Tag Archive: healthism

Healthy lifestyles: Social class. A precarious optimism

Social determinants of health. Marmot, WilkinsonLooking 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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Healthy lifestyles: The unfortunate consequences

Healthy lifestyles yoga poseCollectively, 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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Healthy lifestyles: The antecedents

Healthy lifestyles yoga poseIn 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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On healthism, the social determinants of health, conformity, & embracing the abnormal: (4) The abnormal part

Abnormal psychologyI was initially attracted to the subject of healthism because I felt I’d been a victim of health messaging. But I was also attracted by a sense that something deeper was going on. I now see that the taken-for-granted – the questions that don’t get asked in media coverage of health issues or in the policy positions of governments — unites my blogging topics. In whose interest is neoliberalism? Medicalization? Conformity? Non-holistic medicine? The commercialization of health? Healthism? More often than not the answer is that it’s not in my interest. Nor is it in the interests of the society I want to live in. And that makes these topics personally meaningful to me.

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (3) Connections

Blog topics and their connections~ Conformity and corporatism: Surgically altering one’s appearance (e.g., designer feet) presumably increases one’s chance of success in a society that commodifies bodies (i.e., in a society where salary, career advancement, social status and marriage prospects are influenced by appearance). Altering one’s personality with psychopharmaceuticals allows one to project the qualities necessary for success in a highly competitive society.

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (2) Economics & the socio-political

Blog topics and their connectionsSocial determinants of health (often abbreviated SDOH) refers to unequally distributed social and economic conditions that correlate with unequal and inequitable distributions of health and disease. Presumably there is a causal relationship between the two, not merely a correlation. Definitively identifying the causal mechanisms, however, is difficult. A great many things influence our health, including things we’re not even aware of yet, and it’s difficult to isolate and scientifically study the ones we can identify.

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (1) Bodies, minds & medicine

Blog topics and their connectionsIt’s always hard to be sure about these things, but I think the reason I decided to take a ‘sabbatical’ from blogging last July was that I was interested in too many seemingly unrelated topics. Writing about all of them left me feeling like I never got to the ‘meat’ of any one of them. And I couldn’t convince myself to focus on just one or two things, since that would mean abandoning the others, which I was unwilling to do.

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What is healthism? (part two)

Apple and stethoscopeOur financially and professionally entrenched system of medical care has a vested interest in maintaining an understanding of health that preserves the status quo. Part of the power of our biomedical culture is that its contingency – the very real possibility that it could be different — is ordinarily invisible to us. What would it take to imagine a widely shared understanding of health that called for dramatic changes not only in how our health care needs are met, but in the conditions under which we live our lives? This is the question that I hope an examination of healthism will provoke.

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What is healthism? (part one)

Apple and stethoscopeThroughout 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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Guest post: Guilt-edged

Bananas with the Globe and MailNow The Globe and Mail Life section reveals I could be guilty of hastening my demise by eating fruit. See The New Enemy in today’s paper, which warns that bananas are the arch enemy of the serious dieter and “that the high fructose content makes grapes and cherries as unhealthy as a plate of cookies.” Or not. Depending on which ‘experts’ you believe.

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Guest post: A sound mind in a disintegrating body

Mens sana in corpore sanoIn order to attain the corpore sano required by today’s fanatical health and hotness community you have to devote two or three hours a day to honing the body beautiful so that it contains no lumps, bra overhang or bits that have to be sucked in when you walk past a mirror. This involves lunges, squats, curls, lat pulldowns, pushups, bench presses and eventual death from exhaustion unless you are of that rare elite who are truly in The Zone.

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From healthism to overdiagnosis

H Gilbert Welch OverdiagnosedTo be fair, many of these experts may be true believers, people who want to do everything they can not to miss anyone who could possibly benefit from diagnosis. But the fact that there is so much money on the table may lead them to overestimate the benefits and ignore the harms of overdiagnosis. These decisions affect too many people to let them be tainted by the businesses that stand to gain from them.

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Guest post: A fat lot of good

Slow bicycleThis delightful person, who signed off with “Yours fatly,” is a woman after my own heart. Her wise words took me back to a holiday in France, where the supermarkets were filled with full, fat, soft, unpasteurized cheeses, divine pastries, calorie and fat-laden crème fraiche and whole aisles of wine. I looked for low fat products and found one tiny, slender end-of-aisle display, where a small coterie of non-Europeans searched for fat-free yogurt and pre-packaged egg whites.

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Old age and the limitations of a healthy lifestyle

Old age and Alzheimer'sHealth is an ideology: a set of ideas that establishes goals, creates expectations, and determines our actions. An ideology provides a way to understand the world and ourselves. It’s only natural that we want to exert control over our health, our susceptibility to illness, the length of our lives. Our anxiety about health – amplified by constant discussion in all available media – makes us vulnerable to the latest promise of the rewards of a healthy lifestyle. The obsessive pursuit of health, however, is itself unhealthy.

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Healthy lifestyles serve political interests

Runner healthy lifestylesUltimately, decisions about a country’s health are not a matter of science, medicine, research, or scholarship. They are essentially political choices. When the US leans right, the solution to the health care crisis is to emphasize personal responsibility (aka prevention through healthy lifestyles). When the country leans left, there’s increased interest in the “negative externalities” of advanced market capitalism (pollution, climate change, ethnic inequities). Neither one is exclusively right or wrong. But when the political climate puts the spotlight on patients who are guilty of unhealthy lifestyles, the focus goes dim on those “fundamental mechanisms leading to disease” that have nothing to do with lifestyle. We lose sight of the genuine solutions that an increased focus on those mechanisms could provide.

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The politics behind personal responsibility for health

Reagan and Thatcher danceAnother great example of neoliberal insistence on personal responsiblity: In a 1980 report on the impact of carbon dioxide on climate change – a report requested by Congress – physicist and free-marketer William Nierenberg argued that we should do nothing to prevent climate change because people could simply migrate. “Not only have people moved [in the past], but they have taken with them their horses, dogs, children, technologies, crops, livestock, and hobbies. It is extraordinary how adaptable people can be.”

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