My old friend Martin Downs, M.P.H. Dartmouth, has embarked on a very interesting project: "a full picture of sexual health in the United States" based on an index of 26 measures of sexual health. (Full report here.) The fun part of the project is the resulting Sexual Health Rankings™, which finds Vermont, Connecticut, and New Hampshire the most sexually healthy states, and Mississippi, Louisiana, and Texas the least healthy. Lots of opportunity for mean regionalist jokes there!
But it's also a sign of where public health's going in general, and how it breaks against cultural tides. The indicators include the expected relative incidence of STDs and rape but, taking off from the World Health Organization's idea of sexual health as "not merely the absence of disease, dysfunction or infirmity," but also "a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence," they also consider access to contraception and abortion, sex education in schools, gender equality (partly measured by "proportion of seats held by women in state legislatures"), and "sexual satisfaction" measured by the "proxy indicators" of percent of population married or partnered, and general good health ("numerous studies show that self-reported health is positively associated with sexual satisfaction, and that worse self-reported health is a strong predictor of sexual dysfunction").
You may quibble with some of the metrics; I'm not sure how well you can track sexual satisfaction in the aggregate, short of a Masters and Johnson version of Nielsen Ratings or a test panel made of these. But I like the idea of defining sexual health more humanely than would, say, medical authorities at an Army induction center. Old-fashioned as I am, I still tend to think of public health as reactive, eradicating abnormalities clearly identified as disease -- as in, hmm, people in this village are dying of cholera, let's see if we can stop it. But in some communities, the appearance of such agents of death was once so commonplace as to be considered the norm; it's only when somebody began to think that it didn't have to be that way, and that it could be changed by something other than prayers and mumbo-jumbo, that human health progressed.
Now we see folks turning this approach to conditions no one considered public health issues before -- obesity, for example. Because our general fatty-fat-fatness doesn't look like cholera, and can't be fixed by replacing the town water pump, we are slow to identify it as disease. There's also a better reason: Because the nobs then might determine that we must be saved from ourselves, and try to keep us from having eating barbecue potato chips and onion dip because we must not know what we're doing to ourselves. Lord knows I've felt resistance myself in the face of Mayor Bloomberg's nannying on the soda tax and all that.
Maybe the problem there is that we're Americans, and everything having to do with pleasure confuses us. Maybe we stuff ourselves with junk because we're missing something in our lives, and our leaders try to take these palliatives away from us without any genuine concern for us except as cogs in their machine and reflections of their own enlightenment, and offer us nothing in return except good citizenship medals.
But with this sex thing I don't see a downside. Gender equality? Access to women's health services? "Pleasurable and safe sexual experiences, free of coercion, discrimination and violence"? That doesn't sound like health nazidom to me. Maybe that's because it's about giving access to more choices instead of fewer, and normalizing pleasure instead of restricting it. In any event, I'd sure rather have that than a healthy snack.