Defining Your Health
In 1947, the World Health Organization defined health as “a state of complete physical, mental and social well-being.” Do most folks take that expansive view?
The kinds of statements you’ll get from people are more like these:
“I eat real healthy.”
“You really are doing great.”
“I got great doctors and great medical care.”
The first statement was made by a man whose lipid levels had gone done appreciably with statins, and died of a heart attack six months later. The second came from a patient who considered pizza a food group and noted his “really healthy” use of “heart healthy cereals” like Cheerios. The third was the declaration of an internist to a fellow writhing with chronic pain, impressed more by his low blood pressure and cholesterol values than his continuing misery. The fourth implicitly believed medical care = health – though in most measures of what provokes better physical health, medical care is far down the list compared to factors like sanitation and lifestyle.
How you talk about health doesn’t just change your view of health – it changes your health and that of people around you.
The Absence of Disease
Almost 70 years ago the WHO warned against absence of disease as a marker for health. Guess what? Those are the measures typically used by insurance companies and doctors bound by their “metrics.”
What you measure counts. If you don’t measure it – well, it doesn’t count.
People sigh with great relief when their cholesterol levels are “low enough” that they don’t have to take statins. The truth is that other factors far bigger harbingers of their survival, particularly how they eat and move. Women are thrilled when their annual mammogram “adventure” is crowned with the success of “no disease.” Yet as Gilbert Welch explains in “Less Medicine, More Health,” perhaps every American women whose life was saved treating a “positive” mammogram may be attended by 10 others whose treatment saved nothing – many of the tumors would have gone away by themselves. Overall mammograms remain defensible screenings tools. The numbers game is more difficult to justify with urologists’ mainstay, the PSA. The consensus of many researchers is that with this “screen” of prostate cancer every success is attended by 30-100 people treated unnecessarily – with accompanying mortality, destruction of sexual capacity, and inability to control urine flow for many.
This deeply impoverished “absence of disease” model has now achieved signal success through the protocol guidelines and checklists pervading present day American medical practice. Your doctor doesn’t talk to you anymore because she is filling out boxes on her electronic health record – which then determines your “health.”
Many of the boxes indeed are useful – at least if your definition of health is restricted to longer lifespan. Controlling blood pressure matters. So does avoiding diabetes, and never getting on – or then getting off – cigarettes. But the real way physical health is achieved for the general population – through lifestyle and behavioral changes – rarely achieves even a single box on the checklist.
And mental, social and spiritual well-being? They’re not even in the conversation. Medical care is today more and more limited to specific “risk factors” affecting longevity. Everything else is off the table.
For present day medical practice, most of the important factors affecting your health don’t get assayed. In essence, they don’t count.
Population Versus Individual Health
Health planners, social scientists and public health officials are deeply concerned with health endpoints that matter economically and societally. Most of these involve death.
Lifespan is often reviewed by looked comparing countries. Here, the US usually ranks around 40 to 50th, while our per capita health care costs are generally twice as high as those of comparably developed countries.
Why the mismatch? In part, because of the perception that medical care – and high medical spending = health. Factors like sanitation, nutrition, education, vaccination, are much bigger factors in determining lifespan. But that’s “public” health. Public health does not have giant economic and political lobbies behind it – even if most of the world recognizes that public health efforts make populations live longer, feel better, and become more economically productive.
Yet the highly disciplined people who work hard to be healthy – and read carefully and thoughtfully the huge amount of “health” information available – can be fooled by the population statistics. Many believe that following lifestyle recommendations automatically means they will live longer.
They most probably will feel better. The odds favor that they will live longer.
But they are just odds. Chance, or what people see as luck, is a huge factor in individual health. You can do “all the right things” and still die at 20, or smoke three packs like the great pianist Eubie Blake and die at 100.
An example – Dr. Oz was shocked when he was found to have a large polyp on his screening colonoscopy. As he explained, he ate healthily, exercised, gave his life to helping others. How the heck could he get a big growth that might prove cancerous and kill him?
The same way most of us do – through chance. The risks of populations appear different when applied to individuals. You do what you can to improve the odds. But they are just odds, and the world is filled with uncontrolled and unknown variables.
How you define a problem changes the problem. Americans have possessed an impoverished vision of health. That’s one of the reasons our health is so poor.
And that’s just looking at physical health – lifespan, infant mortality and the like. Start looking at “quality life years” and other measures and we do even worse.
It’s time for some better definitions. As Welch and others now recognize the importance of meaning and purpose – the “spiritual” dimension of health – it’s also time to add meaning and purpose to measures of physical, mental, and social well-being.
Such a four fold approach can be operationalized for populations and individuals. It can also be applied to all phases of medical care – with all four parts brought to bear on every illness, from colds and coughs to cancer.
Until that happens we won’t be taking about health. We’ll just be talking about sickness.
We really deserve better.