Wednesday, May 01, 2013
What is health? (continued)
A synonym for the medical enterprise in the English speaking world is “healthcare,” which you will note has now become one word. (It was still two words when I was a child, and for a while I corrected my students’ papers if they made it one.) So medicine – the social institution led, at least until recently, by people possessing the credential Doctor of Medicine – is purportedly dedicated to caring for our health.
When people visit physicians, they usually do so voluntarily. Presumably, they do this because they want the physician to make them healthier, or keep them healthy. What exactly does that mean? What are they seeking?
This question appears simple. We use the word health all the time. Most people don’t reflect on its meaning any more than they reflect on the meaning of “breakfast” or “basketball.” They answer the question at the top of this post with little thought. It’s obvious, right? Health is . . . .
Actually that’s a very tough question. The preamble to the constitution of the World Health Organization, written in 1946, used this definition: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Not only that, but “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” The second quote is chiseled into the façade of the main building of the Harvard School of Public Health. That is definitely uplifting.
It is also completely nonsensical. Start with the idea of “complete . . . well-being.” Do we really want to say that we’re unhealthy if there is anything we wish for that we do not have? And even if we can come up with a more realistic definition of complete well-being, is there any point in proclaiming that every human being has a right to the highest attainable standard of whatever it is? If we do endorse such a right, it’s not just “one of the fundamental rights,” it’s the only one, because there wouldn’t be anything left over.
We must begin by accepting the human condition. We are all of us born with an incurable, inevitably progressive disease which, beginning in our third decade, gradually degrades our physical and mental capacities and is ultimately fatal. We are, in other words, mortal, and we grow old. What is more, our initial endowments differ. If a congenital condition deprives us of complete well-being, have we suffered a violation of our fundamental human rights? Or is there perhaps a more constructive way to look at that situation?
It doesn’t take much thought to see, further, that my well-being may conflict with yours, and that determinants of my own well-being may conflict with each other. I have the privilege of living in a beautiful place in the country, and having a very desirable job in the city. But this privilege is conferred by the internal combustion engine, which spews ultrafine particles into the atmosphere that contributes to heart and lung disease; causes crashes that kill 36,000 Americans every year and seriously injure many more; and is changing the global climate threatening mass extinctions and unimaginable human misery.
I could go on about this, even write a whole book about it. But our present purposes do not demand it. People don’t go to physicians to claim their fundamental human right to the highest attainable standard of health. They go because they have a particular complaint that they think may be amenable to medical intervention, which is sufficiently disturbing to make the trouble and possible expense worth the trouble and downsides of medical attention.