The Odyssey of Health
We’ve come a long way. Health has come a long way. Every April 7th of the year, we celebrate World Health Day, and this year marks the 75th anniversary of the World Health Organization.
On its website, WHO lays an impressive timeline of its public health milestones, from forming the eponymous organisation in 1945 to eradicating the one and only human disease (smallpox), all centred around various public health programmes. A timeline spanning nearly 8 decades, headlining the progress we’ve made as a global community in health.
And health, as enshrined in the WHO constitution, is “the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. I like this definition. It is succinct yet broad, aspirational but not impossible.
But more than just a state of being, health is also about relationships. It is a relationship of us navigating, interacting and influencing every facet of what determines our health of ourselves and the society we live in.
Health is then an odyssey of how we live, grow and die.
My views on health have evolved over the years. I am first and foremost a clinician at heart, and my view on health is usually through the lens of the delivery of a service. I am no longer a practising doctor, but those brief years as one are the most treasured in my career. Instead of chronicling my experience like WHO’s timeline, I will instead highlight 5 books that have shaped my views on health over the years. My own odyssey, if you will.
The first is Complications: A Surgeon’s Notes on an Imperfect Science by Atul Gawande, a surgeon. What drew me to this book is the honesty with which Gawande discusses the various themes in the book, such as medical errors and ethics. Doctors are notoriously imperious and we tend to think we are infallible but as this book proves it so bluntly, we are not. By exposing our fallibilities and showing medicine is really a series of failures and successes, it forces us to accept well, we doctors are also human. To accept this humility is one of the greatest qualities a doctor should have, but it is not to say errors and failure are acceptable, rather understanding our limits will completely change how we practice medicine.
The second is Robert M. Veatch’s Patient, Heal Thyself How the New Medicine Puts the Patient in Charge. Veatch is a professor of ethics and in this book, he re-centres the patient-doctor relationship, which traditionally is a highly paternalistic system in which doctors are arguably responsible. The premise of this book is really about value judgements. And since doctors are not trained in making value judgements (mostly because each patient is unique and we cannot fully understand their life experiences), the weight of a patient’s input on his or her own treatment is at least equal to the doctor’s medical prescription. Understanding what values patients prioritise will only enhance the delivery of care. The era of “doctors know best” is gone.
The Emergency: A Year of Healing and Heartbreak in a Chicago ER by Thomas Fisher was a sobering read. Told through Fisher’s experience in the emergency department, the book highlights the inequities of healthcare and how it leaves so many African Americans to die young due to lack of healthcare access. Having worked in a public hospital, we like to pride ourselves that the public healthcare service is the most egalitarian of all public services. Healthcare for all, regardless of colour or creed. This book brings the hammer to that thought. It is a beautifully written book that will leave you, a reader, aghast of the health inequities and you, a doctor, infuriated by how the system lets both healthcare providers and patients down.
Sir Michael Marmot’s The Health Gap: The Challenge of an Unequal World expanded my view on health inequities from the hospital to the population. This book focuses on the social determinants of health, and how inequities in power, wealth and resources lead to inequities of health. Marmot dissects these determinants chapter by chapter relentlessly using scientific evidence in child development, education, employment and development of communities. Poverty is a major theme here but equally so, Marmot argues empowerment is the key to closing this health gap. To fix health inequity is to accept health is a political animal to tame.
The last book, one of the most recent I read was Jonathan Wolff’s The Human Right to Health. Frankly, this one gave me a headache. Wolff presents to the readers a very simple question in his book: How can health be a human right if there are lack of resources to satisfy this? To understand this, Wolff discusses the declarations and constitutions of what the human right to health means. This chapter itself will challenge readers of what we think we know and how complex the question is. The book goes through various ethical considerations: what are the roles of governments, human rights organisations, and industry and how do patent mechanisms and healthcare financing all contribute to the question of the right to health. The book is in no way trying to be too pessimistic but instead raises valid questions and only by understanding the history and challenges, we can make progress.
Back to World Health Day, this year’s theme is ‘Health For All’. Coming through the past 3 years, this is more important than ever. The Covid-19 pandemic was called the great equaliser but it is anything but.
So health for all is what we must strive for, but health in all is what we must do to achieve it. Only by putting health in the centre that we may progress. I began this post with WHO’s definition of health in its constitution so I will end with another sentence in the same constitution:
Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.
Sorry for the rather long post, this is what a 4 day weekend does to you. If you made it here, thank you for reading.