“What is Health in the U.S.”
Philosophical theories from human history about the nature of human beings has had far reaching consequences on our understanding of what it means to be healthy in this country even to this day.
As early as 1948, the World Health Organization (WHO) got it right and defined health as a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” In 1986, WHO made even further declarations in the right direction: “A resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.”
In other words, health is perceived as a resource to support an individual’s function in a wider society rather than an end in itself. A healthy lifestyle provides the means to lead a full life with meaning and purpose.
But in 2009, researchers publishing in the Lancet, a medical journal countered with their definition of health as the ability to adapt to new threats and illnesses. They based their definition on the idea that science has taken significant strides in the awareness of diseases by understanding how they work and discovering new ways to slow or stop them. Health was then simply defined as the absence of disease or infirmity.
These conflicting views of what health is in this country exists even to this day. It is clear to me that the United States lacks a clear, integrated definition of health, yielding in practice to an understood biomedical definition in research and health care that significantly contrasts with how most people define health for themselves.
Simply for most people in this country, health means more to them than just the absence of disease and infirmity. There lies a major problem with our medical model and system in the United States today.
Our current health predicament is first and foremost due to a lack of clarity regarding the meaning of health in this country. Despite its importance in our lives, we as country do not have a national definition of health. Therefore, the absence of a health definition defaults to the flawed biomedical, disease-based model that is at odds with how most define their health.
No one can deny that this biomedical model has had undeniable benefits. Today, biomedical investments continue to drive clinical practices and have yielded awe-inspiring treatments for selected diseases. But despite all of its successes in selected areas, the biomedical, disease based model in this country has its short falls.
It focuses primarily on mechanisms and developing interventions for selected diseases, but totally ignore the humanity of people. This very narrow focus leaves little to address the hidden human potential for health and human development in an integrated and holistic sense. That is, a path to well-being, daily functioning, resilience, and capability for a meaningful and flourishing life. Therefore as a country today, we are stuck in this vicious cycle of spiraling chronic disease and spending.
We know now more than ever that health is more than just the absence of disease. We also know that health is influenced and dependent upon a combination of biological, psychological, and social factors. Your health not only depends on the health of your body and absence of disease, but also the health of your mind.
In this context of a new understanding for the foundational nature of human beings and their health, the question remains, “How can medicine in its present form with its narrow focus on biological factors and control of diseases, help human beings achieve health?”
Unfortunately, our medical model and system continues to focus on the human body with its health professionals addressing diseases with complete disregard for illness caused by personal, interpersonal, and cultural reactions to disease. Slowly, health professionals are realizing that freedom from mental illness is as much needed as freedom from disease to experience health and well-being.
Because of the denial of this way of thinking by a majority of our health professionals over the years, what one finds rampant is patient’s and their family’s dissatisfaction with our medical model and system. Part of this dissatisfaction is due to disempowerment of patients and dehumanization of medical care with a cold, impersonal, technical style of clinical practice shaped by the notion the body is a machine devoid of the mind and self. Ever increasing litigation rates, patient noncompliance, increasing recourse to alternative practices, and mounting consumer criticism has been the result.
The dissatisfaction in this country came to head recently with the killing of a UnitedHealth Group CEO in New York City late last year. Listen to the words of another executive of UnitedHealth Group after his cohort’s death,“We know the health system doesn’t work as well as it should, and we understand people’s frustration with it. No one would design a system like the one we have. And no one did. It’s a patchwork built over decades.”
A major cause of this frustration is that the present medical model and system doesn’t look at the whole person with their treatments. In fact over time, it has created artificially set boundaries of professional responsibility influencing the professional attitudes toward and behavior with their patients that is frankly pissing people off. This attitude is putting our medical system at a critical moment, a flash point in its history.
This has been substantiated in a recent article by the Guardian. In this article, it stated that the United States’ health system ranked dead last in an international comparison of 10 peer and similar democratic nations according to the report by the Commonwealth Fund.
The Commonwealth Fund’s report is the 20th in their “Mirror, Mirror” series, an international comparison of the US health system to nine wealthy democracies including Australia, Canada, France, Germany, the Netherlands, New Zealand, the UK, Sweden, and Switzerland. In spite of Americans paying nearly double that of other countries, our medical model and system performed poorly on health equity, access to care, and outcomes. The foundation called this years report card a “portrait of a failing US health system.”
In my opinion, the Commonwealth Fund’s findings not only find a failing grade, but a crisis, a flash point within our country’s medical model and system. Although I feel there are many factors you could point to as an explanation for this negative report, it appears that the major flaw with our medical model and system stems from the logical inference that health is merely the absence of disease.
Therefore, healthcare professionals and practitioners in this country are not concerned with psychosocial issues which lie outside physical medicine’s responsibility and authority as it is defined today.
When searching for a definition of health in this country, we have to keep in mind that there are three possible health definitions that are viable. The first as already mentioned, is that health is the absence of disease and infirmity. The second is is that health is a state that allows an individual to adequately cope with the demands of daily life which also implies the absence of disease and infirmity. Whereas a third definition states that health is a state of balance, an equilibrium that an individual has established within himself/herself and between himself/herself and his/her social and physical environment.
The dominant model of disease still used in our medical model and system focuses only on molecular biology at its basic and foundational scientific field of study, but ignores the psychological and social factors contributing to the health of an individual.
It infers disease can only be fully accounted for and explained by deviations from the norm of measurable biological and somatic variables. It leaves absolutely no room within its current framework and study for the social, psychological, and behavioral dimensions of illness. The variables that truly make us human.
On top of that, our current medical model and system demands that behavioral abnormalities identified in a patient can only be explained on the basis of disordered somatic, biochemical or neurophysiological processes.
When you look at the views toward health in this country, they can be traced back to the scientific and philosophical ideas of Aristotle, Plato, and Descartes.
Their theories and concepts are way too restrictive, too linear for what has been discovered today in the world of science especially after the advent of quantum theory. The human body is an open and complex system, which encompasses a huge amount of information ranging from physiology and psychology, and also from structure to function in biology. Because of its complexity, the governing rules of the human body are beyond the scope of contemporary scientific research. Therefore, the existing knowledge about the human body appears fragmented and unsystematic.
It is clear to see a paradigm shift is necessary in how both science and our medical model and system view the human body. We need a view that is more integrated and unified and revealing everything is connected in a relationship of communication through the body’s various systems. Some more than others, but simply “`quantitative holism” versus “isolationism” that exists to this day.
With the discoveries in the 20th century by Einstein and Bohr, physics and science has gained even more momentum toward the direction of relationships in viewing the body not so much in an isolated, linear manner of of the past, but instead a more circular view of your body where everything is related. Simply, holism versus isolationism. The world of science and especially our medical model and system today needs to recognize this circular view of “holism” of our bodies. Simply, treat the whole person rather than focusing on just the isolated, physical manifestations of disease or injury.
One of my favorite people that has taught me so much about the body’s soft tissues over the years, Ida Rolf, describes this circular rather than linear view of your body this way, “the body is not made up of parts, but is composed of relationships, all of which are related. I am dealing with problems in the body where there is never one cause. I’d like you to have more reality on the circular processes that do not act in the body, but that are the body. The body process is not linear, it is circular; always, it is circular. One thing goes awry and its effects go on and on and on and on. A body is a web, connecting everything with everything else.”
By adopting a more holistic definition of your human mind and body, it could influence how health research is conducted, and offer the possibility and greater potential for generating practical interventions and informing policies that address behavioral, developmental, environmental, and social natures of health.
It would also help create complementary translational research pathways that would focus on discovery, adaptation, and implementation of holistically oriented interventions that address this goal rather than just on the disease process. This unspoken adoption of a dehumanizing, exclusively disease-based definition of health is a major obstacle to addressing the national health crisis in the United States. Again, no one can deny that this exclusive, biomedical approach to health with its linear tenets at its foundation has been successful beyond all expectations, but it too has come at a cost. For in serving as the only guideline and justification for medical care policy, this exclusive biomedical approach has contributed to a host of problems as is evident in our society today with the recent murder of a health insurance CEO and results of this most recent report from the Commonwealth Foundation.
We are now faced with the necessity and the challenge to broaden our approach to health which includes the psychosocial and behavioral aspects without sacrificing the advantages of the biomedical approach.
Quantitative medicine, “holism” is our future in health within this country. It will require a paradigm shift in the practice of medicine that emphasizes the use of quantitative data and mathematical models to understand and treat disease. An approach based on the idea that the human body can be studied as a complex system, with interconnected parts and can be modeled and simulated using mathematical and computational tools. At its core, quantitative medicine is based on precision, personalization, prediction, and prevention.
The concept of returning to a more holistic approach to healthcare through quantitative medicine could be considered an example of a circular pattern in science, where ideas and approaches evolve over time, only to return to a starting point, but at a new level of understanding. This circular pattern could be considered as the “spiral of science” or the “circle of knowledge.”
It is philosopher and historian of science Thomas Kuhn who proposed the concept of scientific paradigms, which are frameworks of understanding that guide scientific research and discovery. According to Kuhn, science undergoes periodic revolutions, in which existing paradigms are replaced by new ones, leading to a significant shift in scientific thinking and practice. However, Kuhn also noted that scientific progress is not always linear, and that there are often periods of stagnation or even regression before a new paradigm emerges.
This circular pattern of progress and regression is sometimes referred to as the “Kuhnian circle.” In the case of quantitative medicine, the use of mathematical and statistical methods together with the potentiality of artificial intelligence represents a new paradigm in healthcare for our future. It has the potential to revolutionize the way we understand and treat disease.
The rise of quantitative medicine has marked a significant flash point in the history of medicine, from a reductionist or mechanistic approach to a more holistic approach.
Our present reductionist and mechanistic approach in medicine for sure has brought many benefits, including more personalized and targeted treatments, and improved understanding of the underlying biological mechanisms of disease. However, it has also presented some challenges and criticisms. In particular, losing sight of the patient as a whole, unique individual. Therefore, it is vital in the future that we ensure our health models and simulations are grounded in a holistic understanding of the complex systems that underlie human health, but also do not forget how it impacts an individual’s life within a society. Furthermore, the rise of quantitative medicine has not occurred in isolation, but rather reflects broader philosophical and scientific trends. No one can deny that the development of new technologies and the influence of reductionist philosophies have been key drivers of this shift. However, it is important to recognize that reductionism has its limitations and that a truly comprehensive understanding of human health will require a synthesis of reductionist and holistic approaches.
As we move forward, it will be important to continue to critically evaluate the benefits and limitations of quantitative medicine so as to ensure we maintain a balanced approach that recognizes the unique complexity of each individual. By integrating insights from philosophy, physics, and other fields, we may be able to develop new and innovative approaches that bridge the gap between what we experience today regarding our health and what we experience in the future that ultimately can improve our health outcomes.
Terry