Directions of travel for crossroads on health and hagiohygiecynicisms

170622 PhilippaOn behalf of the Dahlborg Healthcare Leadership Group (DHLG), I am so very honored to have received permission to share the following essay written by my Global Listening Center (GLC) colleague in Sweden, Philippa Göranson.

Ideas on health can be understood as something that is highly misrepresented or has an outlook from a variety of representations. Ideas for wellness seem constantly to be a field of conflicts between discourses. Whys is this so? Is it because it is mostly officially represented by authorities in health care instead of how a population itself understands and knows what wellness is about? Are health and well-being the same thing or not? Is there a difference between well-being and wellness or not? Who actually has the right to say what anybody’s existential well-being is? Spiritual well-being ought to be a voluntary process. Often enough, it is not and this aspect of the problem is about the authoritarian regime on the ideas of wellness and what dominates a certain country of part of the world. Is existential health gender specific? Should health treatments be gender specific? Does existential health need to be either philosophical, sociopolitical or considered a religious matter? Is existential health and wellness a question of landscape and sense of place? Is health perhaps related to intuition? Of course, health is within the communication process concerning the ideas of the mind and soul that exist and where is all this thinking going…? Existential and spiritual health poses the question of personal identity as a continuity of our memory. Is well-being communicated differently in the press in different countries? What are all the books on health actually about? Who are we to believe or dispute? How argue the validity versus the reliability of health? How discuss the truth versus the certainty of health? On what grounds are we to believe or dispute the voices on health or the idea of healthiness in general? Is health a prestigious project? Is wellness a question of perception and/or personality? Is health the meaning of life or just about being absurd on health? What is the relativity of health? When is it more important to understand the layman understanding of health instead of the expert interpretation of health? Is health a power position? Is health about sexiness? Is spiritual health about the air within and the air we breathe? In what way can health be understood in terms of normality or in the sense of not being normal? When is not being normal (disobedient) the most normal thing one can be according to actually being healthy?

Health can be a created value system

The ideologies of the value system/systems on health vary depending on where in the world it has been created, evolved, reevaluated and then altered. Questions of health are among the key issues for the referendum of debates – this is the kind of vocabulary one can encounter on the policy level of health. What is the “direction of travel” at this level concerning health? Health as a human rights perspective. What public or private health is supposed to mean. How can privatization be either good or bad? Health as law and policy affects us differently. The balance between technological innovations and securing the protection of patients and the health systems themselves needs to be communicated better. The idea that “good science” plays an important role in health policy exists. The sad reality is that the idea of “good science” is not a scientifically determined concept. Health is also considered a non-equal relationship to market-based values (e.g. free trade). The need to articulate the values a country or set of countries have concerning health practices and who actually is evaluating and coming to conclusions on what health is supposed to mean to even be useful or trustworthy still seems a bit foggy. What is health in all policies? Questions on health as an implicit or explicit characteristic – an all or nothing approach can be both lost and found at this level of creating a value system.

Health is a political issue

Health exists on all levels: individual, communal and macro-political. Health and life are primarily values expressed by health care professionals and others. Health is about domestic and foreign policy. What is global health diplomacy today? “Diplomats no longer negotiate only with other diplomats but with anyone who has the resources and authority to be involved in negations on a global level. Health is at the forefront of this change. /—/ Governments are often not clear about their motives behind action on health.” (1) Health is as important as wealth and happiness – or at least the means to travel in the right direction toward it. Do political regimes influence individual health? Does an individuals’ political ideology have any influence on their health status?

A question as: “How is success gauged in the field of international health?” reveals a few dimensions on parts of the quest where it commonly is explained as the belief that international health is about the control of diseases and pandemics, how ailments should be prioritized or how violence and injuries can be prevented. The reply is: “No international health actors agree on how these problems should be addressed”. (2) What is anybody even doing in the discourse at all? Anne-Emanuelle Birn has given a developmental portrait of how actors on an international scale have taken shape. She begins by naming the period 1851-1902: Stage of meeting and greeting, the next period 1902 – 1939: Stage if institution-building and further on 1946 – 1970: Stage of bureaucratization and professionalism and profiles the next years 1970 – 1985 as the stage of contested success and from there where we are still seen as today: 1985 – present: Stage of evidence and evaluation. Since the solution is still not here, something both crucial and vital is still missing.

“Health depends on the vanity or falsity of their promises.” (Michel de Montaigne, 1533 – 1592)

The ideas of health can alter over one’s own life span. Why does one even start to think about it? 

A few days ago, I read my regional newspaper and one spread triggered my questioning on the possibilities of health. The newspaper spread consisted of three articles that together brought several contradicting ideas together regarding society, well-being and bad health. One of the articles in the newspaper claimed education, perseverance and the right to work in a gender equal society creates a healthier country (country being the idea of a healthy population). One other article exposed how women are constantly caught in the middle of everything (work, children, housing, not enough own free time, ill-health due to stress, women’s jobs are not well paid). At least one-third of the population suffers from some kind of anxiety or stress due to life issues. The third piece in the spread then showed that even if people are educated this does not guarantee one will enter the job market. Those who have chosen to study will often be weighed down by their student loans. Educating oneself can be economically contra productive. In school, people are always told to continue to higher education if they want to make sure to get a job at all. The equations are not working out and neither is health in the existential sense of things. Whom are we supposed to be today as opposed to before? How is a person supposed to take care of the self in the midst of all of these concerns and retain health? These examples are perhaps not even big enough if one tries to understand the quest for health on an even bigger scale. These concerns are directed in the first world order – only.

Old mythological storms persist. If we look into the ancient Greek western mythology the state of balance is disturbed by the abduction of the psyche (mind, soul) by the wind. In Greek mythology, it starts as the son of Aestro and Eos abducts Phyché and takes her to his cave; “the wind literally abducts the psyche and leaves it in the hands of love and desire (Eros). /…/Thus, our souls and our minds, ethereal by themselves, are completely at the mercy of the air”. (3) Our psyche is etymologically understood as being “the breath of air” that gives us life, the soul and our understanding. In regards to the idea of health, metaphorically we are not breathing since we have been abducted from our safe haven.

The World Health Organization (WHO) has proclaimed a view of health: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This “view has been criticized as hopelessly utopian and so boundless as to be meaningless. However, it is a better vision against which to compare policy outcomes than one that focuses solely on disease”. (4)

Health promotion according to the WHO standards concern processes: “Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment”. (5)

Health, illness, disease and sickness have a variety of stakeholders to confront. These confrontations can be about prestige or being inferior to different regimes and policies. Or just about not being listened to.

Medicalization is a threat to health

Ivan Illich (1926 – 2002) proclaimed in 1974 that the medical establishment is a major threat to health. Medicalization of health: transforming life issues into medical problems or this can also be described as “a process by which non-medical aspects of human life become considered medical problems”. (6) This is something the culture of healthcare has created and it can be considered healthy to stop and think about what medicine as a phenomenon does to people. Medicalization is constantly disputed within the medical humanities since it is understood as a form of medical imperialism. Healthcare and the healthcare industry are prone to mystifying the conceptualization of health so to give them the control of how people are supposed to understand what health is about. Ivan Illich wanted to warn us and take a closer look at what life is doing to us: “Health, after all, is simply an everyday word that is used to designate the intensity with which individuals cope with their internal status and their environmental status.” (7) Illich’s point on existential health is for people to “drop out and to organize for a less destructive way of life in which they have more control of the environment”. (8)

Ivan Illich concept of healthcare as a nemesis is a reminder to the fact that healthcare regime exceeds in hubris over humility. In Greek mythology, Prometheus was employed by the Zeus to form men from clay and then to inform them on the arts of life and the living. Prometheus went against Zeus will and stole the fire from the heavens. For his pride, Zeus punished him by chaining him to a rock “to suffer everlasting torture”. (9) “Nemesis engineered the God’s revenge on Prometheus and on all those mortals who aspired more than mortal power. Thus Nemesis has demanded retribution from every nation of the ancient and modern worlds when hubris exceeds humility.” (10) The analogy is easy to understand in terms of what modern science and healthcare regime are trying to do. Ideas on health are about power relations and relations to power and authority.

Seamus O’Mahony points out how Illich critique of the institutionalizing of everyday life, medical treatments and how the cultural meaning of life, in general, has been turned into something superfluous made people loose traditional ways of dealing with suffering as a part of life. Ivan Illich had a low opinion of doctors (the medical guild) since they are more concerned with their income and status than in the health of their patients. Doctors “tend to gather where the climate is healthy, where the water is clean, and where people are employed and can pay for their services”. Ivan Illich argued for more public support for alpha waves, encounter groups and chiropractic practice. Medicine has become in Illich’s phrase: “a vast monolithic religion”. “Medicalization has continued unchecked, and Illich would have been wryly amused by the invention of new diseases, such as social anxiety disorder (shyness), male-pattern alopecia (baldness), testosterone-deficiency syndrome (old age), and erectile dysfunction (impotence)”. The Lancet Oncology has called modern medicine: a culture of excess.

Conceptually medicalization and overdiagnosis are also debated as being something both similar and at the same time different since they both expand the concept of disease. Medicalisation deals with the sick-role. Overdiagnosis deals with disease. These two concepts, in turn, refer to different kinds of uncertainty: “medicalization is concerned with indeterminacy, while overdiagnosis is concerned with lack of prognostic knowledge”. (13) Bjørn Hofmann argues these concepts are evolving in different directions and creating new problems: “Medicalization is expanding, encompassing the more ‘technical’ aspects of overdiagnosis, while overdiagnosis is becoming more ideologized. Moreover, with new trends in modern medicine, such as P4 (preventive, predictive, personal and participatory) medicine, medicalization will become all encompassing, while overdiagnosis more or less may dissolve. In the end, they may well converge in some total ‘iatrogenization’. In doing so, the concepts may lose their precision and critical sting”. (14) (Iatrogenic: bad outcome induced by physician due to medical treatment or diagnostic procedure).

A broad sociological perspective on health and illness interpret medicalization as being part of how norms and values develop continually develops. Both the definitions of health and illness develop. In this case, medicalization is just seen as a kind of continuum instead of as a dichotomy over medicalization or overdiagnosis or if health and illness even are to be understood as being different. Medicalization and overdiagnosis can be understood as taking place both within and outside of medicine. Medicalization is a multiplayer game (societal factors, institutional rules, stakeholder interests). Overdiagnosis takes place in healthcare and still one has to reflect on how: “Societal developments and values, thus, influence the practice of medicine”. (15)

“True life – false life – illusory symptoms – Diseases are deaths that appear alive.” (Novalis, 1772 – 1801)

Normality as a threat to health

The concept of normality is a threat to health. Normal is understood as something average or standard. The ideas of normality as concepts for diseases aim at working out a levelling into something. A one and same disease can be different in different bodies. Diseases cannot be levelled out entirely. Health cannot be levelled out. Health is more creative than disease.

The concept of normality stems from the Latin normalis – and norma meaning Carpenter Square or T-square. In the 17th century, it meant standing at a right angle, conforming to normal standards. In the 19th century, the concept of normality was transferred to the understanding of human beings due to the new biological paradigm of the time and as part of the industrial revolution: normal person or thing, usually a state or being. In the 20th century, normality was used as a means of evaluating people technically speaking. Life as it is never returns to any state of normality.

Health designated as adaptation is misleading and paternalistic. In doing so, healthcare is a threat to each person’s right to define his or her own health. How can the concept of normality act in accordance to autonomy, not to harm, do good and fairness?

To apply normality is a way of trying to make sense of how societal changes alter different ideal states of being. Ideals of normality alter over time. Normality is not static. Normality is relative to different societies and groups. In times to come, normality will be less of a threat to health.

 “ hagiohygiecynicism” ( James Joyce, Finnegans Wake)

“ The word ‘hagiohygiecynicism’, which shunts the Greek words for ‘holy’ and for ‘health’ or ‘sanitation’ (Hygieia is the goddess of medicine) onto the philosophy of the Cynica, with its faultfinding contempt for the enjoyments of life.” ( Finn Fordham, Lots of Funs at Finnegans Wake: Unravelling Universals)

Can we agree on conceptualizations of health? 

Health and health promotion are, if not concerns for real life, concerns for different ideas and ideologies. What it means to be in good health varies in different contexts due to the differences in specific cultural, political and medical contexts and backgrounds. Health debate offers a variety of conceptualizations. The need to bring order into the chaotic realm of ideas exists. The problem within healthcare and health politics is that it does not help out on health – mostly disease. Is the quest for health about conserving health or how to promote health?

Through what political, cultural and social processes is health transformed into inequality? Inequality in wellness can almost be interpreted in a similar way as to understanding religious differences, creating inequality through a thicker cultural, normative and political content. Health – well-being and wellness are social sciences. Wellness can be politics on a larger scale. The means for their actual solutions is what should be prioritized. Different political regimes, countries, traditions, history, scientific ideologies and their spaces of thought and conspiracies, hierarchies in knowledge processes, differences in voices of authority, media representations and manipulations, and value systems attend to health issues in completely different manners. This, and more influences health and wellness ideals, interpretations and understandings on narrow and broad perspectives and how one can act upon them.

Health promotion is not a contemporary ideal for the 21st century where the ideal is to shift healthcare from a preoccupation with illness to focus on health. This shift is not always based on philosophical concerns. Sometimes it results weigh mostly of cost-benefit ratios. Healthcare is not health care – it is disease care (Healthcare in Swedish is called Health- and disease-care). In the 17th century, health promotion was used as a means to create population policy. In the 18th century, health promotion helped define demographic developments due to economic and military needs. In the 19th century, health promotion was necessary due to industrial developments and different infrastructural needs. In the 20th century, health promotion became more complex where the quest for higher natality led to disturbing ideals concerning the human race.

The following terms create an overview of concern when starting to take a closer look at the challenges when defining health and what these concepts also lack: Health. Health promotion. Health intervention. Public health. Health conference. Healthy living. Environments for health. Disease prevention. Objective health. Workplace health. Foods. Education. Positive Health. Complete health. Health measurement. Health News. Well-being. Ill-health. Health nonsense. Health standards. Exposures. Ecological health. KASAM. Biomedical health. Health diplomacy. Health politics. Health minister. Health policies. Health rituals. Subjective health. Health direction. Health tourism. Intellectual health. Men’s Health. Health abuse. Women’s Health. Health journalist. Health IT. Health research/-er. Health habits. Mobile Health. Happy health. Mindful health. Health problems. Health blogger. Operational health. Nutritional health. Musical Health. Health Data. Health Biometrics. Health networks. Health statistics. E-health. Health app. Health conditions. Health magazine. Avoidable Health Differences. Health provider. Health information. Anthropomorphic Health. Prevention – promotion – campaign. Physical activity. Health vision. Cultural activity. Lifestyle. Life conditions. Family Health. Health leadership. Health vitality. Health informatics. Health behaviour. Health management. Negative Health. Cultural Health. Cognitive health. Health arts. Health alerts. Cooperative health. Existential health. Mineral Health. Palliative care. Health Science. Spiritual health. Health literacy. Health reports. Ayurveda Health. Health field. Health triangle. Healthy housing. Healthy Cities. Health evidence. Empowerment. Economic health. Coping. Health enhancement. The quality of life. Resilience. Health Solutions. Herbalist Health. Compassionate health. Health leader. Holistic Health. Health wearables. Health Fitness. Naturopathic Health. Health equality. Health impact assessment. Religious health. Mental health. Health determinants. Wholistic Health. Health and Leisure. Politics of clean air. Politics of clear water. Politics of clean soil. Holistic. Ambiguous health. Linguistic analysis on health. Human Kinesiology. Philosophical health. Health ethics. Pathways of Health. Environmental Health. Minorities’ Health. Health therapy. Emotional health. Health status. Healthy design. Health intelligence. Health effects. Societal Health. The Science of Happiness. Spiritual Health. Sensual Health. Sexual Health. Social Health. Visualizing Health. Acceptable Health. Health ability. Non-acceptable Health. Disability and health. Sportive Health. Health as a resource. Health assembly. Primitive People’s Health. Health procedure. Functional health. Health experience. Health classification. Health forum. Positive Psychology. Health as a state. Health is caring. Health as a process. Health codes. Health hazard. Health league. Health maintenance. Healthy anger. TCM Perspective (Taking Charge of Your Health, Well-being). Gender health. Rural Health. Health Fellow. Dental Health. Health terminology. Child Health. Adolescent health. Healthy grown ups. Ageing in health. Generational health. Confessional health. Googling health. Health settings. Health Association. Health continuum (death – illness – health – wellness – high-level wellness). Personal satisfaction as health. Health welfare. Health economy. Traditional Chinese Medicine. Slow Medicine Movement. Health Organizations.

One of the first problems in trying to understand the idea of health is the fact that the idea of health is taken for granted. On a global scale, concepts of health differentiate due to linguistic variations and their cultural distinctions and meanings. In English, ideas of health can be about being whole or wholeness or to heal or healing. In Swedish, health can mean happiness. In German, health can mean success. Concepts from the antique culture in Greece use the old word hygieiat, in Greek this means to live well or a good manner of living. Concepts of health in English, German, Latin or Hebrew do not relate the idea of health from disease.

The two dichotomies concerning the study of conceptualization of health concern: the biomedical versus humanities approaches. Health as the idea of a mechanical system where the well functioning body proclaims when one has good health. Health as a biostatic model is when health is the absence of disease. The holistic idea approaches the idea of health as into how a person can achieve good health thanks to being motivated and having a healthy and socially and culturally supportive environment. Mental health is central to what the idea of health is. A psychosomatic idea of health is the absence of disease due to circumstances of life and living conditions. The Ecologic idea of health is a generalization of an environmental approach where health is seen as being in coexistence with the environment. Behavioral direction portrays health as how a person acts in accordance with his or her health. The Homeostatic ideal of health is a holistic psychobiological understanding of health. The theological basic view sees health as a process regarding body, soul and spirit. The salutogenic idea of health is concerned with the relationship between health, stress and coping and how a person has a sense of coherence. Philosophical health is a philosophical style with the goal of restoring us to a condition of philosophical health in regards to how we speak and talk in our everyday lives (traditional styles of doing philosophy usually lead to sickness). Philosophical psychobiology is the portal to health on the brain’s capacities of imagination for creating meaning.

The ideas of health need an open paradigm instead of demarcations. I never said this would be an easy “direction of travel”. Health, as everything else, is an exercise in language and changes according to the context and the needs it addresses. Perhaps the attempt to fix the meaning of health will fail since, like for diagnoses, there is no foundation on which a fixed meaning can be built and it can only be done at the cost of its relevance and usefulness as a diagnosis of health. A diagnosis of health is the perfect contradiction to the idea of health.

The conceptualization of health within The World Health Organization have important milestones in their “direction of travel” from health to wellness.

The ideals of health have altered since 1948. Four touchdowns in the history of WHO are explanatory: 1948 (WHO charter) – 1974 (Lalonde report) – 1986 (Ottowa declaration) – 1991 (Sundsvall declaration). Four main positions have surfaced. Health starts as a state, health is transformed into an experience, and health continues to become ability and is later health is realized as a process. The conceptualizations completely alter the manner in how health is understood and where it comes from (static and goal oriented) to what its “direction of travel” is in understanding how it is transformed to a spiritually dynamic and interactive modus. The concept health can be seen as outdated. Well-being is derived from the changes the concept of health has undertaken. Wellness replaces health and moves this quest into a higher level of understanding of the complexities of the human condition. Wellness and sustainability or wellness as sustainability as steps to come.

Health could be shortened down to the idea of strengthening the self and changing the environment to rid the conceptual confusions at hand. Should we rest at the point of understanding that we all disagree on what health – well-being and wellness are about? I am curious about the next upcoming concept that might help us reach even better clarity and why.

Ideas on health differ in different parts of the world. Health is a reflection of our beliefs. Health is also a reflection of the value systems, in particular societies. Different societies legitimize different combinations on how health works out. Old traditions and new practices can cooperate, depending on if there is a health policy to support it.

Gender inequality in health is on the WHO agenda. It is directed toward both women and men. Women’s disadvantages in social-, economic- and political status make it difficult to protect their health. Women live longer than men and their additional years are often spent in poor health due to gender-based discrimination and medicalization trends. Gender mainstreaming is a concept developed to focus on better empowerment strategies. This addresses how health problems affect women and men of all ages and the group differences. Normalized beliefs and traditions usually just pass on from one generation to another without there ever being any substantial change. The ideal is to be able to create healthier changes and the goal is expressed in the following words:

“Gender mainstreaming is essential to realizing the right to health and it puts people at the center of public health programs and policies.” (16)

Medical speculations on health as a body of knowledge

Western school of thought, philosophy and medicine can start a “direction of travel” on health with Plato and Hippocrates 400 B. C. Health is conceptualized holistically – body and environment need to be in harmony. Galenos 200 B. C. understands health as something fundamental and when one is able. Vesalius (1514 – 1564), the founder of human anatomy, in the 16th century, has a somatic understanding of health. In the 17th century, the idea of health and disease were divided due to the thinking processes of René Descartes (11596 – 1650), Immanuel Kant (1724 – 1804) and Julien Offray de La Mettrie (1709 – 1751). During the 18th and 19th centuries and due to the new biological paradigm of the times in medicine there are a variety of ideals on health.

The Georges Canguilhem (1904 – 1995) book The Normal and the Pathologicalcontains a presentation of medical thinking on the quest of health as a vital force. In the Introduction, the philosopher Michel Foucault (1925 – 1984) summarizes what physician and philosopher of sciences Georges Canguilhem most prosperous traits offer us: a new conceptual understanding of the concept of life as health by reopening philosophy. To understand, life, illness and health there has to be a sound understanding at several crossroads of thought and research. Michel Foucault points out: “The biologist must grasp what makes life a specific object of knowledge and thereby what makes it such that there are at the heart of living beings because they are living beings, some beings susceptible to knowing, and, in the final analysis, to knowing life itself”. (17)

“Health is a way of tackling existence as one feels that one is not only possessor or bearer but also, if necessary, creator of value, establisher of vital norms.” (18)

Disease is no longer “the anguish for the healthy man”. Disease is from now on the study for a theory of health. The “direction of travel” in Canguilhem’s discourse takes the reader by the hand on different schools of thought on a rhetoric of health as the idea of the living by some European theorists in the 18th, 19th and 20th centuries. Georges Canguilhem exemplifies how different concepts operate “because of their explanatory power and practical value”. (19)

Disease happens to man in order for man to learn not to lose hope. Hope is a means to health. Different kinds of diseases make way for different modes of thought on health. Diseases comply with norms. Health goes into opposition these norms. Health is a deliberating process aiming at higher levels of the human condition and their norms. To explain perfect health is abnormal in the sense that it includes disease. Health as an ideal needs to be free of disease as a normality. Canguilhem does not consider personality traits as to how changes may affect ill-health or health improvement. He just views health and disease as human qualities.

“The science of life should take so-called normal and so-called pathological phenomena as objects of the same theoretical importance, susceptible or reciprocal clarification in order to make itself fit to meet the totality of the vicissitudes of life in its aspects, is urgent far more than it is legitimate.” (21)

Canguilhem opposed the medical training programs when they claim disease are a deviation from a fixed norm of normality. Suffering establishes the state of the disease and illness corresponds to circumstances in the environment. Disease is another way of life where health is attainable.

Disease and health are different forms of excitement (John Brown 1735 – 1788). Medicine is the science of disease; physiology is the science of life (Claude Bernard 1813 – 1878). Health is life lived in the silence of the organs (René Leriche 1879 – 1955).

“The problem of the actual existence of perfect health is analogous. As if perfect health were not a normative concept, an ideal type? Strictly speaking, a norm does not exist, it plays its role which is to devalue existence by allowing its correction. To say that perfect health does not exist is simply that the concept of health is not one of an existence, but of a norm whose function and value is to be brought into contact with existence in order to stimulate modification. This does not mean that health is an empty concept.” (22)

Life, health and the living are part of dynamic struggles that cannot be deduced into scientific abstractions. Health and diseases are experiences of the living. The healthy do more than just maintain its present self – the healthy realize themselves at the risk of catastrophes.

“Health is a margin of tolerance for the inconsistencies of the environment.” (23)

Please note, the concept of health is normally used in singular and diseases in plural. Healths – what are they? Or, which are our healths? How are our healths?

Health is also discussed as a form of an age of innocence. Health is a state of unawareness where the body and subject are one. This unawareness or innocence concerns not knowing limits, threats or obstacles to health. Knowledge and insight have its source in reflections on setbacks to life and health.

Health is about consistency in life and about securities in the present and assurances for the future. Each disease reduces the ability to face other diseases. The original biological assurance without which there would not even be life. To be in good health means to be able to fall sick and recover – “is a biological luxury”. (24)

“To be cured is to be given new norms of life, sometimes superior to the older ones.” (25)

Slowing medicine down… listening to life is healthier

In opposition to overmedicalisation, a slow medicine movement has arisen. According to Italian references, slow medicine saw the day of life in Italy in 2011. The first article published in 2002. The slow medicine movement is understood as a new paradigm in medicine (and at times as a palliative care or wellness in chronic illness). The slow medicine paradigm is about understanding how health and disease operate on complex levels of life and aim at creating long-term responses to better health. The human being is not considered a machine that can be fixed, but as a plant that needs to be listened to before, one can identify the cause of illness. Too often “fast medicine” will diagnose people as depressed and prescribe pills without even trying to understand what environmental issue is behind that needs tending to firstly. Slow medicine combines a variety of health centred ideas instead of just trying at one angle at a time as the earlier conceptualizations in this presentation previously exposed.

“At different levels of complexity in fact, new and unexpected properties appear, such as thinking, emotions, pleasure, health.” (26)

Slow medicine looks at root causes that create disease or illness. Slow medicine asks the question: “What will you do with your life once your health is restored?” (27)

Center for Health Journalism asked some questions to physicians and I am just going to add two questions and responses here as food for thought. The whole set of questions can be found in my reference list if you want to read it.

1) “Medicine gives you a big hammer, but wisdom comes in knowing its limits.As physicians, we can find evidence in the research literature to support or discourage almost anything. If we do not have a coherent approach to care, it’s quite difficult to decide when we have sufficient evidence to change our practice.” (28)

2) “Should we make better use of community health workers? There has been a lot of rhetoric about the value of community health workers, but such programs don’t always work as well as they could. Some basic guidelines could go a long way toward ensuring such workers contribute to the health of patients, particularly those with chronic diseases.” (29)

There is hope… health is hope… is the “direction of travel”. Change of mentality in healthcare, modernizing the existential realm in health policy, being aware of the environmental impact on disease and finding new approaches to understanding ill-health. Ensuring patients’ values are respected instead of stale theories that are applied cynically. A person can only live his or her life at one pace at a time and create a certain amount of meaning for it to still make sense when it comes to issues of health – well-being – wellness – or the next concept to come…

© Philippa Göranson, Linkedin, Lund, Sweden, August 3 rd 2017

This essay has been published on the Dahlborg Healthcare Leadership Group. Thomas Dahlborg is a Studer Group Coach & Speaker, President of DHLG. Thomas Dahlborg is debating on the cause of relationship-centered care and empathy in healthcare. Twitter: @tdahlborg

References:

Alexanderson, Kristina & Medin, Jennie, Begreppen Hälsa och hälsofrämjande – en litteraturstudie, Studentlitteratur, Lund, 2000

Birn, Anne-Emanuelle, “The stages of international (global) health: Histories of success or successes of history?”, Global Public Health, Vol. 4, 3 November 2009, Routledge Taylor & Francis Group

Bonaldi, Antoni, Vereno Sandra, “Slow Medicine: un nuovo paradigma in medicina”Recenti Progressi In Medicina, 2015; 106 (2): 85-91

Canguilhem, Georges, The Normal and the Pathological, Zone Books, New York, 1991

Center for Health Journalism, “Slow medicine”, XXXX

Fordham, Finn, Lots of Fun at Finnegans Wake – Unravelling Universals, Oxford University Press, 2007

Färdow, Joakim, “Sjukdomskritikern Ivan Illich bortglömd bland sina efterföljare”Läkartidningen, No 39, Vol. 108, Stockholm, 2011

Gilmore, Richard, Philosophical Health, Lexington Books, 1999

Göranson, Philippa, Lonely Inc., 2010

Hofmann, Bjørn, “Medicalization and overdiagnosis: different but alike”Health Care and Philosophy, Vol. 19, Issue 2, pp 253 – 264, June 2016

Horton, Richard, ”Georges Canguilhem: philosopher of disease”Journal of The Royal Society of Medicine, Vol. 88, June 1995

Joyce, James, Finnegans Wake, faber and faber, London and Boston, 1975

Kemm, John, Parry Hayne, Palmer, Stephen, Health Impact Assessment, Oxford Scholarship Online, September 2009

Kickbush, Illona, ”Global health diplomacy: how foreign policy can influence health”The British Medical Journal, April 2011

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Nerbrand, Sofia, ”Kvinnor klämmer sig mellan kraven”, Ledare, Sydsvenskan, A2, 23 July 2017

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Footnotes:

  1. Kickbush, Ilona, 2011
  2. Birn, Anne-Emanuelle, 2009
  3. Torelló, Joan, 2017
  4. Kemm, John et al., 2004
  5. Alexanderson et al., 2000
  6. Hofmann, Bjørn, 2016
  7. Färdow, Joakim, 2011
  8. Killeen, Raymond, XXXX
  9. Killeen, Raymond, XXXX
  10. Killeen, Raymond, XXXX
  11. O’Mahony, Seamus, 2016
  12. O’Mahony, Seamus, 2016
  13. Hofmann, Bjørn, 2016
  14. Hofmann, Bjørn, 2016
  15. Van Dijk, Wieteke et al., 2016
  16. WHO, 2011
  17. Canguilhem, Georges, 1991
  18. Canguilhem, Georges, 1991
  19. Horton, Richard, 1995
  20. Horton, Richard, 1995
  21. Canguilhem, Georges, 1991
  22. Canguilhem, Georges, 1991
  23. Canguilhem, Georges, 1991
  24. Canguilhem, Georges, 1991
  25. Canguilhem, Georges, 1991
  26. Bonaldi, A. et al, 2015
  27. Weil, Andrew, 2015
  28. Center for Health Journalism, XXXX
  29. Center for Health Journalism, XXXX
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