Postmodernism Versus Idealism in Public Health

Abstract

contract with the local Ministry of Health. The public health team of the parish had assembled for its An nual Conference. They had reason to be proud of their achievements because outbreaks of polio and dengue fever on the island had mostly spared the parish, new health centre buildings had been com pleted or were under construction in various loca tions under PAHO patronage and most indicators of the maternal and child health program demonstrated clear improvements over the past years. It was my task that day to give a talk for which the senior nurse had picked the topic: the implications and prospects of the WHO Alma Ata Conference and the new campaign, 'Health for All by the Year 2000'... In my preparation I had encountered two prob lems. One was giving my first talk in English in front of a larger group, and I had gone through some 'simulation' exercises at home with my wife acting as an attentive and critical audience. The second prob lem, however, was far more substantial. It was related to the very topic of my statement. How was I to approach the demanding message of this motto? Clearly, 'Health for All' was (and still is) rightly reinforcing the role of health as a principal human right. But how about that queer appendix 'by the Year 2000' was this Utopian and visionary, perhaps with a little blend of provocation and pugnacity, or was it a serious objective that, fuelled by impatience, had got out of touch with reality? Was it meant to rhetorically underline the urgency for instantaneous reaction to global health challenges, or was it rather an idealistic conjecture, a dream close to illusion? I decided for the rhetoric and refrained from outlining any idealistic projections of what the world would be like 20 years later. Was I missing out on a chance that time? In this issue, Johan Mackenbach takes us on a historical journey through idealism in public health. His account is made up of diligently selected exam ples from the arts and history, and an impressive attempt to cover a wide scope of ethical aspects in public health. He leaves no doubt from the beginning that his cherished approach is an inherently 'idealis tic' one. Not only is he interested in the history of idealisms of the past but he defines as the very topic of his essay to deal with the core questions of present day ideals in public health, their roots and sources, and their sustainability. Frankly, I was quite surprised when the editor asked me if I would agree to write a commentary on this essay. I did not see myself as having a recognition for substantive contributions to discussions about ethics in public health, let alone public health ideal ism. I came to conclude though that the commentary was likely commissioned to me as a German epide miologist, thus reflecting the fact that the history of the Dresden Hygiene Museum served Mackenbach as a most appalling example of the political misuse and contempt of human rights in the pursuit of what was then defined as 'Volksgesundheit'. My commentary, which will deal neither exclusively nor specifically with the topic of 'health fascism', will be more of a personal response to Mackenbach's plea for new ideals in public health. However, I am inclined to concede that the sceptical and anti-idealistic views outlined in the following have arisen from sentiments of bewilderment and distrust that emanate from the