Healthcare is only a tiny part of health

On the bed lies a body. At one time it could have been 5 feet or so, but has withered to a size barely measurable in the geometry of twisting limbs locked in rigid angles now permanently affixed to the chest which pumps in hissing heaves like a steam engine whose fuel is a beige milk churning into her belly from a crude plastic machine.

A naked woman walks down the hall at 2am screaming as though someone is murdering her, covered in bruises with burnt lips and dark rivers scarred into her arms; she won’t stop crying until the narcotics flow into her IV and she is quiet for 30 minutes, when we’re lucky.

Looking into her eyes heavy beads like sap become fat until they soil her cheeks and burst on the table of plastic with shapes printed by a machine to look like the lines that form on wood from years of growth within a tree. I wonder what her life will be like with a second child, for the children, and for the scared parents of only 16 years. I follow my mind’s path to her job as a waitress and the children at her grandparents, the music she listens to, her boyfriend’s adolescent tattoos fading, and how they will speak to these small creatures. I ask the same questions when I help with an abortion, and imagine the pains lifted and sometimes imparted. I can’t help but ask myself these questions, as though I was the one with the children sleeping.

Healthcare does not make me think of death, but of life and how we live. Most of what is written about health is about healthcare and all the problems with our particular system: its cost, the poor outcomes, access to resources, hostile and alienating treatment, etc. That is natural in a way. We are confronted with things we’d rather not face most when our lives come apart; when we are in the ER holding a compress to a bleeding extremity, weighing out what will happen if there is or isn’t a fetus stewing inside in amniotic juices, when our loved ones are pale and absent, or when doctors tell us amidst hurried footsteps that our lives will never be the same and there’s a pamphlet with cartoon drawings for what we ought to do and have done unto us. The universal hatred for how our bodies are treated appears to us a distinctly modern kind of thing. Going to clinics and hospitals involves giving up a lot of control to a force that we’re constantly reminded is dangerous, greedy, and hostile in spite of millions of truly dedicated and often altruistic healthcare workers within. The domination we experience through health care is necessary perhaps but manifestly unjust and somehow avoidable; if only we knew how. We take it like bitter medicine but not without scorning the drug maker.

The political prescription of most stripes centers on how we organize, distribute, and access healthcare. Here is a weird point of convergence of the political left: that the solutions to our health lie roughly in equal access to quality health resources. You know something is strange when a motley crew like anarchists, socialists, and most liberals line up on a great deal. There are tactical and strategic differences over profit, how we distribute, pay for, and administer healthcare. To be sure universal free healthcare would be a serious improvement for humanity. Whatever adjustments would have to be made, at the end of the day better access and more democratic administration would bring real joys and capacities to people who might otherwise suffer alone for years. The burden of caring for the ill is massive and literally is ruinous, and nothing to baulk at.

Still there is something backwards in looking at the problem this way. Healthcare is only a tiny fraction of what health is. Healthcare is what happens when your body’s problems become strong enough to motivate you to find someone to help when you couldn’t solve it on your own. In an ideal world that includes education and prevention to anticipate those problems. Progressive ideas of health often include thinking about the environment in helping sustain health and avoid illness and thinking holistically about health throughout life. Such health programs center on the administration and distribution of existing healthcare largely to minimize the impact of illness and improve health across the world.

Despite a lot of work to the contrary thinking of health as the absence of illness still pervades, especially political thinkers. Appeals to holistic health aside, all the solutions line up around resources and their management. Adding some alternative health practices adds more resources to the mix, but doesn’t dig deeper into what we are trying to do with those resources.

If not that then what though? Ultimately we have to start by asking what health is. Health is something like a human potency or our powers and abilities that make a life worth living possible. This kind of definition is inherently about values, what we want and aspire to. Health is not neutral, but is wrapped up in how we think about life, living well, and the social fabric of being human.

The problem with a political approach to health is that a reorganization of healthcare does not get at health at all. Dissecting mundane experiences in health facilities opens this up easily. Most of the major decisions about how we live are made for us without input. For instance it is taken for granted that the best solution is to use medicine to extend life in such a way where elderly people continue to live, however are fully dependent on the care of largely strangers as most work too much to care for their loved ones. Is it best to lengthen life span (and indefinitely?) when our elderly are warehoused often in total sensory deprivation and isolation?

Or consider cancer treatments like expensive chemotherapy which can be truly life saving for some. Is improving access to chemotherapy the answer for patients with cancer? What of cancers themselves proliferating? The problem with thinking of health only in terms of how we organize the industry of health is that as people we come at it differently. We encounter our own health through our living such as when chemotherapy forces many patients to chose not how they want to access those resources, but how they want to live each day balancing different side effects of disease versus those of the treatments, or more importantly what it means to live at all. The relative growth of cancer is a controversial subject in general, but it is clear that there are strong aspects of society producing environmental conditions that facilitate cancer proliferating. Those choices are about how society is built and how we live, and we build healthcare in its image.

What are our goals then with these treatments and tools we have? Is it to allow debilitated patients to continue living entombed in their bodies for decades completely isolated from the outside world? How about the millions of children born into truly horrific circumstances of daily existence, what are the health implications of that? And what of improving health to allow us to work endlessly at meaningless jobs that make people miserable?

If health is about how to live, i.e. an ethical question, then the beginning to solving the problem with healthcare isn’t a political reform or revolution at the level of resources, but rather starts at what we want to do with our time on earth. Whatever healthcare exists can only serve our ends if its about our ends, our values and goals. Health is an activity, something we sustain, create, and reproduce through action guided by our vision. It augments the broader social relationships and action that constitute our living. Health is an embodiment of the desires, powers and will that we sustain and is merely supported by healthcare, reflective of the society we live in and its values.

This way of living and these societies we find ourselves in corrupt our health even before our healthcare. We need a revolution of values before we can uproot the illness that creates all the barbarity anyone with an open heart sees in the clinics, hospitals, and health centers of our times. Struggling to expand our living helps expose the way in which how we live today and our healthcare are strangling our potential, and the vast horizon of humanity open to us should we take another path.