Upstream Health and Susan Linn

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You hear a lot of talk about upstream factors in public health, and there is a strong shared belief in their importance. So what are these upstream factors that drive population health?


I recently read the original article by John McKinlay, which remains not only fresh, but radical. There is a lot to say about this groundbreaking work, but one thing jumps out at me in particular. McKinlay writes with great passion and insight about the theory of upstream factors and why they should be taken more seriously in public health, but when it comes to specifics he identifies only one concrete upstream factor in his article: advertising.  More than anything else (or perhaps for McKinlay there wasn’t really anything else), advertising—whether of cigarettes, obesigenic food, or useless medical interventions—drives health.


The manufacturers of illness, to use McKinlay’s phrase, always deny that advertising makes any difference to purchases, much less to human health, but of course they are wrong. Advertising certainly matters to choices around food, medicine, time-use, and commuting patterns. When marketing distorts decisions made by adults, it’s a public health problem.


When marketing distorts choices made by and for children, it is depraved.


I thought about all this recently when I learned that Susan Linn has stepped down after 15 brave and impressively effective years directing the Campaign for a Commercial Free Childhood (CCFC). She led several really important campaigns to reduce the hold of marketers over children’s lives, including a successful action to get Disney to stop falsely claiming educational benefits for the atrocious Baby Einstein video series, shutting down BusRadio (a company that broadcast ads to a captive audience of children in school busses), and stopping Scholastic from distributing an energy curriculum for fourth graders written by the American Coal Foundation. CCFC has done great work, and it’s a travesty that their work should be needed at all. But it is. This organization deserves our support. It will be well-led by Josh Golin, who has worked there for years, but Susan will be missed.


But what struck me most was, this is upstream public health. If we can’t have commercial-free childhoods, we’ll just have to keep fishing bodies out of the water downstream.

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