Map of life expectancy at birth from Global Education Project.

Friday, January 25, 2008

Why is this hard?

Now I get to the stuff I'm supposedly an expert at, and I find it difficult to do a post. The reason is that I'm accustomed to writing about these issues with footnotes and exact numbers and scholarly reserve and all that, and I don't have time for it in a blog post and it would be boring anyway. So I'm just going to lay out some qualitative ideas and if you want the bibliography, send me an e-mail.

Humans are fundamentally social beings. We're the most altricial of all the earth's creatures, to begin with (double meaning intended). Put a human being in isolation, even in the most benign and resource rich natural environment imaginable, anywhere up to, oh I don't know, at least age eight or so, probably older, and it will quickly die. Eventually we develop enough resources to exist independently if we absolutely need to, but even the most resourceful of adults, placed in total isolation from other humans, will go completely insane in a few years and probably destroy itself.

So, our biological existence depends on our social existence. Of course, it isn't just a dichotomous proposition. Our biological state and life expectancy are strongly determined by our social interactions. While it's all the rage these days to claim that our genes have the most powerful influence on our health, that's highly misleading. A genetic inheritance that make us healthy in one environment makes us unhealthy in another, and our environment is largely socially determined. To a considerable degree, it simply is social. The personality traits, and biological traits, to which our genes predispose us interact with our social environment, and they shape it and are shaped by it in turn. Fussy babies have different interactions with parents, and siblings, and grandparents, than do calm babies, which in turn influences the children's behavior, which in turn . . . You get the idea.

There are strong gradients in health status associated with measures of socio-economic status -- level of formal education, job status, income, wealth -- and there are effects of ethnicity which remain even after controlling for these. Inequality within society is actually more important than overall material wealth. Poor people in the U.S. are less healthy than the average Cuban, although the average Cuban has considerably less income. The more egalitarian European societies, though not quite as affluent on the whole as the U.S., have considerably healthier and longer-lived citizens. And so on.

Looking at it from a different point of view, society determines the very meaning of health, in innumerable ways. Disability is a function not only of biological capacity, but of social expectations and barriers. Using a wheelchair is more or less of a disability depending on architecture, and on the attitudes of people around you. Societal expectations about body shape, height, physical capacities, hair, odor, cognitive abilities, behavior, and so on create actual diseases or make them disappear. Think of homosexuality, which was a disease until 1973. Shyness has become a disease, labeled "social anxiety disorder," now that somebody is trying to sell a drug to treat it. We speak of "healthy" relationships and "healthy" attitudes.

I could go on, there are many more dimensions of interaction between the human organism and society, both physical and conceptual. But the summary is that we aren't bounded by our skin. Who and what we are, how we define health, and how much of whatever that turns out to be we turn out to have, is a function of the interaction among mind, body and society. Why then, do we relegate it to a domain of experts whose training is exclusively biological?

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