In The Primary Source’s “From the Editor” (March 11, “Who’s at the Wheel?”), Source Editor-in-Chief Brandon Balkind’s stance against Health Services’ support of “Sex on the Hill” highlights, to me, a major problem that public health professionals and health policymakers face today. “Health care providers have an obligation to avoid controversy,” Balkind wrote. He goes on to accuse Health Services of lobbying for health policy, which he deems inappropriate.
Professional health care providers have one broad responsibility which should govern all of their actions: to protect and improve health. For every provider, this means something different. For your general practitioner at home, it means monitoring the health and well-being of his or her patients when they come in for appointments. For an emergency room doctor, it means treating the emergencies that come in and making recommendations for follow-up care. And for a university’s health services, that means working to create a healthy environment for the entire population, encouraging healthy behaviors within the community, and providing primary care to the student body.
This is quite the formidable task. But Health Services, at Tufts and elsewhere, is not the same as the practice where you see your family doctor. In addition to training in the traditional biomedical model, practitioners at Health Services are governed by the principles of public and community health. Beyond treating your STD/sprained ankle/sinus infection, Health Services conducts health promotion, prevention, and social marketing campaigns.
In conducting these projects, and in supporting others’ attempts at doing the same, Health Services still maintains the same responsibility of other health care providers: to protect and improve health. There is no obligation to avoid controversy if it is in the best interest of health.
Fortunately, both medicine and public health are fields largely based on scientific studies and evidence-based medicine. Decisions made by providers and practitioners are not based on whim, fancy, or political affiliation. Rather, they are made based on scientific studies and findings. In terms of the Sex Fair, the body of literature supports exposure to sexual terminology, visuals, methods of contraception, and alternatives to intercourse as a means of reducing the transmission of sexually-transmitted infections, the number of unwanted pregnancies, and the occurrence of sexual abuse. In supporting this program, Health Services is fulfilling its obligations to public health.
People understandably fear controversy. But fear of controversy in and of itself is not a valid reason to abandon otherwise valid, evidence-supported programming. Fear of controversy is a political rationale, a self-preservation mechanism. It becomes relevant if one has to face re-election, a partisan boss, or retribution while pursuing other aspects of an agenda. Health professionals should be insulated from these more political arguments. But that does not mean that they should restrict their actions to ones with no political repercussions.
Balkind argues that “the University should encourage abstinence, marriage, or at least monogamy whenever possible, as these are much better practices in public health.” This statement has no basis, or support, in public health. Public health supports protected and safer sexual behaviors. Marriage does not guarantee safe sex, nor does it have a monopoly on safe sex. Abstinence education is impractical, and not supported by public health literature. Promotion of monogamy is also ideological, not governed by health outcomes, but I don’t think Health Services has ever promoted polygamy regardless.
One of the most important concepts in public health is that of harm reduction. This theory accepts the fact that people will engage in behaviors that are potentially risky, and aims to reduce those risks as much as possible. While there is some disagreement and controversy surrounding harm reduction policy in relation to drug use, harm reduction for sexual activity is widely-accepted as the best form of HIV/AIDS, STI, and unwanted pregnancy prevention.
The worst health policies in our nation are the one’s governed by politics and ideology, and not by health research. Policies supporting abstinence-only sex education are based on ideology and refuted by health research. The United States’ policies surrounding the awarding of aid to population assistance and family planning programs are based on the politics surrounding abortion, not on improving the health of women and families in lesser-developed countries. Continued cuts to government-sponsored health insurance programs are based on pleasing the politically powerful upper classes, not on improving the health of the nation (or even saving money in the long run.) If health professionals were to support these policies, than they could be accused of violating their obligations, their obligation to health.
Health Services does not discriminate against conservatives, which is good because HIV/AIDS, sexually-transmitted infections and unwanted pregnancy do not discriminate either. Conservatives have sex — gay sex, straight sex, and everything in between. They have fetishes and proclivities. But if you go for treatment to Health Services, no one will ask your political affiliation. No program forces you to abandon your personal beliefs in abstinence. If a student approached Health Services with an idea for a health education or promotion program that was conservative, but supported by research and the needs of the community, it would probably be encouraged.
However, Health Services must acknowledge the fact that students on this campus are engaging in sexual activities, many of which are potentially unsafe. To avoid research-supported programming simply because it may be controversial would be irresponsible. Yes, health care providers may be biased, but not towards a political ideology, but towards responsible health policy. The actions of Health Services are consistent with the argument that health care professionals should stay out of politics, not vice versa.
Adam Pulver is a junior majoring in political science and community health. He can be reached at [email protected]