No Choice is Completely Personal

The Pandemic is a Failure of Public Health

Last week, The Atlantic published my article about vaccine resistance and hesitancy in my hometown and home state. I went into reporting this with the idea that vaccine reluctance was more complicated than it might appear. Yes, people who believe in conspiracy theories and don’t want to be vaccinated for political reasons are a big, very loud chunk of the unvaccinated population. But there is another group who haven’t been vaccinated for logistical or life reasons, or because they’re just unsure about what to do. This latter group hears the voluble anti-vaxxers but doesn’t hear a vaccine-positive, countervailing message from state and local leadership, which in many places has been largely hands-off about promoting the vaccine, saying that whether or not to get it comes down to personal choice. In such a situation, inertia wins.

“Personal choice” as a concept has been one of the most pernicious and destructive forces at work in this pandemic. We all have agency, yes, but choices are not made in a vacuum—they’re encouraged or discouraged by the political ecosystem around us. Some choices affect those around us as well. I’m not sure what role personal choice should play in a *public health* emergency, but it’s a smaller one than it has had in the United States during the long, never-ending, year plus of Covid. Letting an infectious disease rage like this was and continues to be a political choice, made by those in power, but a rhetoric of personal choice tries to absolve those leaders of blame.

“Personal choice” is also how some conceive of the death around them in the first place. In reporting the piece for The Atlantic, I came across an Arkansas physician, Amy Beard. Beard has been advocating for treating Covid-19 patients with hydroxychloroquine and Ivermectin*, and made anti-vaccine statements along the way. She posted a long video on her public Facebook page July 14, with the statement: “HCQ and Ivermectin have helped many, but your LIFESTYLE choices can have the greatest beneficial impact on your immune response to encounters with viruses.” The video went on to address healthy eating, exercise, and sleeping well. Of those who follow that advice, she said: “We are not succumbing to this virus like other people are.” She is not the only doctor saying things like this, but her statements are very public.

(Beasley is a player for the Buffalo Bills.)

The logical endpoint to this mode of thought is that those who have died made all of the wrong lifestyle choices before the virus found them. If this were true, they’d have only themselves to blame for getting sick. It’s dangerous rhetoric.

The advice to eat healthy foods, exercise, and sleep well is unobjectionable, as far as it goes. Generally, being a healthy person helps your immune system fight disease and prevents some chronic problems. But it’s not some magic shield. By far, the best way to stay healthy is to avoid disease in the first place; for some diseases healthy lifestyles have a big impact, but the way to avoid getting sick with a virus is to be vaccinated for it. We have centuries of public health research and real-life experience to tell us this. It should be uncontroversial.

Again, even with lifestyle choices, people do not make those in a vacuum. I recently revisited Michael Hobbes excellent article in The Huffington Post from 2018, Everything You Know About Obesity is Wrong. The main theme of the article is to prove that health and weight are not synonymous, but also to discuss what actually does matter when it comes to our wellbeing. Every choice we make when it comes to food, exercise, and fitness is influenced, to some degree, by public policy and by the culture around us, and in this country all of those forces have set many of us up to fail. The United States government subsidizes the kinds of foods that make us unhealthy and builds the environments we live in that do or do not allow for regular physical movement and exercise. In those conditions, we make some choices harder and some choices easier, and then we blame individuals alone for lacking the will to make the most difficult ones in front of them. When individuals feel ashamed of their weight or try a fad diet, it sends many of them on a downward spiral to poor health. Our rhetoric makes this worse instead of better.

The United States has a crisis in nourishment, both emotional and physical. We are hard on people and we encourage them to be hard on themselves; we encourage people to withdraw from their obligations to others. We blame only individuals, never our collective selves. There’s no escape from this harshness. We don’t have health care and we create a shitty food system. When a deadly virus came to find us, we decided to keep death at a manageable level and protect our economy, instead of the other way around. In all the places where we should be taking care of people, we have capitalism instead. When individuals don’t overcome the hurdles our society has thrown up, we blame them.

*(A note about hydroxychloriquine and Ivermectin: most peer-reviewed studies have found them useless in treating Covid-19. Additionally, doctors have been searching for treatments for human and animal coronaviruses, which can cause everything from colds to SARS, for DECADES. If existing medicines as readily available as these worked we would already know it.)

What I’m Recommending:

Much of what we think of when it comes to “healthy lifestyles” is itself disordered and unhealthy. Do yourself a favor and listen to Maintenance Phase, a podcast from Hobbes and Aubrey Gordon. They use science and research to take a sledgehammer to most of what you think about when it comes to weight, diets, and fitness in the United States.

A friend recommended the mystery novels of Tana French, and I’m honestly surprised I hadn’t read them before now. I’m obsessed. Someone on Twitter asked for a recommendation for the best book about a woman who goes to a small town and falls in love with the local hunk: More than one person responded with Act Your Age, Eve Brown by Talia Hibbert, so I added it to my list.