What isn’t an epidemic?

Ben’s post on violence, and my response, have got me thinking about one of the (many) questions we raised in class but never really answered: does it always make sense to think of health concerns driven by behavior (rather than, say, microbes) as epidemics? We see this all the time in the media and in the academic literature: the obesity and tobacco epidemics, most famously.  And then there are a host of “epidemics” of behaviors that have been medicalized or psychopathologized to fit into the disease model, but I’m pretty sure it would have sounded absurd to refer to them as epidemics until fairly recently: sex addiction, for example.

What are the problems with using the label “epidemic”? Should the term be potentially applied to any set of behaviors that lead to adverse health consequences, or are there limits? We have discussed some examples where it seems more productive to think of behavior in terms of epidemics even when we may find that behavior abhorrent: needle exchange programs have been very successful in limiting the spread of AIDS and hepatitis, for example, even if some feel that they condone illegal behavior.  The term is also a useful way of undermining the medical tendency to blame the patient: as we know, behavior occurs within a socioeconomic context (cf. structural violence), pretty much every disease results from a complex interaction between behavior and pathogens, and many forms of behavior have a genetic component.  Maybe there are good reasons to use the blanket term “epidemic” to erase the distinction between passive (victim) and active (deviant or unsanitary citizen) when we talk about health.

But there are political consequences of the “epidemic” label as well: to use a current example, Bloomberg has been using the term to justify his attack on soft drinks in New York.  Whether we agree with the soft drink ban or not, it raises the question of how far government control of the behavior of its citizens should extend in the name of addressing a public health concern… and has some uncomfortable resonances with the state-of-exception, war-on-terror rhetoric used to justify the erosion of civil liberties post-9/11.  If violence is an epidemic, should we get rid of the Second Amendment in order to reduce the virulence of the disease?

Thoughts? Can you think of a recent “epidemic” that you don’t think merits the name? This one, maybe? Where and why do you draw the line?


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