Friday, July 29, 2011

How did health become a social responsibility?

At a former job, the president of the small company I worked at once criticized workers for having to call in sick. He said that employees had a responsibility to look after themselves and not impede the orderly conducting of business with their absence. This same man used to take a half day off of work and go home if he had a headache so it was hard to take anything he said seriously given the immense level of hypocrisy that he displayed.

The underlying notion of what he said, however, is becoming increasingly more pervasive. The idea that we "owe it" to others, especially unconcerned strangers or all of society, to care for ourselves in a particular manner is not one that has always been around. Previously, I wrote about how I think that health and how we deal with our own bodies is a personal choice and nobody's business and I pondered today how we have reached a collective mentality which pressures people to attain health, as if it were something we could choose to pursue and successfully acquire (it isn't in many cases, but that is beside the point).

While rolling this notion around in my head, I thought about what life was like hundreds of years ago. Before medical science, people knew that there were certain actions or behaviors which lead to better or worse health and some lived a lifestyle which was more conducive to maintaining health and some less. They did this because health was seen as precious to them and integral to maintaining their livelihood and life. If they became sick, there was little or no confidence that there would be a treatment that would repair the damage or cure the disease.

People during that time also knew that luck played a huge role in whether or not someone was healthy. They may not have known about genetics, but they did know some people were born hearty and some weak and prone to problems. They also realized, all too well, that wealth factored into the availability of food, medicine, and education such that poorer people had a lower chance of living in good health than richer ones. During this time, I doubt that a person who became sick was "blamed" for his or her state (short of those who drank themselves into illness) and certainly was not seen as a burden on society for allowing themselves to become sick. In the past, people wanted health for their own reasons, not because they owed it to their community at large.

So, what happened to our mentality and why did it switch? How did we go from desiring health for our sake to a world which is demanding it for society's sake? I can only speculate, of course, but I think that the following may be factors:

1. The perception that medicine can cure (nearly) anything altered the perception that health was related to luck (genetics, environment, wealth) and transformed it into something we can buy. As we perceive health as something we can choose to purchase or cultivate, we see those who do not attain it as choosing to cost "us" money rather than live a lifestyle that is conducive to health.

2. Media states "you owe it to (whoever)" to be healthy, strong, etc. This notion creates a sense of being obliged to be well. Of course, these messages are commonly offered by companies selling supplements or some other product that promises health, but the messenger's original intent (commercial interests) is lost on people who remember the message but not the source as time goes by. This notion has insinuated it into the collective consciousness.

3. Egalitarian societies which allow for more even distribution of resources lead us to believe everyone has many good choices. In the past, we knew people had unequal access to food, medicine and health education. We didn't expect them to look after themselves well because the perception was they had little choice in the matter.

4. Social welfare created the mindset in which people feel they have a say in your private matters as long as they are paying taxes to assist you. The idea that those relying on public assistance to survive are akin to "employees" who the "employer" (tax-payer) can dictate to is becoming increasingly pervasive.

5. Democracy has an underlying notion of "self-determination" which indoctrinates citizens into the belief that we can do anything if we make the right choices in life. It doesn't provide any context and creates an illusion (which results in just world thinking) that all people have all choices (or at least that the "good choices" healthy people make are available to to everyone). Humans used to understand life was inherently unjust because the evidence was all around them, but that thinking has been replaced. As the material aspects of life have equalized for many people, the illusion that our lives are roughly equitable has created the notion that we all have equal access to health-related choices.

I'm not going to debate whether or not any of this thinking is valid because I've already made it clear in my posts that I think people are far less in control than we'd like to believe. The momentum of personal history drives people to do things another person might not do and our solution is not to help them slow down the car hurtling toward the precipice but to sit by and cluck our tongues in disapproval that they can't get their foot off the gas pedal. In my mind, those people aren't choosing to keep it on there, but their legs are paralyzed and they can't lift their feet. My interest continues to be to help them regain mobility so they can go in another direction rather than to point my finger and accuse them.

I realize my belief that it is far harder to change your choices is an unpopular way of viewing things because it flies in the face of a lot of the thinking I've detailed above. Nonetheless, I think it goes a lot further toward explaining why people continue to do things that hurt them than simply deciding to blame them for their choices. My intention in this post was mainly to explore the factors which I believe have lead us to the point in which we believe health is a social responsibility rather than a personal one. I don't believe that what I do with my body is anybody's business, but that doesn't mean I don't want to understand what drives them to think it is their concern.