In December, I had the privilege of attending the Africa Bitcoin Conference (ABC) in Accra, Ghana. As a public health professor with a background in health education and community health, this may seem like an odd conference to attend, but this trip was pivotal for me as it brought me to my father’s birth country for the first time and connected me to the beauty and resilience of Ghanaians, their fight for freedom, and cemented my ideas that money is a public health issue.
While in Ghana, I met incredibly bright people from engineers to grassroots community educators from various parts of the continent and the world, including a few fellow Canadians. I also had the chance to meet with one of my uncles for the first time, and we walked around Kwame Nkrumah square on a perfectly sunny and hot day. We toured the park where Nkrumah’s Mausoleum was, and my uncle proudly walked around with me, looking at each landmark and memorabilia, and we learned about Kwame Nkrumah’s life and political reign as the President of Ghana. I was able to revisit Nkrumah’s story which led Ghana to independence in 1957, a day celebrated by Ghanaians and many Africans, as this day represented hope and true freedom.
A few days later, I toured the University of Ghana, Legon campus, a gorgeous and intellectually vibrant campus. Among other places, I walked into the campus bookstore and was instantly attracted to books on topics of decentralized government and central banking, specifically books by Kwamena Ahwoi and Ivor Ageman-Duah.
This led me to reflect on some of the discussions at ABC about issues related to the centralization of money. These issues made me realize that centralized money, specifically fiat money, which is imposed on many citizens across the world by governmental decree, is harmful to public health because it is marred by debt, corruption, colonial control structures, and lack of transparent rules. How many millions of African lives could have been saved, wars avoided, workers, and businesses freed from economic shackles if money was not built upon debt?
Public health is ultimately about what we, as individuals in society, choose to do to protect ourselves, families, and our communities. If we continue to repeat our past actions, we carry on to build public health interventions on a flawed socioeconomic foundation and treating symptoms of a broken monetary system. Thus, I have come to the conclusion that we need to explore the merits of new money like bitcoin so it can form a more robust base layer of society.
What is Money?
Money is supposed to be a medium of exchange, unit of an account, and a store of value [1]. However, our money today is far from a store of value. Nowadays, people must earn their money twice: first, work to earn a paycheck, and secondly, figuring out a way to invest a portion in assets or financial products because their dollars lose value due to inflation and currency debasement. This situation impacts everyday peoples’ ability to keep up with the cost of their home and thus negatively impacts their lives and health in devastating ways. It also causes prices of food and energy to rise [2]. Studies show that debt and financial stress is associated with various adverse health outcomes such as depression, suicide ideation, obesity, and cardiovascular disease [3, 4]. Around the world these health issues are at epidemic levels.
Historically, the economy of fiat money and debt has been overlooked by previous research [5]. In many countries, money is centrally controlled, printed out of thin air by authorities, and serviced by debt contributing to crisis situations. Also, the rules of how money is created and circulated is opaque to the everyday individual. This hurts working-class people who save in money that depreciates over time. Therefore, there is a need for money that cannot be debased by central authorities so people can preserve the fruits of their labor. Money, like bitcoin, could encourage more low-time preference behaviors where people could truly save and work less thereby reducing stress and negative mental health problems associated with financial worries of the future.
Bitcoin is public software code that allows for an open peer-to-peer system of money that anyone can join and is ruled by rules and not rulers. More specifically, it is a new monetary network that is deflationary and counter to the prevailing inflationary system of fiat money that operates around the world. If you haven’t already, I invite you to re-visit Bitcoin and ask yourself why you may be dismissing it. Bitcoin is not “crypto” and is not the cause of the scams on fraudulent exchanges like FTX. To learn about money creation and the ills that it spawns in society, I encourage you to read books like:
- The Fiat Standard by Saifedean Ammous.
- Bitcoin is Better by Daniel Hershberger.
- The Hidden Cost of Money by Seb Bunney.
- The Price of Tomorrow by Jeff Booth,
- Fiat Ruins Everything, by Jimmy Song, and
- Broken Money by Lyn Alden.
Debt-based money is a public health issue, and we must start recognizing it as such.
The Health Impact Pyramid and The Base Layer
In 2010, Dr. Thomas Frieden, an American infectious disease doctor and public health physician published “A Framework for Public Health Action: The Health Impact Pyramid,” a theory that is widely used in health promotion today [6]. In it, the five-layered pyramid reveals a hierarchy of public health and health interventions. At the base layer are socioeconomic factors that are foundational to making the greatest population impact. Frieden goes on to say that “interventions focusing on the lower levels of the pyramid tend to be more effective because they reach broader segments of society and require less individual effort.”
Given the importance of socioeconomic factors, I believe that public health and health care professionals should intervene to improve this base layer of population health by examining the underlying health of fiat money and advocating for better money. If fiat money is indeed broken it cannot adequately support public health intervention. “Income” or “living wages” are frequently advocated for; however, these factors are downstream from money. Effectively, if we keep advocating for secondary factors to change when the base layer of money is broken, it is like a doctor treating the symptoms of a disease without first addressing the root cause.
Public Health Advocacy
Almost 100 years ago, before Frieden’s work, the Canadian Public Health Association (CPHA) was established as a sovereign voice in the nation with connections to the international community [7]. Around the world, similar organizations exist, like the American Public Health Association, Africa Healthcare Federation, European Public Health Association, Association of Asian Pacific Community Health Organizations, Public Health Association of Australia, and Public Health Association of New Zealand to name a few. These organizations play an active role in shaping policy and public discourse in the field of public health and health care. For example, CPHA plays a major role in advocacy for bringing awareness to issues that warrant national attention. Over the past seven years, CPHA has called attention to several issues including naming mental health, climate change, and even racism a public health issue. Increasingly, issues related to the social determinants like anti-racism have received a lot of attention both nationally and locally given its associations with colonialism and inequality. This and increased national recognition of inequality in Canada has contributed to the renaming of prominent places in the country like Ryerson University, which is now known as Toronto Metropolitan University and most recently there were talks led by Toronto’s City Council to rename Young-Dundas Square to Sankofa Square [8].
As a Ghanaian Caribbean Canadian, this really strikes me as a superficial way to address social inequality in Canada. Sankofa is a term that derives from the Akan Tribe of Ghana that is depicted by a bird that is looking back with an egg that signifies the future, saying “Always remember the past for therein lies the future, if forgotten we are destined to repeat it.” [9] Renaming historical and prominent places in the city may be appropriate should there be enough community-backing; however, if it fails to address the root dysfunction at the base layer, debt-based money.
If we are to reflect upon history, cowrie shells were once used as money in West Africa. Eventually, European traders infiltrated the system and debased the cowrie shells which reduced their economic value [10]. While the European traders disturbed the local economies, we need to look at the larger issue that regardless of race, man’s heart is never satisfied and is lured to want more. This same trait is existent in our current centralized monetary systems in Canada and around the world. We need money that cannot be debased by another human being.
The Future of Public Health and Money
As public health professionals, it is crucial for us to dig into the issues we stand behind and understand the role that money itself plays in the social determinants that impact health. Currently, in Canada, universal basic income is a hot topic, and intense research and debate is underway to propose a national framework [11]. Such proposals by past presidential candidates in the United States and elsewhere have also brought this up to address inequities. Election years are currently upon us, now in the United States and in 2025 in Canada and public health and healthcare professionals should have an active voice in protecting decentralized money, i.e., bitcoin, so the free market can choose the best money for society.
Public health and health care professionals should consider the following three major points:
- Learn about the history of money: Read books, watch, and listen to podcasts that explore the evolution and innovations of money and how centralized fiat money can lead to poor outcomes for society. Some notable podcasts include Natalie Brunell’s “Hard Money” show; Preston Pysh’s “Bitcoin Fundamentals”; Robert Breedlove, “What is Money?”; Peter McCormack’s “What Bitcoin Did”; and videos by Luke Broyles and BTC Sessions (Ben Perrin). Also, consider joining your local Bitcoin meetup group to learn more about Bitcoin with people in your community or consider volunteering with nonprofits like Bitcoin is Better that aims to introduce Bitcoin as sound money to the working class.
- Naming Debt-Money as a Public Health Issue: As we enter election years now in countries such as the United States and Canada, public health and health care professionals should consider raising their voices to name debt-money as a health issue. The detrimental effects of a centralized financial system on the socioeconomic status of individuals, which directly impacts health outcomes, should be explored, acknowledged, and addressed.
- Promoting Public Discourse on Bitcoin: Public discourse should include conversations around what policies are needed to protect all citizens’ access to a decentralized system like Bitcoin. More specifically, we should openly examine what health outcomes and social equity would look like if there was a global economy that drew its economic energy from a base of only 21,000,000 divisible units. Could life, and specifically public health, be better?
References
- Manuel Tacanho, (2022) https://mises.org/wire/money-what-it-more-important-question-why-it Date accessed February 17, 2024
- Ainul Mohsein, A.M., Taib, F.M, & Sani, S.A. (2019). Rising Cost of Living: The Role of Fiat Money and Money Creation. International Journal of Accounting, Finance and Business (IJAFB), 4(22), 116-125
- Swarup, S. S., et al. (2024). “Cardiovascular consequences of financial stress: A systematic review and meta-analysis.” Current Problems in Cardiology 49(2): 102153.
- Turunen, E., Hiilamo, H. Health effects of indebtedness: a systematic review. BMC Public Health 14, 489 (2014). https://doi.org/10.1186/1471-2458-14-489
- Friedline, T., Chen, Z. & Morrow, S. (2021). Families’ Financial Stress & Well-Being: The Importance of the Economy and Economic Environments. J Fam Econ Iss 42 (Suppl 1), 34–51. https://doi.org/10.1007/s10834-020-09694-9
- Frieden, T.R. (2010, April). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100 (4), 590–595. doi:10.2105/AJPH.2009.185652
- Canadian Public Health Association, https://www.cpha.ca/vision-and-mission, Date accessed February 17, 2024
- Toronto City Council Approves “Sankofa Square” as new name for Yonge-Dundas Square and initiates plans to rename other City assets that include the name Dundas:https://www.toronto.ca/news/toronto-city-council-approves-sankofa-square-as-new-name-for-yonge-dundas-square-and-initiates-plans-to-rename-other-city-assets-that-include-the-name-dundas/ Date accessed February 17, 2024
- Kwarteng, Appiah Kubi (2016), Journal of Applied Christian Leadership: Vol. 10: No. 1, 60-69.
- The Shell Money of the Slave Trade, Jan Hogendorn, Marion Johnson https://www.cambridge.org/us/universitypress/subjects/history/regional-history-after-1500/shell-money-slave-trade
- When could Universal Basic Income start in Canada, Christl Dabu, https://www.ctvnews.ca/canada/when-could-universal-basic-income-start-in-canada-1.6770762, Date accessed February 17, 2024