What We Talk about When We Talk about Health

Like so many people, I’ve been alternately fascinated and appalled to witness the fallout from the passage of President Obama’s health care bill. Even though I am in support of the bill, I do believe both the Republicans and the Tea Baggers have legitimate arguments about the bill’s cost – unfortunately they’ve lost any sort of credibility in engaging in an honest discussion about the cost burden by heaping layer upon layer of hate speech and vitriolic accusations on the American public, and neither mainstream nor alternative news have restrained from covering every asinine or insipid thing any of these people say.

While I happen to think the bill will actually cost us less, in the long run, than paying for the care of people with advanced diseases and continuous emergency room treatments, what amazes me on all fronts is the fact that nobody is actually having a discussion about how we are defining health, itself. What is health, what do we mean by it, what does it mean to say Americans will have access to this kind of care?

There are certain base elements I think most of us, whatever our party affiliation, can agree upon.  Pre-existing conditions shouldn’t limit our access to physicians and the services they provide. Women shouldn’t be denied insurance because they might one day have a child. Sick people should be able to obtain medicine without going into the poorhouse.

What’s interesting, though, is that these aren’t the conversations we are having. Instead, a lot of people seem to be questioning why they should be paying, through their taxes, for the obese, for the smokers, for alcoholics, for those who don’t pay enough attention to their diets.  Most people are good people, at their core – to a point – and are not going to argue with paying a tax to provide antibiotics for the children in our country. These same good people, though, if they perceive themselves to be the kind of people who take good care of themselves, argue about the injustice of being forced to supplement the cost of health care for those who appear not to do so.

So, what do we mean when we talk about health? What is good health, and how do we define it? Some would argue that good health is the absence of any detectable abnormalities – ie, regulated blood pressure, normal cholesterol, a functioning thyroid, a body that produces the right about of insulin, maintaining a normal weight, etc.  And within this discussion, where does personal responsibility begin and end? If we begin making the argument that only people who fall into mandated “healthy” lifestyles deserve low insurance rates, then what do we say to one of the young women I currently am working with, who developed breast cancer at the age of thirty-one? This woman is a slim non-smoker who loves to exercise and eats more than her fair share of fruits and veggies, but because of a silent genetic mutation, her world has morphed from working and dates and dinner parties to chemotherapy, surgery, radiation.  She was healthy, by any measurable standard, until she wasn’t.

And that could be the story for every.single.one.of.us.  We are healthy until we aren’t, and for those of us lucky enough to be able to obtain the care we need, we continue to heal – until such point as, well, we don’t.  Certain things – like smoking and alcohol consumption – we can control , but we cannot control whether  a certain pathway in our DNA is going to shut down suddenly or if we happen to carry inside us a terrifically damaged genetic code.

What is health? Is your friend with the perfect body mass index but who suffers from frequent migraines that keep her out of work and seeing a neurologist regularly more, or less, healthy than you, perhaps a bit heavier than you would like but rarely even getting a cold? Is your father’s untreated high cholesterol more or less worrying than your mother’s lupus? Do you know anyone who doesn’t have something? Our bodies are wonderful but imperfect vessels and things are going to happen.

And the truth of the situation is this – it is the poor in our country who are being left behind in under our current system, and at the same time, it is often the poor who appear to have the lifestyles contributing to some of the worst health problems. I see it every day in my job and the community I live in – the people who have to work two or three different jobs just to keep a roof over their heads are the ones who grab fast food regularly because it is what they have time for, and what they can afford.  They are the forgotten people in our country who don’t have time take their children for well-baby visits, let alone make time for physicals themselves, because they do not receive paid time off from work. Most often they don’t work or live near anything resembling green space – a huge factor in both physical and mental health – and they are most likely to suffer from totally  treatable conditions that instead are left to run rampant in their bodies – high blood pressure destroying kidneys that end up needing dialysis when a simple, but unaffordable, pill could have prevented such progress.

There but for the grace of God go I.

This is why the health care legislation is so terribly important – it makes small steps toward protecting a population most of us would just as soon ignore or, if not ignore, blame. Additionally, it seems (from what I understand of it) to understand that health is not a static state, achieved if only a person would ingest the right amount of whole grains and jog for an hour every day, and broadens our understanding of, and compassion for, our concept of our own health, and the health of our community. As we move forward in this debate – because with mid-term elections looming we are bound to continue this discussion – I think it would behoove all of us to consider how we personally define health, and to reconsider the importance of the health of the whole.

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9 Responses to What We Talk about When We Talk about Health

  1. Dorothy W. says:

    Interesting questions! Most people looking at me would think I’m healthy, and I am, mostly, except for the non-functioning thyroid … you are so right to point out the larger context of health — it’s easy to assume maintaining a healthy lifestyle is simply a matter of choice, when it’s really not that simple.

  2. auntjone says:

    Very well said, C. The whole issue is mind boggling.

  3. litlove says:

    What a fabulous post! If only you could get this to a wider public, Courtney, because you make an excellent point. I know people who smoked all their long, long, lives. And then me, who never smoked, never drank, ate home-cooked food, went to bed at sensible times – I ended up with chronic fatigue (not that I have any treatment for that, but you see what I mean). It’s the idea that we can control our health perfectly that’s a fallacy. We do all we can, but our bodies are not under our control in any evident way.

  4. Stefanie says:

    Well said! A person can do everything “right” and still have health issues. My husband and I are eternally grateful that we can afford the insurance that allows him to get the care he needs for his MS. Healthcare is soemthing that everyone deserves to have no matter if they are rich or poor.

  5. ZoesMom says:

    You do make an excellent point. I couldn’t agree more. I think we’ve certainly lost sight of the big picture. No one asks for cancer or a car accident, but we all deserve care.

  6. Amal says:

    Excellent post, CG. You’ve stated, beautifully, what I have felt but could not put into words.

  7. Emily Barton says:

    One of your best posts, but I’m wondering if I just feel that way because I so agree with you. No, I almost always agree with you. This is just an exceptional piece, and, like Litlove, I wish you had a broader audience for it.

  8. Courtney says:

    Dorothy – yes, exactly. And your non-functioning thyroid isn’t your fault – you didn’t personally cause it! It’s exactly the sort of thing (much like celiac!) that makes this whole discussion so complicated.
    Aunt Jone – aw, thank you!
    Litlove -oh, I’m happy with my audience! Someday I will have the time and patience to pursue something a bit bigger, but then I would have to use spell check, and examine my narrative…
    Stef – exactly. Everyone deserves health care! It boggles my mind that some people disagree with this basic human right!
    Zoesmom – word. Exactly.
    Amal – thank you! I know you have had your own struggles with health, as have I.
    Emily – thank you! We are soul sisters in so many ways! That said, I hope someday to have a bigger audience for my writing but the time is not now, I don’t think…

  9. A Free Man says:

    ‘Small’ is the operative word. I don’t understand why the U.S. could never get a reasonable health care bill through. Having lived now in two countries with ‘socialized’ medicine, I can attest just how much better it is than the situation in the States. In fact, it is one of the reasons that I would never go back.

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