordinating our social concerns to the requirements of business. Friedman’s supporters actually believe that market forces will reduce poverty and provide public goods, including health care and environmental stability.1 In the 21st century, following the economic debacle of 2007, supporters of trickle-down economics now peddle fear of increased taxes or regulation as toxic to this economic system.
The field of social finance has appeared in the form of social impact bonds already in Britain – applying profit motive to some of the most intractable social problems (that monetarism has not been able to address). Recognizing that the market economy is not addressing the problems of poverty, social impact bonds are being promoted. These bonds have caught on in a big way in Britain. Others warn that this is about commercialization of social values. It opens the debate on how outcomes are measured to decide whether the intervention is a success that leads to a payout for investors.
As a consequence of globalization, the business class is no longer under pressure to accommodate citizens (workers) within Canada. The government default position is that international competition is at stake – increasingly lower taxes, less support for labour and deregulation – creating socio-economic status related inequalities at the same time as budget cuts erode social assets and population capacities that might have buffered the effects of the health inequalities. The double whammy – market-oriented politics and policies of government deregulation erode social assets and undermine safety nets at the very time that greater inequalities and knowledge of epigenetic harms are appearing that could use resources to offset the effects of restructuring of the economy. Regrettably, the present evolution of the population health model can be used to accommodate, rather than challenge, current ways of doing things.
Corporate globalization promotes individualism. The cult of individualism that exists in North America today supports minimal government and self-reliance. Public health is about focusing on the common good. Individualism creates a difficult milieu for discourse on the common good – the individual becomes the focus of intervention, consequently, many public health promotions tend to target on life-style changes of the individual. Policies aimed at the individual do little to address the social determinants of health, thus fail to promote the health of all Canadians. When policies are aimed at the individual, this fosters the allusion that a person’s health status is entirely under his or her control. As a consequence, population health problems are assigned solely to the individual. In the end, the individual becomes a victim, being blamed for what really are socially produced health problems.
Since the 18th century, many believed the invisible hand of prosperity and increased wealth created better health for the majority. Late in the 19th century, it was a community of concerned public health officials who led the charge for clean water and better housing, and the unions for better working conditions for the worker. Ann Robertson, professor in Social and Behavioural Health Science at the University of Toronto, noted: “… it was not simply Adam Smith’s ‘invisible hand’ of wealth that provided the key to health improvements. They were, to a great extent, the result of the constellation of a number of factors, including: improved sanitation, nutrition, living and working conditions, and family planning. And, as Szreter demonstrates, these did not occur ‘naturally’, but rather as the result of the efforts of a coalition of public health reformers, labour activists, and others working from reformist social and political agendas. These are the historical roots of the current health promotion movement which, unlike population health, is not only explicitly political but also explicitly normative.”2
With the completion of the human genome project in 2003, it became known that genetics accounts for about 10% of diseases, and the remaining causes appear to be from environmental and occupational source insults. In the 21st century, the epigenetics revolution is rewriting our understanding of genetics disease and inheritance. Epigenetics is about integrating genes, the organism and the environment. From believing that our biological fates were written in our genes, we now recognize that the environment, and more specifically our perception of the environment, directly controls our behavior and genetic activity. Individuals are much more sensitive to exposures from their environment, diet and lifestyles than previously thought. Epigenetic control of our genes represents a fundamental shift in the way we understand our world.3
Epigenetics is the new science that studies the complex mechanisms of genes being turned on and off according to environmental ques. The genome is very stable; mutations are seldom. On the other hand, the environment is very volatile. In order for our species to survive, the genome has mechanisms that respond to the volatile environment by turning on and off genes. As our genes can be influenced by the environment, our lifestyle can impact the expression of our genes. Early studies show an association between epigenetic marks (in the human genome) and socio-economic status. This has implications for population health and chronic diseases like cardiovascular disease.
How we deal with epigenetic harms implicates the underlying fairness and justice of our social contract. How we develop mentally, and physically, has a tremendous impact upon our inherent capabilities and our set of life opportunities. Attention should be paid to poor health as a mechanism for intergenerational transmission of poverty. Children born into poor families have poorer health as children, receive lower investments in human capital, and have poorer health as adults. As a result, they will earn lower wages as adults, which will affect the next generation of children who will thus be born into poorer families. In Canada, one in four children living in poverty will grow up to be an adult living in poverty
The emerging field of epigenetics suggests the possibility of a happy trickle-down effect. “Those same lifestyle choices may help silence ‘bad’ genes while supporting the activity of ‘good’ genes,” says Andrew Weil, Director of the Center for Integrative Medicine of the College of Medicine, University of Arizona. Because of the role epigenetics plays in human development and in disease causation, there is an important role in regulating epigenetic harms. This could prevent chronic diseases, as well as create a health benefit that can be passed on to children and grandchildren. Weil notes that up to 70% of our health may be influenced by our environment, or epigenetics.4
We need to adopt policies that have science behind them. The trickle-down economic theory was rebranded in the 1970s to an ideology – supply side economics – the doctrine that tax cuts could be had for free (incentive effects would generate new activity hence more revenue) without causing budget deficits. An ideology is a set of ideas proposed by the dominant class of a society to all members of this society (that is normative or based on what is considered the normal or correct way of doing something). In the 21st century trickle-down economics is a fraud – the majority of people are not benefiting, in fact, the gap between the rich and the rest of society is increasing.
Epigenetics explains how environmental factors can switch genes on and off based on choices we make, and highlights the effects of inequality in living and working conditions, as well as a range of disparities in societal opportunities, including income, housing, employment, and access to health care. The effects of age, what someone eats, and the salary of the father trickle down to the child. Epigenetics empowers people to take control of their health by making choices that may override their genetic code, such as diet, exercise, and personal attitude – opening doors for applying epigenetics to the prevention and treatment of many disorders. By incorporating the knowledge of the dynamic nature of epigenetics into decision-making, it is possible to reduce epigenetic harms and create the trickle-down benefits similar to investment in the space program fifty years ago, and ongoing spending in CERN.
In the 21st century we are faced with three deficits: current fiscal imbalance of various levels of government, the need to reverse the epigenetic harms from the toxins in air, water and food, and the debt to future generations as the growing economic gap will ensure them poorer health as adults, which will affect their economic status as they earn lower wages. We need to see the world and ourselves from a new perspective. Because of the role epigenetics plays in human development and disease causation, there is an important role in regulating epigenetic harms. We need to switch from making public policy decisions through the lens of individualism (which oversimplifies complex and multi-faceted problems) to filtering social and economic policies through the lens of the social determinants of health before they are implemented (to ensure they support actions that reduce inequities in the system). The new idea available for the 21st century for everyone to reach their potential is to harness the ability of epigenetics to create a positive trickle down effect!
1 Horsman, Greg. (2012) Objectivism Lost and an Age of Disillusionment, p. 76.
2 Robertson, A. (1998). Shifting discources on health in Canada: from health promotion to population health. Health Promotion International, 13(2), 155-166.
3 Choi, Sang-Woon and Simonetta Fisco. (Sept 2013) “Epigenetics: A New Bridge between Nutrition and Health.” http://advances.nutrition.org/content/1/1/8.full
4 Goldman, Leslie. “Like Mother, Like Daughter.” <http://www.naturalhealthmag.com/health/mother-daughter>.