Passive Complicity takes a look at western Health Care, starting with some thoughts of Nortin M Hadler, whose 2013 book The Citizen Patient (UNC Press)  forms the basis of this and tomorrows posts.

This book ‘examines the modern doctor-patient relationship and the many perversities that characterise the American “health-care system”.’  Hadler wrote this ‘in order to enable ….. enlightened Citizen Patients’ to drive-health care change.

A necessary first step in devising a rational solution to our national health-care problem is preparing all patients to take responsibility for assuring that whatever is being said or offered or done will really be to their benefit. If “health care” and the system that underpins it were intrinsically trustworthy, patients could relax, secure in the knowledge that whatever happens to them has a salutary benefit-to-risk ratio.  Sadly, we know that this is not the case; in fact the present health-care system is structured to frustrate that security.

Any discussion of “health care” must necessarily begin with a discussion of “health”.  What do we mean by “health”?  One can enjoy “good” health or suffer “bad” health.  Is “bad” health no more than the absence of “good” health?  Is there a continuum between “good” and “bad” health?  Can either be objectified reliably?

Good health is not the absence of symptoms; all of us will suffer symptoms repeatedly, symptoms that give us pause without compromising our belief that we are basically well.  Episodes of backache, headache, heartache, “colds”, “flu”, and much more are predicaments for which most of us are a match most of the time.  Despite such predicaments, we can remain in good health.

Nor is good health the absence of disease.  If we define disease as pathology, as abnormalities in our anatomy or physiology, by midlife all of us harbour diseases – and I mean important diseases.  Some of these are so commonplace as to be part of the course of life: gray hair, bunions, degenerative changes in the spine, hardening of the arteries, some forms of cancer, and the like.  Some are lying in wait to smite our good health.  Some are contenders for the ultimate smiting, the cause of our demise.  Most will still be lying in wait on that fateful day.  Despite our diseases we can remain in good health.

Health is not a purely scientific construct; the components of health that can be quantified and studied systematically barely scratch the surface of what most of us mean by good health.  Science is no match for individuals perceptions of well-being, for the temporal component of well-being, or for the vagaries of the social construction of well-being.  A century ago, obesity indicated good health, while today it’s generally considered to indicate bad health, even though we know that it is the correlative socioeconomic status that influences health far more than heftiness itself.  A century ago orgasms were considered bad for you; today, their absence is considered something that merits treatment.

To be continued…