Health Versus Health Care
Talk to Americans about health and the topic generally switches—immediately—to health care.
It makes sense. Health care is our Titanic.
In what other country do you spend 18% of your total economy on a crazy, dysfunctional system which ranks you 50th in the world for lifespan (according to the CIA). In the U.S. we have a “system” where appendectomies in the same market can cost $1,500 or $183,000, and debt collectors sit interviewing patients in ERs. With health care simultaneously critical to individual survival and bafflingly bizarre, no wonder people first want to talk about health care.
But that’s taking your eye off the ball.
Health is a much bigger issue than health care. Health is a social, political, and economic issue that speaks to national survival. A healthy economy requires a healthy population. A healthy population is also a resilient population, that can grow an economy and help create the kind of society people year for.
So what are people’s workaday definitions of health? Here is a sampler of some responses I’ve gotten:
Family doctor - “Your numbers look great.”
Schoolteacher in her early sixties - “The doctor said my numbers look really good.”
Professional ball player - “I can play. Despite the injuries, I can play.”
Health Insurer – “We had to pay virtually nothing on this guy. It was a fantastic saving.”
Orthopedic surgeon - “The new joint looks great on X-ray.”
Oncologist –“We can’t find any evidence of disease on scans.”
Therapist - “We took care of most of his major issues.”
Worried patient in his fifties - “I still might have cancer. They didn’t do many tests the last time I saw the doctor.”
Drug using teenager - “When I take the stuff, I feel great. My health is fine.”
World Health Organization – “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Beyond Absence of Disease
If you’re an oncologist, making a tumor disappear on PET scans is a very, very big deal. The ordeal of surgery and chemotherapy may look small by comparison. Yet absence of disease is an impoverished vision of health.
Let’s just look at a common, less narrow definition of being healthy – that of lifespan.
In this regard, the U.S. does both dismally and brilliantly. The Eight Americas Study, which subtyped Americans by ethnicity and locality, found different subpopulations varied in survival by more than 35 years.
That’s not a matter of health care. That’s a matter of lifestyle – of how people live.
Asian-American women in Suffolk County do not have an expected lifespan of 95.6 years because Suffolk County’s health care is greatly superior to everywhere else on the planet.
The huge increase in lifespans in the world through the last century occurred primarily because of improved public health – better sanitation, nutrition, education and vaccination. The death rate from infectious diseases in the U.S. decreased by three quarters before effective antibiotics were even introduced. When it comes to overall lifespan, health care is an also ran - compared to lifestyle and public health factors.
And the WHO definition of health matters for many other reasons. Physical and mental health is greatly affected by how people eat, move, rest and socialize. Social well-being and social support keep people living longer.
And feeling better.
To the WHO definition I would also add spiritual well-being. As recent studies of religious groups by Andrew Newberg and others demonstrate, being part of a spiritual community keeps people alive longer – and feeling better. For living connected to ideas greater than oneself has innumerable benefits in enjoying life – and feeling fulfilled.
So perhaps here is a definition of health we can work towards – “Complete physical, mental, social and spiritual well-being for individuals and populations. ”
Then maybe we’ll begin to understand that tax-supported agricultural subsidies that make the most obesogenic foods the cheapest, is an effective economic strategy only if you want to create legions of adolescents diabetics. That in what should be the healthiest part of the American population, people aged 10-24, having a death rate twice that of Britain, France, and Sweden is a national disgrace. That a rate of premature births where we rank alongside Kenya and Honduras represents a national shame.
It’s time to think of health before we think of health as the goal. And not just in our individual lives.
Health should be the goal of health care, too.