Last updated: 23 December 1998
The dialectic cannot stop short before the concepts of health and sickness,
nor indeed before their siblings reason and unreason.
Exuberant health is always, as such, sickness also.
The very people who burst with proofs of exuberant vitality could easily
be taken for prepared corpses, from whom the news of their not-quite-successful
decease has been withheld for reasons of population policy. Underlying
the prevalent health is death. All the movements of health resemble the
reflex-movements of beings whose hearts have stopped beating.
And how comfortless is the thought that the sickness of the normal does
not necessarily imply as its opposite the health of the sick, but that
the latter usually only present, in a different way, the same disastrous
Substantial proportions of the population did not see health as the
most important thing in life - and these were more likely to be people
with more, rather than less, education.
Health is not, in the minds of most people, a unitary concept. It is
multi-dimensional, and it is quite possible to have 'good' health in one
respect, but 'bad' in another.
Health can be defined negatively, as the absence of illness, functionally,
as the ability to cope with everyday activities, or positively, as fitness
and well-being. It has also been noted that in the modern world, health
still has a moral dimension.
What is a health which merely makes people ripe to be damaged, abused,
and shot at again?
[H]ealth is something which should be enjoyed, not abused. A long painless
life to a ripe old age, culminating in a death replete with life, is still
outstanding, has constantly been planned. As if newborn: this is what the
outlines of a better world suggest as far as the body is concerned. But
people cannot walk upright if social life itself still lies crooked.
[H]ealth is a wavering notion, if not directly in medical terms, then
in social terms. Health is by no means solely a medical notion, but predominantly
a societal one. Restoring to health again means in reality bringing the
sick man to that kind of health which is respectively acknowledged in each
respective society, and which was in fact first formed in that society
If the exploited lives to which so many are returned were worth something,
and if a war did not make up in days for years of lost death, then doctors
could be half content with the course of the last hundred years.
In capitalist society health is the capability to earn, among the Greeks
it was the capability to enjoy, and in the Middle Ages the capability to
So hardly any of the ills of the body are removed when it is seen in
isolation. That is why all improvers of our situation who merely concentrate
on health are so petit-bourgeois and odd, the raw fruit and vegetable brigade,
the passionate herbivores, or even those who practise special breathing
techniques. All this is a mockery compared with solid misery, compared
with diseases which are produced not by weak flesh but by powerful hunger,
not by faulty breathing but by dust, smoke, and lead. Of course there are
people who breathe correctly, who combine a pleasant self-assurance with
well-ventilated lungs and an upright torso which is flexible to a ripe
old age. But it remains a prerequisite that these people have money; which
is more beneficial for a stooped posture than the art of breathing.
All in all, even without grotesque visions, every organic desire for
improvement remains up in the air if the social one is not acknowledged
and taken into account. Health is a social concept, exactly like the organic
existence in general of human beings, as human beings. Thus it can only
be meaningfully increased at all if life in which it stands is not itself
overcrowded with anxiety, deprivation and death.
... health, which is undoubtedly the chief good and the foundation of
all the other goods in this life. For even the mind depends so much on
the temperament and disposition of the bodily organs that if it is possible
to find some means of making men in general wiser and more skilful than
they have been up till now, I believe we must look for it in medicine.
It is true that medicine as currently practised does not contain much of
any significant use; but without intending to disparage it, I am sure there
is no one, even among its practicioners, who would not admit that all we
know in medicine is almost nothing in comparison with what remains to be
known, and that we might free ourselves from innumerable diseases, both
of the body and of the mind, and perhaps even from the informity of old
age, if we had sufficient knowledge of their causes and of all the remedies
that nature has provided.
It is a disturbing fact that Western civilization, which claims to have
achieved the highest standard of health in history, finds itself compelled
to spend ever-increasing sums for the control of disease.
Clearly, health and disease cannot be defined merely in terms of anatomical,
physiological, or mental attributes. Their real measure is the ability
of the individual to function in a manner acceptable to himself and to
the group of which he is a part.
One may wonder indeed whether the pretense of superior health is not
itself rapidly becoming a mental aberration.
Money has, as we know, no value in itself. It is a convenient yardstick
for a large number of material values. But the health and life of an individual
as well as the health of a nation cannot be measured by that yardstick.
If we, entrusted with protecting and defending the health of the population,
give in to a salesman's scale of values we are lost.
To state that the cost of proper medical care itself surpasses the financial
resources of any of the countries in the West is of course ridiculous,
not the least when one considers the other purposes for which money is
freely being used and working hours spent.
It wasn't a healthy attitude, but it wasn't really a healthy world.
He looked a shade too healthy and nobody likes that. Particularly in
The main health hazard in the world today is people who don't love themselves.
The sustaining of life, in a bodily sense as well as in the sense of
psychological health, is inherently subject to risk.
The human body contains blood, phlegm, yellow bile and black bile. These
are the things that make up its constitution and cause its pain and health.
Health is primarily that state in which these constituent substances are
in the correct proportion to each other, both in strength and quantity,
and are well mixed.
A wise man ought to realize that health is his most valuable possession
and learn how to treat his illnesses by his own judgement.
Instead of changing our mechanistic workplaces to make them safer and
more conducive to the human body, we can screen, monitor, or change the
bodies of workers so that they better fit the modern workplace.
Good health has become a new ritual of patriotism, a market place for
the public display of secular faith in the power of will.
Low income is related to poorer housing, poorer diet, fewer social amenities,
worse working conditions. (...) After adjustment for age, sex, race, smoking,
alcohol consumption, sleep habits, leisure-time physical activity, chest
pain, diabetes, or cancer, there was still an increase risk of 1.6 for
those with inadequate incomes.
... social environment in childhood affects achieved adult height, life
chances, and ultimately mortality rates in adult life. (...)
The social forces affecting health are expressed in class structure.
This division into classes encompasses economic, political, and cultural
differences, all of which may have an impact on health. At the very least,
differences in health and disease by social class point to the importance
of the social environment. Within medicine, the tradition is to focus on
individuals: individual differences in biological makeup, in disease, in
lifestyle, and in choices about health. The implication is that such disease
that is not genetically determined is determined by individual exposure.
While this supposition is not necessarily incorrect, it is incomplete.
General improvements in health/decline in mortality do not affect all
classes equally. As mortality rates fall, social inequalities commonly
Something is happening to America, not something dangerous but something
all too safe. I see it in my lifelong friends. I am a child of the "baby
boom", a generation not known for its sane or cautious approach to
things. Yet suddenly my peers are giving up drinking, giving up smoking,
cutting down on coffee, sugar, and salt. They will not eat red meat and
go now to restaurants whose menus have caused me to stand on a chair yelling,
"Flopsy, Mopsy, Cottontail, dinner is served!" This from the
generation of LSD, Weather Underground, and Altamont Rock Festival! And
all in the name of safety! Our nation has withstood many divisions - North
and South, black and white, labor and management - but I do not know if
the country can survive division into smoking and non-smoking sections.
The forces of safety are afoot in the land. I, for one, believe it is
a conspiracy - a conspiracy of Safety Nazis shouting "Sieg Health"
and seeking to trammel freedom, liberty, and large noisy parties. The Safety
Nazis advocate gun control, vigorous exercise, and health foods. The result
can only be a disarmed, exhausted, and half-starved population ready to
acquiesce to dictatorship of some kind.
Remember, your body needs 6 to 8 glasses of fluid daily. Straight up
or on the rocks.
Sanity is not truth. Sanity is conformity to what is socially expected.
Truth is sometimes in conformity, sometimes not.
... the idea of a sharp distinction between health and disease is a
medical artefact for which nature, if consulted, provides no support.
The essential determinants of the health of society are thus to be found
in its mass characteristics: the deviant minority can only be understood
when seen in its societal context, and effective prevention requires changes
which involve the population as a whole.
Social norms rigidly constrain how we live, and individuals who transgress
the limits can expect trouble. We may think that our personal life-style
represents our own free choice, but that belief is often mistaken. It is
hard to be a non-smoker in a smoking milieu, or vice versa, and it may
be impossible to eat very differently from one's family and associates.
Social norms set rigid limits on diversity, and those wishing to persuade
minorities to be different from the majority would do well to remember
In a democracy the ultimate responsibility for decisions on health policy
should lie with the public. At present that does not happen.
For 'wellness', naturally, is no cause for complaint - people relish
it, they enjoy it, they are at the furthest pole from complaint. People
complain of feeling ill - not well ... Thus, though a patient will scarcely
complain of being 'very well', they may become suspicious if they feel
Enhancement not only allows the possibilities of a healthy fullness
and exuberance, but of a rather ominous extravagance, aberration, monstrosity
... This danger is built into the very nature of growth and life. Growth
can become over-growth, life 'hyper-life' ... The paradox of an illness
which can present as wellness - as a wonderful feeling of health and well-being,
and only later reveal its malignant potentials - is one of the chimaeras,
tricks and ironies of nature.
Of course, everyone wants to be healthy. The amusing thing is no one's
really sure how to do it.
Our tradition in this country has not been to deny health information
to interested individuals when they claim that they can handle it and are
willing to pay for the cost of getting it.
Science becomes a propaganda of quack cures, manufactured by companies
in which the rich hold shares, for the diseases of the poor who need only
better food and sanitary houses, and of the rich who need only useful occupation,
to keep them both in health.
Where once it was the physician who waged bellum contra morbum,
the war against disease, now it's the whole society.
[M]ilitary metaphors have more and more come to infuse all aspects of
the description of the medical situation. Disease is seen as an invasion
of alien organisms, to which the body responds by its own military operations,
such as the mobilizing of immunological "defenses", and medicine
is "aggressive" as in the language of most chemotherapies.
The only ideals allowed are healthy ones - those everyone may aspire
to, or comfortably imagine oneself possessing.
Health hype is like any other kind of hype. It exaggerates. It overstates
the case. Whatever the facts may be, health hype feels compelled to magnify
... class differences in health represent a double injustice: life is
short where its quality is poor.
Improved health contributes to economic growth in four ways: it reduces
production losses caused by worker illness; it permits the use of natural
resources that had been totally or nearly inaccessible because of disease;
it increases the enrollment of children in school and makes them better
able to learn; and it frees for alternative uses resources that would otherwise
have to be spent on treating illness.
World health spending - and thus also the potential for misallocation,
waste, and inequitable distribution of resources - is huge. For the world
as a whole in 1990, public and private expenditure on health services was
about $1,700 billion, or 8 percent of total world product. High-income
countries spent almost 90 percent of this amount, for an average of $1,500
per person. The United States alone consumed 41 percent of the global total
- more than 12 percent of its gross national product (GNP). Developing
countries spent about $170 billion, or 4 percent of their GNP, for an average
of $41 per person - less than on-thirtieth the amount spent by rich countries.
Serious environmental health problems are shared by both developed and
developing countries, affecting:
Health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity.
Copyright © by Eberhard Wenzel, 1997-2001