Transdisciplinarity and the Development of an Integrated Model of Personhood, Health, and Wellness
Good health and well being require a clean and harmonious environment in which physical, physiological, social and aesthetic factors are all given their due importance. The environment should be regarded as a resource for improving living conditions and increasing well being.
– World Health Organization
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
– Martin Luther King, Jr.
Economists at the Centers for Medicare and Medicaid Services released a report in February of this year indicating that expenditures on health care are expected to reach 20% of total spending or $4 trillion dollars in the United States by 2016.1 The cost of out of pocket co-pay expenses is projected to rise 5.3 percent annually, while the cost of health insurance is expected to rise 6.4 percent during the same period of time. The bill for health care will average $12,782 per year for every man, woman, and child, representing a dramatic increase from the current $7,498, which is the highest in the world by almost double what Switzerland with the second highest costs per capita spends on health care. And yet when all this money is spent, Americaâ€™s overall health care ranks the lowest among economically developed nations and anywhere between 30th and 37th in the world.2 In short, we pay the most per capita in the world for our health care and yet our overall health is, to say the least, far from optimal. Moreover, a number of studies tell an even gloomier and far more troubling story as they suggest that the medical system itself is the leading cause of death in the United States.3
The reasons for this situation are of course numerous, but certainly one of the principal explanations for our nation spending so much on health care and yet enjoying less than optimal health is that we invest far more time, energy, resources, and above all money on responding to sickness, extending life among the chronically ill, and providing comfort to those who are dying than we do on promoting healthy lifestyles and creating social and natural conditions that make healthy living universally affordable and relatively easy to do.
In what follows I take up the challenge of identifying what must be done to construct a health care system that puts a premium on health and wellness promotion. I begin by exploring the philosophical, sociological, economic, and ethical dimensions of the institutionally and culturally dominant model of personhood, health, and wellness in the United States. I then elaborate on how developing a transdisciplinary approach to knowledge production, trans-institutional and community cooperation, a co-evolutionary relational ontology of personhood, and cultural-spiritual ethic of practical compassion, harmonious co-existence, and social justice can help us to develop an integrated (or holistic) model of health and wellness promotion that ensures our shared wellbeing.
I. The Historical Development of the Dominant Model of Health Care
The scientific revolution and capitalist political-economy contributed equally to the development and continuation of what has been and remains the dominant model of personhood, health, and wellness. Whereas the modern scientific revolution presented a mechanico-atomistic theory of reality, reductionist-analytic method, and general ethical orientation toward exercising control over reality rather than working in harmony with reality, the capitalist revolution reinforced this scientific worldview by reorganizing the entire system of socioeconomic relations as relations among purportedly free individuals and codifying into law a view of individuals as self-producing monads, freely entering into relationships with each other and responsible for their own conditions of existence At the same time, the emergent bourgeoisie, as owners and investors, sought everywhere to subordinate people, animals, and the earth to the machinery of production and general processes of global capital accumulation. In this way, the philosophical, ethical, and legal-political transformations associated with modern science, the Enlightenment, and liberalism theoretically reflected and simultaneously fortified capitalist social relations.4
Dating when the modern scientific revolution began is a matter of great philosophical, theoretical, and historical debate. Many historians, however, date its beginning with the publication of Nicolaus Copernicusâ€™ On the Revolutions of the Heavenly Spheres and Andreas Vesaliusâ€™ On the Fabric of the Human Body in 1543, and argue that the modern science worldview was forged over the next two hundred years. Developed by such philosophical figures as Sir Francis Bacon (1561-1626), Galileo Galilei (1564-1642), Joseph Kepler (1571-1630), Rene Descartes (1596-1650), and Sir Isaac Newton (1642-1727), the scientific worldview involved a shift form a geocentric to a heliocentric cosmology, from Aristotleâ€™s view of matter as comprised of earth, water, air, fire and ether to a view of matter as composed of separate atoms, from the idea that bodies move according to their own essences to the view that bodies move according to the same laws of motion, and from an epistemology that emphasized knowledge deriving from scriptures, revelation, and intuition to an epistemology that emphasizes knowledge deriving from empirical observation, rational analysis, and controlled experimentation.
In his Principia, Isaac Newton refined and systematized the mechanical-atomistic ontology, empiricist epistemology, and reductionist-analytic methodology, providing the ontological, epistemological, and methodological foundation of modern scientific theory and practice, a foundation which came to inform and in large measure still informs the theory and practice of mainstream medicine. Such a view promoted a view of the body, in both sickness and health, as so many separately functioning systems, acting separately from each other, and the entire body as existing separately from the social and natural environment.
Informed by these ideas, political philosophers argued that just as atoms are what they are as a result of their internal essences and function best when they operate in accordance with their essences, so too individuals are who they are as a result of their essencesâ€”and not their relationships to other human beings, society, or natureâ€”and function best when they are free to realize their essences by pursuing their own interests. Elaborating on this theory, the English philosopher John Locke argued that the central function of government is to promote individual freedom by protecting private property as the basis of individual self-realization. Individuals are responsible for their own wealth, health, and happiness and governments are instituted primarily to ensure they are free to be responsible by negotiating conflicts between individuals and limiting laws that might impede individuals from pursuing their own interests and ends.
Hobbes, meanwhile, presented a darker view of human nature and the relationship between individuals, society, and nature. Rejecting Descartesâ€™ mind/body dualism, free-will, and the immortality of the soul, Hobbes argued for a full-blown materialism that viewed human beings, including their minds, as being complex machines determined by an inescapable appetite for self-preservation and perpetuation and bleakly concluded that life as such is â€œa war of all against all.â€ As many feminist philosophers have noted, Bacon further darkened this already rather gloomy picture. Frequently employing aggressive and sexist metaphors to describe the optimal relationship between man and nature, Bacon, advised his readers to â€œbind [nature] to your service and make her your slave,â€ and in so doing contributed significantly to the development of a general scientific ethos which sought to understand nature for the purpose of subjugating and controlling natureâ€”a view that deeply influenced the development and implementation of modern medicine.
During this same period, the rising bourgeoisie embraced a similar credo as they sought to incorporate human beings as wage-laborers, servants, and slaves, and nature into the expanding machinery of commodity production and wealth accumulation. Their incorporation was justified on the grounds that it created a world in which individuals are equally free to enter into contracts with each other, to buy and sell goods, including their own ability to work, and that society functions best when government protects the right of individuals to act freely without interference. And yet, as is well-known, the ideal freedom of the market place in which individuals are purportedly free to enter into or not enter into contracts with each other, like Lockeâ€™s ideal of the independently acting and self-producing individual, conceals an ontologically weightier level of social reality that compromises the realm of freedom. In Capital Volume I Karl Marx describes the effect of ownership of the means of livelihood, production, and money on the realm of equality.
This sphere that we are deserting, within whose boundaries the sale and purchase of labour-power goes, is in fact a very Eden of the innate rights of man. There alone rule Freedom, Equality, Property and Bentham. Freedom, because both buyer and seller of a commodity, say of labour-power, are constrained only by their own free will. They contract as free agents, and the agreement they come to, is but the form in which they give legal expression to their common will. Equality, because each enters into relation with the other, as with a simply owner of commodities, and they exchange equivalent for equivalent. Property, because each disposes only of what is his own. And Bentham, because each looks only to himself. The only force that brings them together and puts them in relation with each other, is the selfishness, the gain and the private interests of each. Each looks to himself only, and no one troubles himself about the rest, and just because they do so, do they all, in accordance with the pre-established harmony of things, or under the auspices of an all-shrewd providence, work together to their mutual advantage, for the common weal and in the interest of all. On leaving this sphere of simple circulation or of exchange of commodities, which furnishes the “Free-trader Vulgaris” with his views and ideas, and with the standard by which he judges a society based on capital and wages, we think we can perceive a change in the physiognomy of our dramatis personÃ¦. He, who before was the money owner, now strides, in front as capitalist; the possessor of labour-power follows as his labourer. The one with an air of importance, smirking, intent on business; the other, timid and holding back, like one who is bringing his own hide to market and has nothing to expect butâ€”a hiding.5
Just as exchanges between human beings are always inescapably shaped by extra-individual social, political, and especially economic forces, so too are personhood, health, and wellness shaped by trans-individual social and environmental conditions. For the most part, however, the dominant model of personhood, health, and wellness has rarely taken into serious account these conditions, and has simultaneously provided the basis for arguing against calls to address health as a fundamentally public health concern requiring significant government intervention. Referring to neo-liberalism, medical doctor, anthropologist, and human rights activist Paul Farmer notes that â€œwithin this doctrine, individuals in a society are viewed, if viewed at all, as autonomous, rational producers and consumers whose decisions are motivated primarily by economic or material concerns. But this ideology has little to say about the social and economic inequalities that distort real economiesâ€ and which, he adds, in no small measure determine our health and wellbeing.6
Historically, then, modern scienceâ€™s mechanical-atomistic ontology and reductionist-analytic methodology converged with, supported, and still support capitalismâ€™s view of human beings as monadic individuals responsible for their own conditions of existence and helped to shape the development of what became and remains the institutionally and culturally dominant model of personhood, health, and wellness.
II. The Nature of the Dominant Model of Health Care
This model of personhood, health, and wellness is characterized by several well-known features, including, as identified above, an emphasis on responding to sickness rather than promoting health; an emphasis on allopathic and osteopathic rather than homeopathic and body-friendly interventions; an emphasis on technologically sophisticated and intensive, often physiologically, emotionally, and psychologically invasive, and always financially expensive interventions over relatively simple, low-tech, natural and complementary remedies; an emphasis on body-part and body-system alteration over habit and life-style modification; a tendency to interpret physical, emotional, and psychological symptoms in abstraction from each other and the larger life-world as if the body, soul, and mind did not intimately affect each other and were not intimately affected by the social and natural life-world in which they exist; that is, a tendency to interpret symptoms solely as signs of individual illness rather than as symptoms of an unhealthy lifestyle or degraded conditions of life.
Among the most revealing examples of the dominant model of personhood, health, and wellness is the increase in bariatic surgery in response to obesity.7 According to a recent University of Michigan study, between 1996 and 2002, the â€œuse of bariatic surgery has increased seven-fold nationally, and its use has more than tripled among youth.â€8 Given the intense personal and commercial pressure on women to look as perfect as the computer enhanced images of flawless women they are bombarded with hundreds of times each day, it comes as little surprise that â€œmore than 80 percent of individuals in all age groups who underwent the procedure were female.â€ The study also indicates that the increase in bariatic surgeries â€œis having a noticeable impact on health insurance: in 2002, hospitals charged more than $2 billion for these procedures, with more than 80 percent billed to private insurers. On average, each hospital stay in 2002 for bariatic surgery led to about $29,000 in charges.â€9 Add to the increase in surgeries for obesity the equally dramatic increase in cosmetic surgeries among all age groups, including teenagers, and that, according to some studies, â€œonly 8% are happy with their bodiesâ€ and that they â€œseem to be getting unhappier every yearâ€ and you have a sense of societyâ€™s physical health as well as its emotional, intellectual, social, and spiritual health.10 Rather than address the larger social conditions that make it easy for individuals to overeat bad food, we turn to surgery, medicines, and other invasive therapies to fix problems that might otherwise be addressed by fostering healthy behaviors and creating social conditions that make adapting and practicing these behaviors easy and affordable.
Meanwhile, when we arenâ€™t turning to surgery to cure our physical, emotional, and psychological ailments, we are turning to medications; much to the portfolio pleasure of the owners and investors in the largest international pharmaceutical companies. Under enormous and growing pressure from the most profitable industry in the United States,11 from health maintenance organizations and health insurance companies which have increasingly reduced the time health practitioners may spend with patients, and from patients who, having been convinced by multibillion dollar drug company marketing efforts, expect lickety-split cures for their physical, cognitive, and emotional problems, doctors find themselves dispensing pharmaceutically generously supplied medications to cure every illness we suffer, however real or imagined these illnesses may be.12
Drugs are now marketed for everything from diabetes, headaches, backaches, every kind of stress related disorder, both real and imagined, muscle aches and pains, insomnia, fatigue, high cholesterol, hypertension, irritable bowel syndrome, depression, sexual dysfunction, acid reflux, constipation, attention deficit disorder, restless leg syndrome, and digestive problems that inevitably result from eating fast food so that one may continue eating fast food without suffering the immediately unsettling physiological effectsâ€”of course this drug does nothing to inhibit fast foodâ€™s long-term and as is well-known ultimately lethal effects. There is nothing we suffer that cannot be cured by taking a pill.13 Stan Cox offers a detailed description of how â€œthe pharmaceutical industry has a dream: at least one disease (and more than one prescription drug) for every Americanâ€:
Drug corporations and their “awareness” groups, as we’re all painfully aware, have defined and redefined a host of medical conditions — including female sexual dysfunction, erectile dysfunction, restless legs, sleeplessness, bipolar disorder, attention deficit disorder, social anxiety disorder and irritable bowel syndrome — to include larger and larger segments of the population in the United States and other Western nation. Accepting for a moment the industry’s claims about the numbers of people suffering from the eight diseases listed above, we could do some simple calculations showing that up to 93 percent of adult women and men in the United States suffer from at least one of them. Throw in a few more conditions like depression, bone density loss and premenstrual dysphoric disorder, and industry figures make it appear that virtually every American has a disease in need of a treatment.14
Moreover, consumption of drugs is leading to increased environmental problems. Writing for the National Resource Defense Council magazine OnEarth, Elizabeth Royte offers an equally alarming description of the relationship between prescription drug consumption and the water systems on which all life depends. She notes that â€œprescription drug sales rose by an annual average of 11 percent between 2000 and 2005. Americans now fill more than three billion prescriptions a year,â€ a fact which in itself is troubling enough (10/23/06). What makes this figure more troubling, however, is that many of these drugs are showing up in the streams, rivers, and lakes that supply water for agriculture, animals, and humans. Dr. Marc Taylor, medical director of the River Glen Health Care Center, in Southbury, Connecticut, expresses â€œâ€˜concerned about pharmaceuticals in the river because I am a doctor â€¦ and because I know these drugs are bioactive.â€™ That is, they can enter the bioprocesses of aquatic organismsâ€ (ibid.).
A Baylor University researcher found tiny amounts of Prozac in liver and brain tissue of channel catfish and black crappie captured in a creek near Dallas that receives almost all of its flow from a wastewater treatment plant. The creek also connects to a drinking water supply. A University of Georgia scientist found that tadpoles exposed to Prozac morphed into undersize frogs, which are vulnerable to predation and environmental stress. The EPA reports that antidepressants can have a profound effect on spawning and other behaviors in shellfish and that calcium-channel blockers (used to relieve chest pain and hypertension) can dramatically inhibit sperm activity in some aquatic organisms. Even at extremely low levels, ibuprofen, steroids, and antifibrotics — a class of drugs that helps reduce the development of scar tissue — block fin regeneration in fish. According to a report by the Scientific Committee on Problems of the Environment, a worldwide network of scientists and scientific institutions, and the International Union of Pure and Applied Chemistry, more than 200 species — aquatic and terrestrial — are known or suspected to have experienced adverse reactions to such endocrine disruptors as estrogen and its synthetic mimics.15
Our fast food way of life, a way of life that is tremendously wasteful, producing enormous quantities of toxic wastes, does not encourage us to exercise regularly, to eat more fruits and vegetables, fresh, whole, and if possible local and organic foods, and in general eat less, as Michael Pollan advises in The Omnivoreâ€™s Dilemma (2006), nor meditate, nor spend less time watching television and computers and more time reading, in nature or with friends and family, nor drink fresh water,16 a practice many studies show is the single most important thing we can do for our overall health and wellbeing. Rather we are culturally and institutionally encouraged to consume ever expanding quantities of unhealthy â€œfoodâ€ and beverages and spend the majority of our waking-life, desk-bound, car-seated, and couch-potatoed. The fast food way of life is reinforced by a health care system that responds to sicknesses resulting from this life rather than helping to create a society that promotes healthy life-styles. It is, in fact, no way of life at all.
Research on diseases, increasingly driven by corporate funded grants, focuses more on curing diseases than it does on promoting health, more on how best to respond to diseased bodies than on how to prevent bodies from becoming diseased in the first place. Hundreds of millions of dollars are spent annually, for example, on trying to find a cure for cancer. At the same time, however, we invest much less time, energy, resources, and money to research on what might be done to detoxify our homes, workplaces, air, land, and water of known carcinogenic chemical contaminants and to build environments that do not put our health at risk.17
The dominant model of personhood, health, and wellness still defines health in primarily negative terms as â€œthe absence of diseaseâ€ rather than the presence of health and wellness.18 The advice, â€œif it ainâ€™t broke, donâ€™t fix itâ€ crudely expresses this modelâ€™s approach to health, and we might add, to finish the advice, â€œwhen a part is broken, apply copious quantities of medications and technology to fix it, and as quickly as possible.â€ So pervasively institutionalized is this view that many critics argue we do not have a health care system in the United States so much as we have a â€œsickness-careâ€ system.19 We are, in other words, a far cry from being guided by the World Health Organizationâ€™s definition of health as a â€œstate of complete physical, mental, and social well-being and not merely the absences of disease.â€20
Lamentably our tax money all too frequently goes to supporting bad health behaviors. By giving billions dollars in tax subsidies, holidays, and write-offs to multinational agricultural, fast food, tobacco, and pharmaceutical companies, governments support the very same forces that make choosing healthy lifestyles socially, culturally, and economically more challengingâ€”in short, we do not invest in the creation of healthy social environments to the same extent we invest in the creation of environments that compromise our health.21 In Food Politics: How the Food Industry Influences Nutrition and Health, Marilyn Nestle notes, for example, that at â€œits peak, the 5 A Day fruit and vegetable program from the National Cancer Institute had $2 million for promotion. This is one-fifth the $10 million used annually to advertise Altoids mints.22 In turn, the Altoids budget is a speck compared to budgets for the big players—$3 billion in 2001 for Coca-Cola and PepsiCo combined just for the United States.â€23
And yet, while evidence regarding the success of the dominant model of personhood, health, and wellness to support the creation of a healthy society is at best anemic, this model nevertheless remains firmly institutionalized, buttressed by medical specialization and disciplinary compartmentalization, and above all economically entrenched. While there is no shortage of brilliant ideas regarding how to build a health care system that invests as much, if not more, time, energy, resources, and money into the promotion of health and wellness as the current system does responding to illness, dying, and death, implementing these changes requires confronting the fact that, as indicated, the current model of personhood, health, and wellness is reinforced by the free-market ideology of individualism and by powerful corporations and individuals getting rich or, more often, even richer from the current system. Inasmuch as the free-market promotes the idea that individuals are who they are in abstraction from their social and natural conditions of existenceâ€”that individuals are the sole makers of their own (sick)bedâ€”it reinforces the idea that illness may be adequately understood and addressed without attending to the complexity of conditions that determine our health and wellness.
When asked if learning about lifestyle, nutrition, and prevention were part of medical school education, Neal Barnard, M.D., author of Eat Right, Live Longer; Food for Life, and founder of a program for reversing diabetes without the use of medications, explains that â€œnot only were those things neglected in medical school, they were completely neglected in my personal life.â€ He elaborates: â€œWhen I went to medical school, we learned a great deal about how to diagnose conditions, how to manage them medically, and how to prescribe drugs. Unfortunately, one thing we did not pay much attention to was how to prevent conditions like cancer or heart disease.â€24 Lamentably, attention to preventing cancer, coronary heart disease, and other chronic diseases still takes a distant second to the attention devoted to treating these diseases once theyâ€™ve developed.
Moreover, given the enormous fortunes made by individuals, organizations, and industries from sickness and suffering (more than 16% of GDP), shifting to a health promotion model that reduces the incidence of sickness and thereby the source of this wealth is not something that can be accomplished without on the one hand challenging the still culturally entrenched idea that health care remain primarily a means for making profits and on the other affirming the idea that health care ought to be understood as a fundamental human rightâ€”an idea affirmed by many nations around the world, a growing number of health care providers and citizens in the United States, the World Health Organization, Millennium Development Goals, Earth Charter, and the1948 United Nations Declaration of Human Rights which specifies that everyone should not only enjoy access to health care but also health promoting social and natural environments.25
III. An Emerging Alternative
In fact, over the past few decades the dominant model of personhood, health, and wellness has been challenged on several fronts. It has been challenged by Eastern and religious and alternative philosophical ideas and practices, including yoga, meditation, Ayurveda, homeopathic and naturopathic medicine, acupuncture, massage, and herbal medicine. The percentage of citizens becoming informed about these ideas and taking up these practices has increased dramatically over the past thirty years. The number of products, businesses, books, institutes, courses, and schools devoted to these ideas and practices has grown exponentially and continue to grow in number every year. We might add to this growth the fact that grocery stores are expanding their health food offerings so that foods which once took up only a small portion of a single isle now take up an entire section of the store.
The dominant model of personhood, health, and wellness is also being challenged by an emerging worldview that, in distinction from the atomistic-mechanical worldview, emphasizes the complex, interdependent, and co-evolving nature of and relations within biological and ecological systems and on the basis of this worldview recognizes not only that mind, body, and spirit influence each other but that built and natural environments also shape our intellectual, emotional, physical, social, and spiritual health and wellbeing. Scientific theories of co-evolutionary adaptation, biological complexity and emergence, and quantum physics, theologies which emphasize the developing nature of existence, Buddhist ideas of co-dependent origination, and Native American ideas regarding the complex web of creation and the Earth as source of all life, as well as fecund insights from art, poetry, literature, music, and dance are all in their own way helping to give form and content to this emergent worldview.
Moreover, the dominant model of personhood, health, and wellness is being challenged by organizations like the Templeton Foundation and Metanexus which by fostering interdisciplinary dialogue make it possible to generate new insights and responses to health and wellness. The Canadian philosopher Charles Taylor, winner of the 2007 Templeton Prize for Progress Toward Research or Discoveries About Spiritual Realities, hits the methodological nail on the head when he contends that we must avoid the reductionism and specialization that has structured the production of knowledge since the modern scientific revolution and develop more complex models and modes for understanding the evolving and interrelated nature of the world if we are to successfully address the urgent challenges of our time.
Fourth, and as indicated, the dominant model is being challenged by mounting evidence and widespread first-hand experience that it not only fails to promote healthy human beings, it fails to ensure that all persons receive good care when they do get sick. In â€œIs US Health Really the Best in the World?,â€ an article published in the July 2000 issue of JAMA, Barbara Starfield, MD, MPH, writes that
the high cost of the health care system in the United States is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care, despite evidence from a few studies indicating that as many as 20% to 30% of patients receive contraindicated care. In addition, with the release of the Institute of Medicine (IOM) report â€œTo Err is Human,â€ millions of Americans learned, for the first time, that an estimated 44,000 to 98,000 among them die each year as a result of medical care. The fact is that the US population does not have anywhere near the best health in the world. Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators.26
As many as 50 million Americans or one in six lack health insurance and a good portion of those who are insured face rising co-pays and increased limits on what their insurance will cover, thereby further reducing access to existing medical care providers, resources, and services. The leading cause of personal bankruptcy in the United States is medical bills.27 Moreover, the number of individuals whose illnesses are misdiagnosed or not diagnosed at all, who are given unnecessary diagnostic tests or not given tests that would make it possible to detect diseases in the earliest stages of development or prevent the development of diseases altogether, who are overmedicated, undermedicated, and sometimes both, or given the wrong treatments, unnecessary medications and surgeries, who contract bacterial infections and communicable diseases while undergoing treatment in health facilities, and who are permanently impaired or perish every year as a result of the mistakes and problems enumerated above, all of these numbers have been on the rise and contribute to a high percentage of the total number of deaths in the United States, so many that some researchers contend that the medical system itself is the leading cause of death and injury in the United States.
A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million. Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics. The number of unnecessary medical and surgical procedures performed annually is 7.5 million. The number of people exposed to unnecessary hospitalization annually is 8.9 million. The total number of iatrogenic [induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures] deaths â€¦ is 783,936. It is evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251. 28
In â€œWhatâ€™s Making Us Sick is an Epidemic of Diagnoses,â€ H. Gilbert Welch, Lisa Schwartz, and Stevel Woloshin add that itâ€™s not only the enormous and seemingly growing number of diagnostic, therapeutic and other medical mistakes made by health care professionals that are responsible for so many unnecessary injuries and deaths, but also that there is in general â€œan epidemic of diagnoses. This epidemic is a threat to your healthâ€ and partly a result of â€œthe medicalization of everyday lifeâ€ in which â€œexperiences like insomnia, sadness, twitchy legs and impaired sex drive now become diagnoses: sleep disorder, depression, restless leg syndrome and sexual dysfunction.â€29 The other factor contributing to an epidemic of diagnoses is â€œthe drive to find disease early.â€ In any case, one thing is clear, the expanded definition of what constitutes disease means â€œmore money for drug manufacturers, hospitals, physicians and disease advocacy groups.â€
Finally, the dominant model of personhood, health, and wellness is being challenged by a growing public interest in and demand for alternatives to the current system. As more citizens confront impossible medical bills and sky-rocketing health insurance costs, the idea that health care, like education, ought to be culturally understood, institutionally recognized, and socially organized as a basic human right available to all regardless of income and the need for some kind of national health insurance are both gaining public support. Beyond creating a system of universal access, however, there is also, as noted, growing awareness regarding the need to develop a model of health care that promotes physical, mental, emotional, intellectual, and spiritual health, and which understands that accomplishing these goals requires us to build healthy social and natural environments.
In a study published this April in the American Journal of Public Health, Steven H. Woolf, M.D., M.P.H., professor in Virginia Commonwealth Universityâ€™s Department of Family Medicine, and his colleagues note that â€œsocial change could trump medical advances in saving lives, because social conditions hold great influence over health status.â€30 Their study indicates that whereas medical advances prevented approximately 175,000 deaths in the United States between 1996 and 2002, eight times as many lives could have been saved by improving education and social conditions. Unfortunately, adds Woolf, â€œtoday’s leaders embrace opposite priorities, however â€¦. Indeed, budget pressures from escalating health care costs and medical research have led the government to reduce support for social services, including education, thereby choking off an upstream strategy that could reduce the demand for health care.â€31
Colborn, Dianne Dumanoski, and John Peter Meyers, authors of Our Stolen Future, a book detailing the effects of chemicals on our health and wellbeing, write:
Yes, medical advances in treating malignancies like prostate cancer have achieved dramatic improvement in survivorship. But the cancer itself still extracts an important toll on life. In this case, it’s impotence. Children suffering from brain tumors have life-long legacies of the disease and the treatment, even though they are cured of the cancer itself. Women after surgical treatment for breast cancer struggle with the psychological and physical impact of mastectomy. These examples, and many more, emphasize the need to focus on prevention, on reducing the incidence of cancer, not just decreasing the mortality rate once cancer develops. A exclusive focus on “cure” misses entirely how best to advance public health protections, and any individual or organization that uses cancer mortality data to buttress an argument that we are winning the war against cancer should be suspected of abetting interests that place a secondary value on public health.32
In a similar vein, the Center for Disease Control and National Institute of Health contend that â€œâ€˜Intensive lifestyle interventionsâ€™ including physical activity and improving diet can help prevent pre-diabetes [among many other conditions] from progressing in adults and it’s likely the same can happen in children…. [S]ystematic societal changes are needed, too, including more healthful school lunches. â€˜It’s just not enough to tell people to exercise and eat rightâ€™,â€33 rather we must create social conditions that make it easy to do both.
There is a growing recognition that a good number of the ailments we currently suffer, including the leading causes of morbidity in the US, are in larger measure the result of choices we make with regard to such things as diet and exercise. The top ten leading causes of death in the United States are, in order, chronic diseases of the heart (28.5% of all deaths), cancer (22.8%, (stroke, 6.7%), chronic lower respiratory disease (5.1%), accidents (4.4%), diabetes mellitus (3.0%), influenza and pneumonia (2.7%), Alzheimerâ€™s (2.4%), kidney disease (1.7%), and blood poisoning (1.4%).34 Among these, numerous studies suggest that the first two, heart disease and cancer, which account for more than half of all deaths, as well as diabetes, Alzheimerâ€™s, and kidney disease, are strongly correlated with diet, exercise, or lack thereof, and environmental conditions. In other words, by encouraging healthier diets and exercise and by creating environments that support good diets and exercise we have every reason to believe that we would see a dramatic diminishment in these numbers and resulting diminishment of the costs associated with what is currently called health care in the U.S.
We may reasonably assume that if we spent as much money on health promotion, and no doubt it would amount to much less than what we currently spend right now on responding to diseases and other ailments, we could radically reduce the leading causes of suffering, disease, and mortality in the United States. The challenge before us, then, is to creatively reorient our thinking about health care away from its current focus on how best to respond to sickness toward how best to promote a healthy society for everyone.
IV. Developing an Integrated Model of Personhood, Health, and Wellness
More than a patient-centered model of health care or whole person-centered model of health, what is needed more than ever and not just in the United States but in many parts of the world is a whole-person-in-community-and-nature model of health and wellness. In 1989, the American Journal of Health Promotion contributed to meeting this need by defining â€œoptimal health as a balance of physical, emotional, social, spiritual, and intellectual health. Lifestyle change can be facilitated through a combination of efforts to enhance awareness, change behavior and create environments that support good health practices. Of the three, supportive environments will probably have the greatest impact in producing lasting change.â€35 The AJHP definition of health goes well beyond the definition of health as the absence of disease by identifying dimensions of health that comprise not just the physical body but other dimensions of what it means to be a person. By defining health as the presence of physical, emotional, social, spiritual, and intellectual health, the AJHP provides a basis for developing an integrated model of individual and societal health promotion. Such a model would focus on the creation of resources, professionals, and institutions whose overarching goal would be to foster awareness, change behavior and facilitate the construction of social, cultural, economic and natural environments that make it possible for individuals to enjoy optimal health. In â€œRequirements of a health environment,â€ The World Health Organization rightly notes that â€œgood health and well being require a clean and harmonious environment in which physical, physiological, social and aesthetic factors are all given their due importance. The environment should be regarded as a resource for improving living conditions and increasing well being.â€ To create environments that make it possible for citizens to enjoy good health and wellbeing will require us to make a complex of interrelated theoretical-methodological, institutional, socioeconomic, cultural, and ultimately spiritual changes.
A. Transdisciplinarity and an Integrated Model of Health and Wellness
Developing a transdisciplinary method for producing knowledge is essential to developing an integrated model of health and wellness. Such an approach involves bringing together experts from different disciplines, including the natural, life, and social sciences, as well as the arts and humanities to discern how best to build a society that nurtures all of the dimensions of what it means to be a healthy person. Working in collaboration, physicians, biologists, environmentalists, sociologists, economists, architects, urban planners, theologians, philosophers, artists and writers, can share what they know and explore new ideas regarding how best â€œto enhance awareness, change behavior and create environments that support good health practices,â€always bearing in mind, as the American Journal of Health Promotion indicates, that creating â€œsupporting environments will probably have the greatest impact in producing lasting change.â€36 It would be difficult, if not impossible, to determine what must be done to build social and natural environments that nurture our physical, emotional, social, intellectual, and spiritual health and wellness without the input of individuals from diverse disciplines and backgrounds.
Developing a rich appreciation for and understanding of the complex relationships between individuals, society, and the environmental can only be successfully accomplished by creating institutional resources that make it possible for researchers, scholars, practitioners, and community members to share what they know with each other and work together to create knowledge that enables us to â€œraise awareness, change behaviors, and, as importantly, build environments that support good health practices. In short, itâ€™s not enough to call for scholars to work together to produce transdisciplinary knowledge. They must be supported institutionally and financially to do this work.
To ensure transdisciplinary research actually improves the health and wellbeing of ordinary people it must be translated into specific programs, policies, and practices which individuals, businesses, governments, schools, and communities can actually implement. This can be done by creating opportunities for researchers to work with extra-academic institutions, organizations, communities, and individuals. Transdisciplinary research is, in other words, most likely to make a difference that makes a real difference with regard to promoting health and wellness if we create relations of trans-institutional and extra-institutional collaboration.
The goal of such collaboration would not so much be to develop â€œthe whole story of the whole cosmos for the whole personâ€ but rather to forge practical knowledge about human beings, society, nature, and the cosmos that help us to design environments and care for nature in a way that ensures optimal health and wellbeing for everyone. Here Aristotleâ€™s concept of phronesis or practical wisdom, wisdom that derives from the labor of thinking about and transforming oneself and the world, may provide a fruitful way to think about the telos of transdisciplinary work. In his Nicomachean Ethics Aristotle suggests that:
The most characteristic function of a man of practical wisdom is to deliberate well: no one deliberates about things that cannot be other than they are, nor about things that cannot be directed to some end, an end that is a good attainable by action. In an unqualified sense, that man is good at deliberating who, by reasoning, can aim at and hit the best thing attainable to man by action.37
In this case, the ethical end toward which our collaborative deliberation aims is to create a society that promotes all-around health and wellnessâ€”an end that is most likely to be achieved if our intellect, imagination, passion, spirit, and creativity are fully involved in he work of achieving it. InLove’s Knowledge: Essays on Philosophy and Literature, Martha Nussbaum notes that,
Aristotle tells us in no uncertain terms that people of practical wisdom, both in public and in private life, will cultivate emotion and imagination in themselves and in others, and will be very careful not to rely too heavily on a technical or purely intellectual theory that might stifle or impede these responses. They will promote an education that cultivates fancy and feeling through works of literature and history, teaching appropriate occasions for and degrees of response.38
Transdisciplinary research can at its best not only bring together scholars from diverse disciplines but also engage all of the dimensions of who we are as individuals. We are after all most likely to succeed in our efforts to build environments that nourish our physical, emotional, social, intellectual, creative and spiritual health if we mobilize our physical, emotional, social, intellectual, creative and spiritual capacities.
B. Relational Ontology
The American Journal of Health Promotionâ€™s definition of health as one that attends to physical, emotional, social, spiritual, and intellectual dimensions of what it means to be a person and that recognizes the need to â€œenhance awareness, change behavior and create environments that support good health practicesâ€ invites us to shift from an atomistic-individualistic to a relational concept of personhood that understands the self as shaping and being shaped by her social and natural conditions of existence. In other words, shifting to a model of health care that invests seriously in health promotion means shifting away from the concept of personhood as a monadic entity, a self-producing and consuming being, whose existence is not determined by his or her relations with others or by the social and natural conditions within which he or she exists, a view which, though belied by the biological fact of our essentially social nature and the social fact of our deepening interdependence, leads citizens to believe their health is largely unrelated to society and nature. In contrast, a relational concept of personhood holds we are who we are as a result of our relationships to others and to our social and natural environment. While individuals make their own bed, they never do so entirely from materials of their own making. A relational concept of personhood is capable of more fully appreciating that adopting healthy behaviors depends on a complex of conditions, including being aware of what are in fact good health practices, having the personal capacity to undertake these practices, and enjoying environments that support their undertaking. One may know a lot about the importance of diet and exercise but lack the financial means to buy healthy food and afford the costs associated with exercising. Or one may lack both the money and access to healthy foods and live in neighborhoods that are not conducive to exercising outdoors.
Numerous studies suggest that unhealthy social and environmental conditions of life and living are as much a problem as lack of knowledge about health and wellness. Obesity in the United States and around the world has increased dramatically with the increasing prevalence of fast-food restaurants and stores. From 1960, when McDonaldâ€™s had very few restaurants, to the year 2000, when McDonaldâ€™s had more than 30,000 restaurants, the rate of obesity increased from 13.3 to 30.9%. Furthermore, according to a new study published in the American Journal of Public Health, â€œkids are eating fast food much more often than they used to; nearly 20 percent of calories that 12- to 18-year-olds eat come from fast food, compared with 6.5 percent in the late 1970s,â€ an increase that is most certainly due to the fact that, as a study of 1,292 schools revealed, â€œon average, schools were about 500 meters away from at least one fast food restaurant. Thirty percent of schools had at least one restaurant within 400 meters, an easy five-minute walk, while 80 percent had one or more within 800 meters, or about 10 minutes away on foot.â€39 Add to this that fast food is often readily accessible within schools and itâ€™s not difficult to appreciate the role that built environments play in shaping behavior. It should come as no surprise, then, that despite relatively widespread information regarding the importance of good nutrition, diet, and exercise adult obesity rates continue to rise.40 In short, all of the good education in the world is no match for a social environment that provides easy access to unhealthy food and does little to encourage an active lifestyle.
A recent study suggests that as much as 25% of diagnoses of depression may be misdiagnoses, as they identify normal responses to depressing situations as abnormal; in short, by interpreting symptoms as signs of individual illness rather than as signifiers of the social context within which people live.
Up to 25 percent of people in whom psychiatrists would currently diagnose depression may only be reacting normally to stressful events such as a divorce or losing a job, according to a new analysis that reexamined how the standard diagnostic criteria are usedâ€¦. The finding could have far-reaching consequences for the diagnosis of depression, the growing use of symptom checklists to identify those who may be depressed, and the $12 billion-a-year U.S. market for antidepressant drugsâ€¦. Diagnoses are currently made on the basis of a constellation of symptoms that include sadness, fatigue, insomnia and suicidal thoughts. The diagnostic manual used by doctors says that anyone who has at least five such symptoms for as little as two weeks may be clinically depressed. Only in the case of someone grieving over the death of a loved one is it normal for symptoms to last as long as two months, the manual saysâ€¦. The new study, however, found that extended periods of depression-like symptoms are common in people who have been through other life stresses such as a divorce or a natural disaster and that they do not necessarily constitute illness. The study also suggested that drug treatment may often be inappropriate for people who are experiencing painful — but normal — responses to life’s stresses. Supportive therapy, on the other hand, may be useful — and may keep someone who has been through a divorce or has lost a job from going on to develop full-blown depression. The researchers — including Michael B. First of Columbia University, the editor of the authoritative diagnostic manual — based their findings on a national survey of 8,098 people. They found that those who had experienced a variety of stressful events frequently had prolonged periods in which they reported many symptoms of depression. Only a fraction, however, had severe symptoms that could be classified as clinical depression, the researchers saidâ€¦.”The cost of not looking at context is you think anyone who comes under this diagnosis has a biological disorder, so should more or less automatically get antidepressant medication, and everything else is superfluous,” said lead author Jerome Wakefield, a New York University researcher who studies the conceptual foundations of psychiatry. “There is a trend to treat people in this somewhat mechanized way.” Said First: “One issue this would play out at is at the level of medication. If someone has a normal grief reaction, you wouldn’t give that person an antidepressant, you would favor counseling. If someone has major depression you would be more likely to medicate. So this could influence how clinicians think about medications or psychotherapy.”41
What such studies point to is precisely what NYU researcher Jerome Wakefield indicates, namely, that we need to look at the social context within which people live. It may well be that the most salient reason for depression is the depressing nature of our social circumstances. Feeling sad, depressed, sorrowful, melancholy, frustrated, angry, despondent, etc., may be precisely what we would and should expect healthy human beings to experience in response to the varied, difficult, and often alienating conditions in which so many human beings exist and try to find their way in the world. In short, the key to mental, emotional, and physical health may well lie in the adoption of different health practices and the construction of social environments that support those practices.
In The Food Revolution, John Robbins notes that
In 1997, the American Institute for Cancer Research, in collaboration with its international affiliate, the World Cancer Research Fund, issued a major international report, Food, Nutrition and the Prevention of Cancer: A Global Perspective. This report analyzed more than 4,500 research studies, and its production involved the participation of more than 120 contributors and peer reviewers, including participants from the World Health Organization, the Food and Agricultural Organization of the United Nations, the International Agency on Research in Cancer, and the U.S. National Cancer Institute. Since its publication, the report has been hailed by scientists around the world and has helped to establish a new foundation for research and education efforts related to cancer prevention. The report finds that 60 to 70 percent of all cancers can be prevented by staying physically active, not smoking, and most important, by following the reportâ€™s number one dietary recommendation: â€œChoose predominantly plant-based diets rich in a variety of vegetables and fruits, legumes, and minimally produced starchy staple foods.â€42
While knowledge regarding the value of staying active, not smoking, and eating a primarily plant-based diet rich in a variety of vegetables, fruits, legumes, nuts, grains, and seeds is essential to good health, equally important is the need for a just distribution of appropriate social resources and the creation of health-promoting social conditions that make it relatively easy for individuals and communities to exercise and to eat healthy. To recognize the impact of social resources and conditions on our health is to recognize, as Paul Farmer points out, what the World Health Organization now acknowledges: namely, â€œthat poverty is the worldâ€™s greatest killer: â€˜Poverty wields its destructive influence at every stage of human life, from the moment of conception to the grave. It conspires with the most deadly and painful diseases to bring a wretched existence to all those who suffer from it.â€43 Recognizing the impact of social resources and conditions requires us to respond forthrightly to the economic forces that condemn entire populations to poverty.
Itâ€™s not enough, however, to attend to the effect of socially created environments on our health. We must also consider how the natural environment affects our health.44 In “Hundreds of Man-made Chemicals Are Interfering with Our Hormones and Threatening Our Children’s Future: A Special Report,â€ Gay Daly writes:
There are now more than 100,000 synthetic chemicals on the market, and these chemicals are everywhere. They enter our bodies and those of other animals through every possible route of transmission. They are in our food supply, so we eat them. They drift in the air, so we breathe them. (Carried on thermal currents, they have long since reached the Artic, so polar bears breathe them too.) Present in landfills, they leach into the water supply, so we drink them. Released as effluent into lakes and rivers by factories, they affect the habitat of fish, frogs, and all aquatic life, right down to plankton. Ubiquitous in cosmetics, they are absorbed through our skin. Pregnant women pass them to their fetuses; mothers feed them to their newborns when they breastfeed.45
The toxic chemical saturation of our worldâ€™s land, air, and water continues apace, with no small degree of support from the most powerful governments in the world, whose legislative representatives are quite often under heavy lobbying pressure from the same multinational corporations that manufacture the chemicals our representatives are responsible to regulate. Studies on the effects of these chemicals on human, animal, and ecological health do not make for exactly uplifting reading: the impact of DDT on womenâ€™s ability to become pregnant and give birth to healthy babies; toxic chemicals migrating to the Artic and threatening animals and the humans who depend on these animals for sustenance (as Marla Cone notes, “even before they leave the safety of their dens, [polar bear] cubs carry more pollutants than most other creatures on Earth, having ingested industrial chemicals from their mother’s milkâ€); the link between pesticides like alachlor, diazinon, and atrazine and reduced sperm counts and higher rates of prostrate cancer; the relationship between carcinogenic arsenic-treated wood products, including child playground sets sold at major home improvement stores on childhood cancer rates; the presence of birth control drugs in river systems impairing fertility in fish and highly toxic chemicals found even in fish living in glacier-fed, remote lakes; the fact that half the rivers in the United States are now compromised by chemical contaminants; the effect of endocrine disrupting chemicals, including brominated flame retardants and Teflon, on normal biochemical processes; the impact of low level lead exposure on neurological development; the effect of rocket fuel perchlorate in lettuce and other produce grown in the southwest on human health; the relationship between mercury-based additives in vaccines and autism; that, according to a United Nations Environment Programme report, â€œthe world’s environment is increasingly contaminated by mercury, a developmental neurotoxinâ€; and that the Colorado river, a source of drinking water for more than 15 million people and which provides water for much of the agricultural in the southwest is contaminated with perchlorate, a chemical which even at â€œlow levels â€¦ interferes with thyroid action and may thus disrupt developmental processes under thyroid control, including brain developmentâ€”to describe a few of the many environmental reports released during the years 2002 and 2003 alone. â€œGiven our understanding of the way chemicals interact with the environment, you could say,â€ as does Sir Tom Blundell, chair of Englandâ€™s Royal Commission on Environmental Pollution and the University of Cambridge department of biochemistry, â€œwe are running a gigantic experiment with humans and all other living things as the subject,â€ and this experiment, far from being limited in its effects, is radically altering the bio-chemistry of the earthâ€™s ecology.46
Given this fact and the more general degradation of the earthâ€™s ecosystems, it is clear, as the most recent Millennium Ecosystem Assessment report unmistakably indicates, that efforts to promote human health and wellness will in large measure come to naught if we do not simultaneously concern ourselves with promoting the health and wellness of our planet. Doing so means moving toward not merely toward a holistic concept of the self but rather toward a concept of the self as self-in-community-and-nature. We must deepen our awareness and understanding of the intimate relationship between self and world.
An ontology of relationality suggests that our personal health is inescapably dependent on the health of others and the larger biotic community to which we belong and upon which we depend. While individual health and wellness depends on what each of us does individually, what each of us can do is deeply shaped by the world in which we exist. We may read that itâ€™s good to drink a lot of water but if the water we drink is poisoned with mercury, PCBs, and other heavy metals or comes to us by way of plastic containers, as is increasingly the case for all human beings, we risk contaminating our bodies with these agents and in so doing increasing our risk of developing physiological, emotional, and mental diseases.
An ontology of co-evolutionary relationality makes it possible to appreciate what Chief Sealth (Seattle) is said regarding the web of life in a letter he wrote to the president of the U.S. in December of1854, He reminded the president that â€œwe are part of the earth and it is part of us,â€ that the â€œshining water that moves in the streams and rivers is not just water but the blood of our ancestors,â€ that â€œthe rivers are our brothers,â€ and that we â€œmust henceforth give the rivers the kindness you would give any brother,â€ that â€œthe air is precious â€¦ for all things share the same breathâ€”the beast, the man, they all share the same breath â€¦ [and] shares its spirit with all life,â€ that â€œwhatever happens to the beasts, soon happens to man. All things are connectedâ€¦ What befalls the earth befalls the sons of the earth. Man did not weave the web of life, he is merely a strand in it. Whatever he does to the web, he does to himself. The whites, too, shall pass; perhaps sooner than all other tries. Contaminate your bed and you will one night suffocate in your own waste.â€ And here we are, more than one hundred and fifty-two years later, and we are suffocating in our own waste. There is no time like now to affirm Sealthâ€™s wisdom regarding our place and responsibilities in the great web of life, an affirmation that calls each of us to rethink not only the multiple dimensions of health and wellness but the very way we relate to the planet from which we derive everything that makes it possible for us to live at all.
V. Transforming All our Relations
Developing an integrated model of personhood, health and wellness requires not only developing resources that â€œenhance awareness, change behavior and create environments that support good health practices,â€ it also, as suggested, requires a shift in values and transformation in the way we relate to each other, other living beings, and the earth. Such a transformation involves challenging economic imperatives which subordinate the goal of ensuring optimal health for all persons to that of making sure that a few individuals are able to enrich themselves from the buying and selling of health care commodities. This means making social justice central to our understanding of and efforts to build a model that promotes universal health and wellness. Paul Farmer writes: â€œmany of the concepts currently in vogue in public healthâ€”from â€˜cost-effectivenessâ€™ to â€œsustainabilityâ€™ and â€˜replicabilityâ€™â€”are likely to be peverted unless social justice remains central to public health and medicine.â€47 Farmer concludes: â€œA human rights approach to health economics and health policy helps to bring into relief the ill effects of the efficacy-equity tradeoff: that is, only if unnecessary sickness and premature death donâ€™t matter can inegalitarian systems ever be considered efficacious.â€48 A human rights approach and the principle of social justice help us to appreciate the value of ensuring that our relations with each other, other living beings, and the earth are characterized by mutuality, respect, dignity, and reciprocal care and concern.
Affirming human rights and social justice echoes what our religious traditions emphasize when they affirm the spiritual importance of mercy, compassion, and love. Called to testify on stem-cell research for the National Bioethics Advisor Committee, Pittsburgh Theological Seminary professor Ronald Cole-Turner submitted that â€œthe moral test of any system, including our system of medical research and treatment, is how well it treats the least privileged members of society, first of all within our own nation, but also globally. And so we would challenge those who fund and develop these therapies by asking the following question: How will the benefits be shared universally?â€ Echoing Cole-Turnerâ€™s position, Father Demetrios Demopulos of the Holy Trinity Greek Orthodox Church cites Jesusâ€™ commandment to â€œheal the sick, raise the dead, cleanse lepers, cast out demonsâ€ and to do so â€œwithout pay,â€ adding â€œthe intention is clear: Attend not to profit, but to the medical needs of others.â€ The Jewish tradition, writes Laurie Zoloth affirms â€œtikkun olam, the mandate to be an active partner in the worldâ€™s repair and perfection, a concern for the most vulnerable, and â€œthe idea that broad social liberation must take place in a responding and listening community.â€ Finally, inWhere Do We Go from Here: Chaos or Community? King describes the need for a revolution in values:
We must rapidly begin the shift from a thing-oriented society to a person-oriented society. When machines and computers, profit motives and property rights, are considered more important than people, the giant triplets of racism, extreme materialism, and militarism are incapable of being conquered. A true revolution of values will soon cause us to question the fairness and justice of many of our past and present policies. On the one hand we are called to play the Good Samaritan on life’s roadside, but that will be only an initial act. One day we must come to see that the whole Jericho Road must be transformed so that men and women will not be constantly beaten and robbed as they make their journey on life’s highway. True compassion is more than flinging a coin to a beggar. It comes to see that an edifice which produces beggars needs restructuring.49
Developing an integrated model of health and wellness promotion means promoting nothing less than an international Marshall Plan to reconstruct our social and natural conditions of existence so that they robustly support our health and wellbeing. It means expanding our understanding of health to include the extra-individual factors that determine whether we do or donâ€™t enjoy robustly supportive conditions of physical, emotional, intellectual, creative, social, and spiritual health. It means recognizing that social, economic, and political institutions and policies are always also health institutions and policies and, as Paul Farmer proposes, that â€œmaking social and economic rights a reality is the key goal for health and human rights in the twenty-first century.â€50
In addition to making human rights and social justice guiding principles in the work of developing a model of integrated health and wellness promotion, we ought also to consider the related importance of developing a culture that promotes the practices of partnership, compassion, harmonious co-existence, and solidarity. In place of Baconâ€™s culture of subjugation, domination, and control, we must if we are to survive and flourish as a species build into our everyday practices and the practices legitimated and reinforced by our social, political, economic, and medical institutions a deep sense of compassionate partnership and harmonious co-existence and solidarity. In The Power of Partnership: Seven Relationships that Will Change Your Life, Raine Eisler articulates the need for us to revolutionize our relationships with each other, other living beings, and the earth. She calls us to shift from relations of domination to partnership relations that affirm social justice, human rights, and environmental sustainability as key values to ensuring the well-being of the entire biotic community; values very much shared and supported by the Templeton Foundation and Metanexus.
The Mahayana Buddhist tradition emphasizes what is known as the Boddhisattva ideal of living a life oriented by a concern to alleviate the suffering of all sentient beings. Such an ethical orientation does not so much involve selfless acts of altruism as it does an outward flowing of acts aimed to improve our shared conditions of happiness.
Finally, John Robbins offers a summary of what ultimately the stakes and significance of building a model of integrated health and wellness promotion involve.
Maybe we aren’t on a one-way road to oblivion. Maybe we’re standing at a crossroad, facing what may be the most important choice human beings have ever faced, a choice between two directions. In one direction is what we will have if we do nothing to alter our present course. By doing nothing, we are choosing a world of pollution and extinctions, of widening chasms and deepening despair, a world where humanity moves ever farther from achieving its highest aspirations and ever nearer to living its darkest fears. â€¦ Our other choice is to actively engage with the living world. On this path we work responsibly and joyfully to make our lives, and our societies, into expressions of our love for ourselves, for each other, and for the living Earth. In this direction we honor our longing to give our children, and all children, a world with clean air and water, with blue skies and abundant wildlife, with a stable climate and a healthy environment. We all live, now, with both the pain and the possibility we carry in our hearts, both the despair and the hope that we may yet learn to live in harmony with our precious and endangered Earth. There is not a person alive today who does not, at some level, know we are facing these two directions, and understand how much is at stake. I am aware how strong are the forces of ignorance, greed, and denial in our society. I know it is possible that we won’t make it. But I am also aware of how strong is the longing and the love of life in the human heart. And so I know it is possible that we will make it, that we will create a sustainable economy that protects the living systems of the Earth, that we will come to be part of the world’s repair. The power of darkness in our world is great, but it is not as great as the power of the human spirit. We can learn to provide for our needs and limit our numbers while cherishing this beautiful planet and its creatures. It is in our nature to honor the sacredness of life. What is at stake today is enormous; it is the destiny of life on Earth.51
Developing a model of integrated health and wellness promotion depends on the development of transdisciplinary models of knowledge production and trans-institutional and extra-institutional collaboration. Moreover, it depends on the development of a co-evolutionary relational ontology of the self that fully appreciates that self is always self-in-community-in-nature and that ensuring individual health and wellness requires us to build social and natural conditions that support this goal. Finally, and related, developing a model of integrated health and wellness promotion means transforming all our relations such that our personal practices and institutional policies are guided by the precious values of social justice, human rights, environmental sustainability, compassionate partnership, harmonious co-existence and biotic solidarity, that is, a deep and active love for life.
Clearly we have much work ahead of us.
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1. No part of this paper may be published without written permission from the author.
2. The U.S. spends almost double what the second ranking nation spends on health care (presently US $5274 per capita per year) yet according to the World Health Organizationâ€™s 2000 report on world health the U.S. ranks 37th among selected high-income OECD countries. See World Health Report 2000 â€“ Health Systems: Improving Performance, WHO; Also see, Schoen, et.al; Banks, et.al.â€; and Institute of Medicine.
3. See Null, et.al.
4. I am indebted Freya Mathewsâ€™s essay â€œThe Ideological Implications of Atomismâ€ for this section.
7. The Center for Disease Control and Prevention (CDC) refers to obesity as our nationâ€™s number one health care crisis. According to the CDC nearly 2/3 of adults in the U.S. are overweight and more than 30% are obese. Moreover, â€œNearly 21 million Americans are believed to be diabetic, according to the Centers for Disease Control, and 41 million more are prediabetic — their blood sugar is high and could reach the diabetic level if they do not alter their living habits. Nationwide, the disease’s cost for 2002 — from medical bills to disability payments and lost workdays — was conservatively estimated by the American Diabetes Association at $132 billion. All cancers, taken together, cost the country about $171 billion a year.â€ See McNally. Meanwhile, the National Institutes of Health (NIH) estimates that 300,000 deaths per year are due to excess weight and obesity-related illnesses.
8. See U. of Michigan. 01/20/07.
11. While the lowest taxed of any major industry in the United States, pharmaceutical companies make the largest percentage profit of any industry, with an annual average percentage almost always above 15% or three times higher than the second leading industry profit rate. In 2006, the top ten pharmaceutical companies in the world made almost $80 billion dollars in profits. Significantly their profits rose on average of 27% when the Bush Administrationâ€™s Drug Prescription Plan went into effect midway through 2006. See Waxman, et.al.
12. Americans spend more than 200 billion dollars on prescription drugs, the largest component of health care costs. A trip to oneâ€™s local CVS reveals the extent to which we have become a drug addicted society.
14. See â€œHow the Drug Companies Want Us to Be Sickâ€ by Stan Cox.
17. Stan Cox summarizes much of recent research on the relationship between environmental toxins and cancer when he writes that: â€œEvidence is piling up that emissions from the production of synthetic compounds in non-stick cookware, cleaning products, and a host of other common products may cause cancer and other health problems.â€ See â€˜Toxic Teflon.â€ Also see Ginty.
18. For a list of specializations see: http://www.abms.org/Downloads/Statistics/Table4.PDF
19. In their investigation of iatrogenic deaths in the United States entitled â€œModern Health Care System is the Leading Cause of Deathâ€ (2004), Null, et.al., suggest â€œthe words â€˜health careâ€™ give us the illusion that medicine is about health. Allopathic medicine is not a purveyor of health care but of disease-careâ€ (Pt. IV).
20. From the Preamble to the Constitution of the World Health Organization, as adopted by the International Health Conference, New York, 19 June – 22 July 1946; signed on 22 July 1946 by the representatives of 61
States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. The definition has not been amended since 1948.
21. Philip Morris USA, the nationâ€™s number one cigarette manufacturer and marketer, and a subsidiary of the Altria Group, which also owns Kraft Foods, producer of some of the most unhealthy â€œfoodâ€ in the world, was recently given by the city of Richmond, Virginia a piece of downtown real-estate estimated to be worth 3.2 million dollars and a ten year 40% tax abatement for its $300 million dollar research complex, saving the company an average of $7 million dollars per year for ten years, this is the equivalent amounts of money the subsidies provided to organic farmers nationwide. See Philips.
22. Cited in Brownell, 6.
24. See â€œHow To Solve the Diabetes Epidemic.â€ Terrence McNally.
25. That health care costs represent more than 16% of GDP gives one some idea of the financial stakes involved in developing a society that vigorously promotes health and wellness. See University of Maine.
28. Null, et. al. Internal citation numbers were removed from this quotation to make it easier to read. Please see Null, et.al., for the sources of the data summarized in this quotation.
29. Welch, et. al.
30. See â€œSocial Change Could Trump Medical Advances In Saving Livesâ€ 03/01/07. Medical News Today.
32. From Our Stolen Future at http://www.ourstolenfuture.org/commentary/News/press.htm
33. â€œ2 Million Kids Are Pre-Diabetic.â€ 11/07/05. CBS News.
44. â€œIntegrated Assessment of Environment and Health: Americaâ€™s Children and the Environment,â€ Amy D. Kyle, Tracey J. Woodruff, and Daniel A. Axelrad write that â€œthe significance of environmental factors to health and well-being is increasingly apparent.
45. â€œHundreds of Man-made Chemicals Are Interfering with Our Hormones and Threatening Our Children’s Future: A Special Report.â€ Gay Daly.