What is health?
Monday, August 10 2009
H. Gilbert Welch, MD, has an essay in the New York Times pointing out that health care needs to begin with a definition of ‘health’:
The Canadians haven’t figured it out. Neither have the Japanese, the French or the British. No health care system has seriously grappled with the question most fundamental to its task: what constitutes health?
As the United States contemplates an overhaul of its system, maybe we should take a stab at it.
Dr. Welch continues to say that the health care industry “has settled on a most convenient answer: health is the absence of abnormality.”
That may be true for the industry, but here in the trenches I have a very clear definition of health: whatever it takes to get me through a working day. Don’t get me wrong: I want to be able to work. I want to have a job, be productive, get matching contributions to my 401(k), and tack Dilbert funnies to the wall of my cube. But I also want to be cured of Crohn’s disease. I also want to flap my arms and fly. Sometimes, we don’t get everything we want.
Because health insurance is usually tied to a job – and health care is so expensive anyway – a sick person basically has no choice but to work, unless they qualify as disabled. But there’s a lot of territory in between disabled and workable. A lot of illness can be livable, or at least survivable, but nonetheless make working very difficult. Our society has very few means by which to bridge that gap, and no apparent interest in building those bridges.
And then there’s the consequences of health care itself. A few years ago I had a full-time job, and experienced a mild flare. My gastro suggested prednisone as a cheap and effective alternative, but I said ‘no’ – reason being, prednisone screws with my brain, the dreaded “‘roid rage”. I have had four car accidents in my life that were my fault, all of them while I was taking significant doses of prednisone. I told my gastro that he started me on prednisone, I couldn’t drive safely. And if I couldn’t drive safely, I couldn’t make my 45-minute commute. We did prednisone for a little while – I took some time off – and then moved on to more exotic and expensive treatments. As a result of that experience, I’ll never look for work anywhere I can’t get to via public transit or a bicycle again.
The rules are pretty clear for sick people: you are expected to work. So long as there’s another medicine you can take, no matter how expensive or dangerous, you’re not too sick to work. That’s our definition of ‘health’.
