Sin in the Secular Age: Smoking and Obesity

The Judeo-Christian concept of sin is an offence against capital-G God. It is going against His will or plan for us human beings. Some sins are considered minor (venial sins), others are major (mortal sins), but any type of sin carries with it not only consequences in this life, but in the life hereafter. Unless, of course, the sinner is sufficiently repentant, and in the cases of some religious sects, adhering to the correct faith.

We who hold a secular worldview today scoff at the concept of sin, and for a few good reasons.

First, while many behaviors traditionally regarded as sinful do harm (such as lying and stealing) others are not necessarily harmful and might even be beneficial to a person's well-being (such as having healthy sexual relationships outside of marriage.)

Second, inherent in the concept of sin is an additional punishment for supposed misdeeds. It is not enough that lying carries the risk of being caught and not trusted in the future, or that those who steal risk trial and punishment by law enforcement. There must also be the threat of either extra time in purgatory, or eternal torment in hell.

Third, the concept of sin tends to glaze over the reasons behind peoples' misdeeds and focus on punishment. Sin easily goes from being a verb (something a person capable of good or evil has done) to the noun sinner (a person whose fundamental nature is wicked.) When this happens, anger, righteousness and condescension trump humility and compassion. Punishment is emphasized over prevention or more constructive ways to modify harmful behaviors.

The thing is, these problems with sin are not exclusive to those of Judeo-Christian faith. Just as many people of faith emphasize compassion and forgiveness over self-righteous judgement, many secular people have adopted a sort of secular concept of sin.

One example of this is rising premiums on health insurance for smokers. The trend began a few years ago, and the Affordable Care Act does nothing to stop it.

All the problems with sin are present: These measures punish all smokers, even those who smoke in moderation and/or who suffer from no health problems directly connected to their smoking. It adds punishments in addition to the possible ill-effects of smoking (which disproportionately impacts those with lower income, who I might add are those more likely to smoke and have more difficulty quitting.) And instead of addressing the root causes of tobacco addiction and finding non-punitive ways of helping addicts who want to quit do so, it simply punishes them, hoping that these additional punishments will be the deterrent that finally works.

Let's look at a second, similar example: The rising cost of health insurance is driving many companies to pressure obese employees to meet arbitrary weight-loss goals and into participating in often humiliating weight-loss programs. Again, the Affordable Care Act does nothing to stop this discrimination against the obesity in the workplace.  

And again, all the problems with sin are present: These measures punish all (and only) obese people, regardless of any individualized assessment of their health and lifestyle, and while ignoring those who are thin but unhealthy for other reasons. It adds punishments in addition to the possible health problems that disproportionately impact many obese people (not to mention the social discrimination obese people face because they are outside mainstream measures of attractiveness.) Instead of addressing root causes of diseases correlated with obesity (such as diabetes and heart disease), it burdens and shames an entire class of people, hoping that will change their behavior and that those hypothetical changes will yield desirable outcomes.

Smokers and the obese do not need more arbitrary consequences from employers and health insurance companies. Either they are perfectly happy with their behavior choices, or they are not and already have enough motivation and challenges for modifying their behavior. In the case of the former, bug-off because we all have our personal indulgences which are nobody's damn business. In the case of the latter, people need encouragement when and from whom they request it.

While all of our day to day choices will never be 100% in line with our personal goals and values, we can always strive toward personal improvement. The benchmarks are different for different people based on circumstances. Not everyone's values are identical nor should they be. Knowing how much a person smokes or drinks or how much he or she weighs does not give a measure of how hard he or she is working toward personal improvement.

Perhaps some of you reading this post think smokers and obese people should be further punished for their behavior, either because their transgressions deserve it, or you are convinced (despite evidence to the contrary) that shaming people actually works. If that is the case, I implore you, go hang out with the Religious Right where you belong.

Beyond the Birth Wars

The Grieving Parents by Kathe Kollwitz

Since writing two essays which address the natural childbirth movement (first in 2011, then again last week) I feel a bit as if I've been sucked into the tunnel vision of the Birth Wars. 

Taking a step back, I see it all as a paltry debate among those of us who are lucky enough to have quality and choices when it comes to our health care.

Don't read me wrong; it's clear that there is a whole lot of natural childbirth woo out there that is distinctly anti-science, anti-medical establishment, and anti-feminist. It is clear that lay midwives attending high-risk births in homes instead of hospitals has resulted in the preventable deaths of babies and women. 

It's just that in reading about the broader picture of birth in both America and across the world, I see a much greater concentration of death and harm among the economically disadvantaged, and especially women of color. I feel compelled to check my priorities. It's not that every woman and baby doesn't matter. It's that every woman and baby does matter.    

The Widow II by Kathe Kollwitz

For many pregnant women and their newborn babies, the difference between rich and poor is the difference between life and death. For instance, according to Save the Children's State of the World's Mothers 2013, in Cambodia, babies born to the poorest 20% of parents have a 144% elevated risk of death compared to babies born to the richest 20%. More than a quarter million women die every year because of complications from childbirth.The dead babies (and consequentially the grieving mothers, many of whom must endure their grief without sufficient social or mental health support) number over a million every year. Without question, most of these deaths are preventable, connected to, and exacerbated by the conditions of poverty.   

America's GDP doesn't make Americans immune to the deadly disadvantages of poverty. In 2011 the World Health Organization reported that the USA had a higher newborn mortality rate than 40 other nations. And a 2010 publication by Amnesty International reported about the high rates of maternal deaths and complications associated with pregnancy and birth for American women. 

In addressing these issues, natural childbirth advocates cry out about overused medical interventions and unnecessary c-sections. But it seems apparent to me that the problems for women and babies at higher risk begin long before a woman becomes pregnant. Food insecurity, poor nutrition, unsafe and/or highly stressful living conditions, and inconsistent access to preventative health care set women up with issues such as high blood pressure, diabetes, and obesity, all of which can easily lead to complications in pregnancy, which then may very well require all those interventions and c-sections. 

Then there's the elephant in the room that nobody wants to talk about, and often if anyone does, they are shut down: racism. Race is the strongest predictor of outcomes for birth in America (with black women and babies suffering the worst outcomes), and yet when these huge disparities are reported and discussed, the focus tends to stick exclusively to economic disadvantages and ignore the *gasp* possibility that black women are treated differently by doctors, nurses, and other health care workers (not to mention employers, teachers, social workers, or anyone else they encounter and who might impact their lives.) But is it so hard to imagine that pervasive and damning stereotypes of pregnant black women, especially poor, young, pregnant black women, could have at least a subtle impact on the way they are handled and advised by medical professionals during prenatal care, birth, and postpardum care? 

Authors of the 2010 article Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach, outline a 12 point plan which includes suggestions which seem indirectly connected to pregnancy and birth, such as "Invest in community building and urban renewal", and "Reduce poverty among African American families." People who enjoy strong communities and financial security often take their huge benefits for granted and fail to see how they dramatically impact a person's overall health, behavior, and choices. 

Of course the broad suggestions in this 12 point plan need to be refined into specific programs, many uniquely tailored for particular communities, but the overall point is sound. 

The issues that result in dead or injured women and babies at birth can't be solved by either warm and fuzzy homebirth midwives or even a well-trained OB with a scalpel. The physical, emotional, and social needs of impoverished women not being met are far too great.