Map of life expectancy at birth from Global Education Project.

Thursday, January 06, 2005

The crux of the matter. . .

There is an analogy often used in public health literature, the origins of which are lost in the mist of time. Suppose there is a steep cliff in the town, and people are falling off. At the bottom of the cliff are all the caring, compassionate people who make up the medical industry. As the people hit the ground, the medical workers rush in to stanch their bleeding, set their fractures, and rush them off to the gleaming new hospital for recovery and rehabilitation.

Meanwhile, at the top of the cliff, there is no warning sign or fence. Indeed, some people are being enticed toward the cliff by people from tobacco and fast food companies and other firms, who are selling them tickets to jump off. Other people are actually in chain gangs, being driven toward the cliff by overseers with whips.
What is the sensible thing to do in this situation? Spend more on the doctors and ambulances and hospitals, so we can get to more of the people faster? Or stop squandering all that money and put up a fence?

We do the former because we depend on the market: individuals who have already fallen off the cliff will pay (or their insurers will pay) for treatment; but only society, through its government, will pay to put up a fence, and as a society we have not made this choice.

The myth that the biomedical industry holds the key to health and longevity stands in the way of creating a just and humane society. We are not just biological entities, but also social, psychological and spiritual. We are physically healthy only to the extent that we are socially healthy. Biomedicine, with its one-dimensional and mechanistic interpretation of the body, denies our very nature.

If we want a healthier society, we need to spend less on biomedicine, not more. Yes, biomedicine can cure some illnesses and reduce the symptoms of others, but it has side effects as well. I won't go through all of the harms that some people have ascribed to biomedicine -- that's for another day -- but I have identified one of the most important, and that is its opportunity cost. If we get so-called "health care" reform that appropriates an increased share of workers' income to pay for biomedicine, they will very likely be left less healthy. If we as a society have faith that the 15%+ of national wealth that we spend on biomedicine is the best possible investment in health, and if we let that share keep growing at the expense of meeting our important social needs, we will be less healthy.*

(* This passage is largely taken from a previously published work by yours truly.)

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