Public Health, Thermodynamics, And The Cat Food Commission

A previous article discusses the future of health systems operating under neoliberal ideology as it comes a cropper in a world undergoing degrowth.[i] Here I consider how this thrusts public health[ii] into in a “Which side are you on?” dilemma[iii] likely to separate its institutional administration from its frontline professionals –and the public it is meant serve- as part of the larger process of political/economic conflict, cultural and environmental decline, chaos and (possibly) cultural renewal.

The effects of government-imposed austerity[iv], erroneously claimed to restore fiscal responsibility and restart economic growth, are a reflexive (or cybernetic[v]) reaction to protect the economic interests of wealthy elites at the expense of other citizens.[vi] The funding and operation of the public health system and the array of socioeconomic factors that ultimately ensure a nation’s health[vii] are damaged by austerity.

The deep-seated reasons for recent and continuing financial and economic crises (despite mountains of propaganda and self-delusion that a recovery is underway) lie in neoliberalism’s congenital rent seeking,[viii] its class-based dynamic to channel wealth to a tiny economic elite,[ix] and its inability to realize that modern economies are reaching the thermodynamic limits to growth.[x] (This third characteristic is shared by most modernist forms of political thought, from the left to the right.)

It follows that neoliberal leaders of governments and their corporate masters view the ongoing economic contraction as a temporary deviation from the “natural” pattern of wealth accumulation-to-elites-trickle down-to-the-masses economics made possible by constant growth. Therefore, economic elites see an “opportunity” to use austerity as a cover to increase upward wealth transfer.[xi] A bonus is to accomplish the long-standing atavistic goal of rolling back[xii] the gains of the New Deal and Great Society.[xiii] Hence the massive governmental and corporate propaganda assaults on Social Security, Medicare and Medicaid –and other social benefits programs- as “Entitlements” that allegedly weaken the collective moral character, fiscal integrity and work ethic of the nation. The central premise of this attack -which is arrantly false yet widely disseminated without skepticism by mainstream media- is that these entitlements[xiv] for the “Lesser People”[xv] place the United States government at high risk of debt[xvi] default[xvii] or bankruptcy.[xviii]

Sixty years ago Karl Polanyi anticipated the present crisis when he wrote that belief in “free market forces” –a dogma at the core of neoliberalism[xix]– is a direct threat to the “natural environment…[which also] would result in the demolition of society.”[xx] Contemporary society is in the throes of what Polanyi foresaw and I suggest that the science of thermodynamics and the metaphor of the Cat Food Commission are indispensible guides for public health professionals to grasp what is unfolding in this era of ecological overshoot[xxi] and subsequent socioeconomic and cultural upheaval.

Public Health and Austerity

Before turning to thermodynamics and the Cat Food Commission, we must examine austerity’s impact upon public health. Austerity is an ethically decadent and intellectually simple-minded reaction that in the short-term serves economic elites but in the long-term is politically volatile and socioeconomically revanchist. The conclusion from several years of evidence from Europe –Greece, Latvia, Portugal, Spain, Cypress, Great Britain, Italy- is inescapable that social inequality and the collective health of nations are worsened by governmental austerity policies. Add to this the well-known negative health consequences of large and increasing disparities in social inequality and income distribution produced by decades of neoliberal policies[xxii], which have accelerated to warp speed in the United States since 2009.

In political terms, class conflict –not utilitarianism- drives public policy making in nations imposing austerity.

As a government provided service public health must not utter the name class conflict or, it follows, oppose austerity. In policy-speak, this means that the profession’s institutional leaders have no “exit” option, which in turn intimidates them not to use their “voice” option, and therefore renders them loyal to the status quo.[xxiii] They are constrained to play the role of the proverbial Three Monkeys who hear, see, and speak no evil.[xxiv] Put in a larger context, acknowledging the reality of class-based politics behind austerity would undermine the restraining myth of modern democracies that public policy serves the greater public good. Therefore, questions about whose side public health is on are absent from mainstream public health discourse.

Simultaneously, I sense that there is an untenable collective cognitive dissonance in the rank and file of public health in which, on the one hand, practitioners cringe at the unfolding consequences of fiscal austerity in Europe, and its potential for damage in Canada, the United States and elsewhere. On the other hand, they reduce dissonance by framing austerity as a short-term bitter pill –“shared sacrifice”[xxv] and “hard choices”- that will lead to long-term restoration of prosperity. Once growth resumes, this rationalization goes, urgent and mounting public health threats and risks will receive the funding necessary to mitigate them and the social determinates of health[xxvi] will be revitalized by economic recovery.

This hopeful –and obsequiously loyal[xxvii]– interpretation is proffered in an editorial in the January 2013 edition of the American Journal of Public Health[xxviii], the flagship organ of the American Public Health Association. While I do not know if this editorial is a strategy or symptom of Stockholm Syndrome[xxix], I find it a signal to the Obama administration that institutional public health in the United States wishes to frame the ravages of austerity as “adjustments of transition” so as to avoid assessment of the intellectual and moral turpitude[xxx] of neoliberalism. Indeed, the editorial should be construed as official public health’s grotesque curtsy to neoliberalism.

I have a divergent interpretation, which leaves behind the conventional understanding of left versus right politics, to share with those in public health and related health professions who are beginning to recognize that they are laboring inside a failing public health system. It stems from the contention that as the laws of thermodynamics take charge and class-based public polices proceed- this question will surface among many public health practitioners: “Which side –of the class conflict- are we on?”

I propose that institutional public health, such as professional associations, state health bureaucracies and schools of public health, will continue on in the Three Monkeys orientation to the neoliberal regime of truth.[xxxi] In realpolitik terms these leaders have no choice even as the substantive health threats and risks they are charged to deal with deepen and spread. High-level administrators will not bite the hand that feeds them; if they do they will be replaced with status quo compliant executives. This is not a static situation, however, so we should not fully write off all leadership, especially as the conditions for maintaining the health of the public continue to deteriorate and their exit, voice and loyalty options are altered by volatile and worsening economic and sociopolitical conditions.

In contrast, front line public health professionals will become increasingly despondent, angry and alienated from institutional leaders as their tacit knowledge grows that massive cultural, political and socioeconomic changes are not “structural adjustments” but pose huge threats to the health of the public. These professionals will realize that institutional public health –and the state and federal governments, corporations and foundations that supports it- has no solutions[xxxii] and will tolerate harmful class-based public health policies. Frontline professionals will be open to a new paradigm[xxxiii] –or way of being in the social world[xxxiv]– that offers an intellectual, moral and ethical path forward.

It is vital to remember that on the whole, they do not yet understand why modern societies -right now- are entering a post-growth world, which augers a context where government public policy –if it overcomes neoliberalism,[xxxv] which is not guaranteed- faces the central challenge of justly divvying up a shrinking economic pie. (Remember that almost every public health lecture, article and discussion in the United States ends with some variation of this exhortation: “We’re the wealthiest and greatest nation on earth. We’ve got the technology, know-how and resources to do the job; we just need the determination to commit them…”)

Neoliberal governments are blind to the emerging world of degrowth and continue apace facilitating the 1% to impoverish and cannibalize widening segments of the 99%, in essence producing more and more socioeconomically and politically superfluous people in the process. Neoliberalism can only operate in a social world where as the economy contracts -for thermodynamic reasons- wealth and other economic benefits continue to flow upwards, while the costs and burdens fall upon those outside the tiny elite economic.

Thermodynamics and Public Health

Politically and spiritually, the most important thing to know about the laws of thermodynamics is that their “power” –just like that of gravity- cannot be overcome, especially by political propaganda or bullsh*t[xxxvi]. And thermodynamics never gives out a Mulligan; low-entropy energy is for all practical purposes available to humankind once. These laws express the way the physical world works and, by logical extension, they set parameters for human political/economic activity and social organization. This realization has been hidden from industrial societies in large part because of the enormous endowment of low-entropy fossil fuels –which encouraged the illogical notion that growth on a finite planet is endless- and a companion Enlightenment belief that technology and “progress” solve all social problems, including environmental ones and class conflict.

Specifically, the laws of thermodynamics are about the science of energy flow and how energy behaves during its transformation from one state to another, in the process producing both heat and work. These laws were formulated during the industrial revolution when early physicists attempted and failed to create a perpetual motion machine. In other words, scientists tried to capture and recycle into work (waste) heat released by the combustion of coal doing work (like running a steam engine). This futile pursuit lingers on in the widespread belief that technology can produce energy. It cannot. We moderns have no choice but to organize society so that it works within the laws of thermodynamics.

C.P. Snow ironically notes the human significance of these laws:

(1) You cannot win or exit the game (you can’t get something for nothing because matter and energy are conserved) (2) You cannot break even (you cannot return to the same energy state because entropy [chaos or randomness] always increases) (3) you cannot get out of the game (because absolute [the temperature of] zero is not attainable).

In summary, thermodynamics explains why we cannot go back to an era when economic growth was taken for granted as the mechanism to integrate or placate social class conflict and deliver material prosperity to all those who honestly worked to achieve it.

There are several excellent academic explanations of how the laws of thermodynamics set the boundaries of human economic activity,[xxxvii] but they can be tough sledding. Readers unsure or downright puzzled by the connections between thermodynamics and economy are pointed to Mark Cunnington’s essay, “Thermodynamics for Economists, Or, “Economics for Scientists,” where he in plain English walks through this process: “energy flow from sunshine –> plants –> food –> humans –> labour –> economy.”[xxxviii]

Cunnington synthesizes a host of predicaments that too often set concerned groups apart or even at odds. I refer to peak oil, climate change, water scarcity, and acidification of the oceans, to name few of these dilemmas. All are connected to the overexploitation and overconsumption of resources and they cannot be addressed individually or serially or, frankly, in ignorance of the laws of physical reality. Further, he has an excellent discussion of money, debt and how our current economic and financial systems are out of sync with the laws of thermodynamics. Finally, Cunnington makes clear why social inequalities should be understood as unequal access to energy, the source of not just wealth but good health and one’s life chances.[xxxix]

In short, conservation of natural resources and reductions of social and technological complexity are in order[xl]; in fact they are occurring now in derivative or disguised forms: unemployment, health systems (blatantly on display in Greece) in decline, public services and businesses disappearing or being cut back, car sales plummeting in Europe,[xli] all manner of financial and fiscal upheaval and so forth.

We should not imagine, however, that human society is merely a reflection of the laws of thermodynamics. Neoliberal ideology is a social construction of reality that is based upon unequal distribution of energy and other natural resources –money = access to energy and resources. In the United States neoliberalism’s desperate responses to degrowth –without its adherents even comprehending degrowth is occurring!- is the Cat Food Commission, to which we now turn.

The Cat Food Commission

The title “Cat Food Commission” is a sardonic moniker –or metaphor- meant to connote that many retirees and the growing list of economically vulnerable groups will be forced into humiliating life-shortening and threatening penury, reminiscent of pre-Social Security times, if proposed cuts to Social Security, Medicare and Medicaid and other Safety Net programs are enacted. The official description of this commission is:

 

The National Commission on Fiscal Responsibility and Reform (often called Bowles-Simpson/Simpson-Bowles from the names of co-chairs Alan Simpson and Erskine Bowles; or NCFRR) is a Presidential Commission created in 2010 by President Barack Obama to identify “…policies to improve the fiscal situation in the medium term and to achieve fiscal sustainability over the long run.” (For further official details, see the White House site in this footnote:[xlii].

 

“The Cat Food Commission” epitomizes the class-based nature of the United States government’s organizing principle[xliii] of defending wealth, even at the cost of doing physical, mental and socioeconomic harm to the rest of the citizenry. This is a difficult to blasphemous realization for most Americans, including public health professionals, because it shatters the mythology that the United States is a historically unique society of equality and boundless opportunity for all.

There is a critical literature on the commission, including its content, how it is connected to ginned up hysteria about the fiscal cliff, the neoliberal sentiment behind the commission’s formation, and the public relations campaign of the bi-partisan support for reducing Entitlements.[xliv] I recommend interested readers visit the website Naked Capitalism, where there are original essay and aggregations of “Cat food Watch” articles from various sources. (Google: Naked Capitalism+Cat Food Commission”)

Summary

I have introduced the science of thermodynamics to explain the unavoidable contraction now occurring in industrial economies and have offered the metaphor of the Cat Food Commission as a metaphor of class conflict. Thermodynamics explains the physical basis of how energy is needed to make things happen –to do work- in the natural world; it describes the physical limits of growth and the loss of low-entropy energy inputs involved in extracting natural resources from the earth and transforming them into goods and services for a human economy. The Cat Food Commission metaphor informs us that the (contingent) way humans have arranged the political/economy of the modern world in the early 21^st century is invidious and unsustainable in a world at the end of growth. Henceforth, neoliberalism “works” only if more and more groups –classes of people- are pauperized. In sum, “Cat Food Commission” embodies social inequality.

 

This is the turbulent context in which public health must first locate itself and then (explicitly) answer the question posed at the outset, Which side are we on? I feel this question will produce a split between, on the one hand, incumbent high-level administrators and “leaders” and, on the other hand, those who are on the front lines engaging a plethora of public health dilemmas and problems. The only way to protect the core functions and essential services of public health[xlv] is by simultaneously understanding thermodynamics and the morality behind the Cat Food Commission and the acting upon this knowledge.

Health after Oil