Just imagine if we could cure everything. We could all pack our bags and go home.
You assume you have a right to be healthy, or at the very least, expect health as a prerequisite for a good life. We are all born with this assumption programmed into us and if you don’t believe me, ask yourself this question. When you are sick or unhealthy, what tends to be the first thought that crosses your mind? Why me? It is as though the gods of ill intent have personally singled you out for a dose of pain and misery.
We use the term ‘health’ freely to describe, well, pretty much anything related to our ‘health’, but what do we actually understand of the word, in terms of definition. What does your ‘right to health’ actually entitle you to? Does it relate just to your physical state and being free of disease or does it encompass more? Should you be considering your social and economic conditions when you pose the “why me’ question and are they a part of your ‘health’?
How does the ‘healthcare’ industry interpret this term? It’s an important question as this directly impacts the treatments and outcomes you can expect from your health providers. Are doctors, for instance, tasked simply with your physical wellbeing (illness and disease), or do their duties extend beyond that.
Let’s turn to the organization that is arguably seen as our global gatekeeper for health, the World Health Organization (WHO) to explore the answer. How do they define their very reason for existence? How do they define ‘health’?
“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”World Health Organization
That’s a pretty tall order and a seriously extensive scope of responsibility for one single term and to bring home the further complexities of modern healthcare, this diagram from America’s Health Rankings (AHR)shows the overlaps of various disciplines considered in the field of health when they compile their data
What’s important about the little diagram above is the center, entitled health outcomes. It’s become a watchword for American healthcare. Successful outcomes are how we now gauge healthcare in America. The factors listed in the diagram, Behaviours, Physical Environment and Social Factors shouldn’t be confused with your understanding of health or the WHO definition. These environmental, social, and geographic factors are however crucial in developing healthcare’s responses and planning with regards to the care they provide you. So indirectly, they do affect your ‘health’.
Let’s explain this through the use of an example. America, in global terms, ranks terribly for infant mortality at birth. In fact, out of the 36 OECD countries measured, America comes third from last. Let’s use the 2020 data provided by AHR to support this statement.
As an aside, if you’re wondering which state is best for pregnancy care, Vermont scores the highest, and statistically, your birth is safest in Massachusetts (3.8 deaths per 1000) and most at risk in Mississippi (8.7 deaths per 1000). According to the AHR 2020 report;
In 2018, over 21,000 infants died in the United States. According to the Centers for Disease Control and Prevention (CDC), the leading causes were birth defects, low birthweight and preterm birth, maternal pregnancy complications, sudden infant death syndrome (SIDS) and unintentional injuries.
The U.S. infant mortality rate has been consistently higher than other developed countries, and 1.5 times higher than the average (3.8 deaths per 1,000 live births) among Organization for Economic Co-operation and Development countries. Research indicates socioeconomic inequality in the United States is likely a primary contributor to its higher infant mortality rate.
According to the CDC report referenced above, race affects these figures in the following way. Sections in bold added by way of explanation.
Black women had the highest mortality rate (10.75), followed by infants of non-Hispanic NHOPI (Native Hawaiian or Other Pacific Islander: 9.39), non-Hispanic AIAN (American Indian or Alaska Native: 8.15), Hispanic (4.86), non-Hispanic white (4.63), and non-Hispanic Asian (3.63) women.
So that part of our diagram above, entitled Social and Economic, is actually the driving factor that increases the risk of your baby dying at birth. Does this have anything to do with your health and your child’s health, other than implying you move to Vermont for your pregnancy and deliver the baby in Massachusets? What if you’re black? Will moving help or is your race a fixed determinant in your child’s chances at birth?
This where it gets complicated and where healthcare treads on quicksand. Your race, from a genetic point of view, does not affect your risk of infant death at birth and that is what makes the figures above so damning. These figures have nothing to with genetics or you but are rather an indictment of how the color of your skin, your sex, and your economic and social situation determine your access to healthcare and a healthy lifestyle. In effect, your right to ‘health’.
Racism, it turns out, kills babies, not race. Being socially disadvantaged kills babies. Being financially impoverished kills babies.
In terms of health, the above are all classic WHO indicators of physically healthy people living in an unhealthy society. If we are to judge by the WHO definition, then American healthcare, in its current state, fails to live up to the lofty goals set, and it isn’t just in the field of infant mortality that it falls short.
The question is, can we blame the American healthcare system for social and racial disparities? How can you hold doctors responsible for generations of institutionalized racism, sexism, and social inequality? No fair.
There is a quandy at the heart of modern healthcare. Is your provider merely required to treat your symptoms or do they have a moral and ethical responsibility to look beyond the diseases, to identify the causes and address these, to seek cures, rather than treatments? Where does their remit begin and where does it end?
The dangers of mixing the fields of medicine and health with finance, economics, societal politics, and race are that the lines begin to blur. Boundaries are necessary for the effective functioning of any system. Act beyond the scope of your boundaries (profession) and you dilute both your efficacy and your impact.
While we cannot hold Healthcare accountable for societal racism, sexism, and general inequality, we most certainly can expect the industry not to engage in any of these practices. That is sadly not always the case, but the industry is beginning to assess itself more introspectively with a view to rooting out these practices. Empowering and recognizing the voices of women within Healthcare is a massive step in the right direction.
Patients can also, and rightly so, expect health care providers to address the imbalances in their communities that lead to the racial disparities so clearly underlined by infant mortality in America.
Let’s clarify that statement as it’s a weighty one. This expectation does not involve doctors and nurses dropping their stethoscopes and picking up banners for the next BLM protest. It refers to them addressing these imbalances from within the scope of their professional abilities. A clear set of “non-medical symptoms” or parameters exist to identify the at-risk and healthcare needs to respond accordingly by pre-empting the 8.7 dead babies for every 1000 born in Mississippi.
The healthcare profession is about exactly that, health. It isn’t about creating a revolving door of repeat business, but rather seeking out the lofty aspirations of the WHO. To treat a ‘sick’ society as their primary patient, particularly if that patient lies at the heart of burgeoning illness and disease.
Providers need to encourage free weekly clinics in marginalized communities, governors need to increase budget allocations for communities that are in dire need of healthcare, free medication needs to be made available for those unable to provide for themselves., courtesy of a cash-rich Pharmaceutical industry. All of these things and more need to be put into action. Not to act is to be aware of the growing tumor and refusing to treat it.
It leaves the industry with blood on their hands.
By now, I hope you understand that your ‘health’ means far more than simply waking up in the morning with all your fingers and toes accounted for. To be truly healthy, you need to strive for a stable social and economic environment, for you and your family. Achieving this is within everyone’s reach and when we encounter obstacles intentionally placed in the way of people achieving their true health, it falls on everyone’s shoulder to speak out and speak up.
Not just healthcare.