By MIKE MAGEE, MD
Today the notion that health is a preferred state of being, rather than a set of disconnected functions or services, is increasingly being embraced. A recent JAMA article promoted a health measurement system called the “flourishing index” focused on 6 key domains: happiness and life satisfaction, physical and mental health, meaning and purpose, character and virtue, close social relationships, and financial and material security.
Dr. Gro Brundtland, former director-general of the World Health Organization, wrote in the World Health Report 2000 that “The objective of good health is twofold – goodness and fairness; goodness being the best attainable average level; and fairness, the smallest feasible differences among individuals and groups.”
In the age of Trump, with forced separation of immigrant mothers and children, criminalization of abortion, and purposeful obstruction of enhanced access to health care for vulnerable populations, it becomes impossible to ignore a significant modern-day truism. Health is profoundly political.
Health is a collection of resources unequally distributed in society. Health’s “social determinants” such as housing, income, and employment, are critical to the accomplishment of individual, family, and community well being and are themselves politically determined.
Health is recognized by many throughout the world as a fundamental right; yet it is irreparably intertwined with our economic, social, and political systems. And growth in health, health care, and health systems requires political debate and political consensus.
As the nation struggles to contain an essentially lawless executive branch, it is easy to lose sight of the fact that fundamental changes in attitude over the past two decades have laid the groundwork for today’s majority support for universal health care as a right for all Americans.
In health delivery, we have moved away from paternalism toward partnership; from individual care models to team approaches; and from intervention toward prevention and health planning.
Many sites now embrace evidence-based clinical care, while others incorporate educational and social missions as well. We are moving away from hospitals and outpatient care sites toward home settings, and away from authority directed by professional elites toward inclusive power sharing between patients and their care teams.
But despite this shifting environment, there is a growing political disconnect between those in control of our federal government and the people they are governing.
Are we as a nation and a people “flourishing”?
Our president and his protectors reinforce silos and the status quo. But our people, in majorities, seek broad, fundamental and comprehensive reform.
Such reform includes expansion of insurance coverage, realignment of financial incentives toward prevention, increased reimbursement of health professionals for coordination and continuity, support for early diagnosis and screening, and expansion of funding for education and social determinants that allow citizens to flourish.
This is no longer simply a battle over the future health of Obamacare. This is fundamentally a battle over the health of our nation and the future ability of our citizens to flourish in a changing world.
Mike Magee, MD is a Medical Historian and the author of “CODE BLUE: Inside the Medical Industrial Complex” (Grove Atlantic, June 4, 2019).