Looking back, it’s now obvious that the Lalonde report did initiate a change in our fundamental understanding of the determinants of health – an understanding that is now beginning to flourish. By stressing the influence of non-medical factors on population health, the report made it possible for governments, academics, and foundations to endorse practices outside conventional medical care. Medical practitioners are equally aware that health care by itself cannot secure a population’s health. Following the Lalonde report, politicians, health merchants, and mass media moguls seized on the idea of healthy lifestyles. They tried to convince us that personal responsibility was the primary determinant of health. In the end, however, I am cautiously optimistic that it is not their voices that will prevail.
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Collectively, increased health consciousness was followed by increased health care costs. The promotion of healthy lifestyles was not the only reason health consciousness increased in the late 20th century. And there were, of course, many other forces at work that increased the costs of health care. But it seems fair to say that the new perspective on health ended up providing opportunities to expand the demand for more medical services. Any hope that individual responsibility for healthy lifestyles would reduce costs – still touted today by some politicians and health care economists — turned out to be a mirage.
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In the 1970s, public health policies began to promote the idea that individuals are responsible for their health and therefore have an obligation to adopt healthy lifestyles. Over the ensuing decades, health became an especially popular topic for media coverage as well as a lucrative market for vendors of health-related products and services. What followed was a substantial increase in health consciousness and greater anxiety about all things that concern the body. Do healthy lifestyles produce better health? That they should may seem like common sense, which is one reason it’s been so easy to promote the idea. The question is difficult to answer with absolute certainty, however.
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By
Jan -
February 20, 2012
Throughout history there’s been an understandable desire to find connections between our behavior and our health. Human beings have practiced health regimens involving diet, exercise and hygiene since antiquity. When medicine was based on the humoral theory of disease, for example, individuals were advised to purge the body in the spring and, in the summer, avoid foods or activities that caused heat. Bathing in ice water was recommended in the 19th century. Mark Twain quoted the advice: “the only way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d druther not.”
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Will the London riots raise questions about a world that doesn’t care about the socially disadvantaged? Questions, yes. But will that be enough to bring about a change in attitudes and policies? Probably not. Unfortunately, the situation will need to get much worse. Even when that happens, current financial interests are likely to prevail. A discouraging prospect, yes, but a struggle worth waging.
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I’m taking a break from frequent blogging – want to take time to read, do some research, reflect, and think about what I most want to write about next. At the moment, my inclination is to write about the history of medicine, starting with the Enlightenment and the transformation of medicine into a science in the 19th century. I want to think about what light that sheds on the 20th century.
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Literature, fine art, poetry, music serve to remind overworked clinicians that they are part of a timeless tradition of healing whole human beings, who present in all their magnificence and complexity. Also, that physicians themselves participate in the tradition of physicians as humanists. Perhaps that’s why a liberal arts education – in my opinion – makes an important contribution to the practice of medicine today.
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From 1911 JAMA: An alarming increase in the number of street accidents from the recent development of motor traffic is shown by the report issued by the Highways Protection League. In 1905, thirty-five persons were killed and 1,557 injured by accidents due to motor traffic, while 118 were killed and 6,323 injured by horse traffic. In 1909, 163 persons were killed and 6,579 were injured by motor traffic, while 123 were killed and 5,589 were injured by horse traffic.
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In part one of this post I explained how a new anatomical understanding of disease in the 19th century changed the practice of medicine. Prior to this insight, there was no need to expose the body to observation or to touch parts of the body that were normally clothed. The anatomical theory sent doctors on a search to discover what was happening inside the body. The new physical exam required much greater exposure and invasion of the body, a significant change for the patient experience.
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The need to reveal private and intimate parts of our bodies is a routine occurrence in medical practice today. Though it may offend our modesty, we take it for granted that the embarrassing moments of a colonoscopy, a Pap test, or a prostate exam are necessary for our health. Has it always been so? Have doctors always expected patients to disrobe? Have young male technicians always exposed the chests of female patients in need of a routine EKG? Have patients always been willing to allow doctors and their staff to view parts of the body normally seen by only the most intimate of partners? The answer is a resounding no.
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Jan -
January 13, 2011
What’s not widely known, however, is that this is not the first time the physical exam has gone into decline. We know from surviving medical treatises that the exam was an integral part of a physician’s practice in ancient Greece and Rome. This continued to be true until the late Middle Ages (1300-1500). The hands-on exam then disappeared for hundreds of years, reemerging gradually in the late 18th century.
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By
Jan -
October 26, 2010
There was no way to use a catheter or give him an IV. We solved the problem the way we would have 50 years ago, with warm compresses and oral antispasmodics. … It has been very important that the [medical] team include older physicians, like me.
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Jan -
October 19, 2010
I‘m now a monthly guest blogger on ConsultantLive, and my first post appeared today. It’s the one where Marcus Welby gives a speech on the rewards of general practice as opposed to specialization. … My column on the site is called “How Health Happened.” It’s mainly about the history of 20th century medicine and how that relates to changing attitudes towards health.
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By
Jan -
October 17, 2010
When we hear the words “tyranny of health” these days, it’s usually a reference to the tyranny of health care. It brings to mind images of protesters carrying signs that denounce the “socialism” of Obamacare. As recently as 1994, however, the tyranny of health had a different meaning … the idea that patients should be coerced into being healthy.
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Jan -
October 16, 2010
That we’re not routinely made seriously ill by this shortfall … is due largely to the fact that most medical interventions and advice don’t address life-and-death situations, but rather aim to leave us marginally healthier or less unhealthy, so we usually neither gain nor risk all that much.
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By
Jan -
October 14, 2010
The American Medical Association once complained about rival practitioners who invented new diseases. A hundred years later, medical thought leaders (also known as Key Opinion Leaders) are paid to promote new diseases.
Is this progress?
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Looking back, it’s now obvious that the Lalonde report did initiate a change in our fundamental understanding of the determinants of health – an understanding that is now beginning to flourish. By stressing the influence of non-medical factors on population health, the report made it possible for governments, academics, and foundations to endorse practices outside conventional medical care. Medical practitioners are equally aware that health care by itself cannot secure a population’s health. Following the Lalonde report, politicians, health merchants, and mass media moguls seized on the idea of healthy lifestyles. They tried to convince us that personal responsibility was the primary determinant of health. In the end, however, I am cautiously optimistic that it is not their voices that will prevail.
