Health manifesto

[liv]

This is partly inspired by being a bit irritated by the latest from the NHS's Change 4 Life campaign, but it's something that's been brewing for a while. I have some pretty strong views about health and personal responsibility, and I think it's time I lay them out in my journal.

1. Health is complex and multi-dimensional.
   
   You can't get everyone in the world and line them up in order of how healthy they are. There's no lifestyles, behaviours or diets which are always healthy or always unhealthy. The healthiest option isn't an absolute, but depends on the circumstances, depends on one's goals, depends on what options are in fact available. And health is often relative, and partly culturally dependent, and can mean different things to different people.
   
   
   
2. Health is individual.
   
   What's healthy for one person can be unhealthy for another. It's healthy for some people to eat plenty of fresh fruit and vegetables as a source of vitamins. It's unhealthy for some people to eat too much fruit because a high fibre diet can exacerbate inflammation of their digestive tract. It's healthy for some people to be physically active, it's unhealthy for others who are recovering from injury or living with chronic fatigue. What's healthy for babies is different from what's healthy for teenagers, what's healthy for middle-aged adults, what's healthy for old people. And that's just generalizations, for each specific person, the healthiest choices will vary greatly depending on all kinds of personal factors.
   
   
   
3. Health depends on multiple, interlocking factors.
   
   How healthy someone is partly a consequence of their personal choices, but it's also partly determined by their genetics, their environment and the society they happen to be part of, and sheer random luck. Lots of people hold odd articles of faith about the relative importance of personal choices and uncontrollable factors, and it bleeds into political tribalism, but the fact is you can't just decide to be healthy, or everyone would.
   
   
   
4. Health is not virtue.
   
   Healthy people are not always more disciplined and admirable than unhealthy people. Sometimes they're just richer or luckier or hey, just younger. Lazy, irresponsible people may or may not be less healthy than "good" people. This rather follows on from [3], in fact.
   
   
   
5. There are no short-cuts to health.
   
   The only way to be healthy is to actually be healthy. You can't just eat a magic berry or take a pill or follow one weird tip. A healthy diet means a balanced and varied diet, means effort to prepare food and money to spend on good quality food. A healthy lifestyle means putting serious time and effort into maintaining your health. It has to be ongoing, a new year's resolution or a "cleansing" treatment won't cut it.
   
   
   
6. You can't judge someone's health by looking at them.
   
   Perhaps you find some people ugly. It's up to you to own your prejudices, and not pretend that your displeasure at someone's appearance is "concern" for their health. Making up evo-psych stories about how our primitive ancestors looked for symmetry and the absence of disfigurements in order to select the most likely mates doesn't actually give people magic powers to judge all the complex factors that contribute to health just at a glance.
   
   
   
7. Mental health is part of health.
   
   If supposedly "healthy" choices are making someone miserable or even depressed, then it's not in fact healthy for them to do those things.
   
   
   
8. People have the right to take risks with their health.
   
   That includes short-term risks like taking part in dangerous / extreme sports or not bothering with safety precautions like helmets. And it includes long-term risks like choosing food that's bad for you or ingesting substances that increase chances of disease and early death. If your risk-taking affects others that's a different story; I don't believe that parents have the right to expose their children to unnecessary risks, for example, and smoking is an edge-case because it can affect other people than the smoker. But adults' bodies are their own and each person has to make their own judgement of the balance between risk and benefit.
   
   
   
9. Being healthy isn't an absolute moral imperative.
   
   It seems a bit of a truism that it's better to be as healthy as possible. But that's not the only thing in life. People may have different priorities; it's perfectly moral to prefer to spend your time and money on other aims than getting healthier. People have a variety of obligations. It's not always possible to spend enough time on a job to earn enough money to live comfortably, and take care of your dependants, and have enough leisure time to feel contented and balanced, and on top of all that spend several hours a week on cooking healthy food from fresh ingredients and getting the recommended amount of exercise. Some people might prefer voluntary work over going to the gym, and others might prefer pursuing a hobby or hanging out with their friends, and that's their right.
   
   
   
10. All of the above are true for fat people.
    
    Fat people as in too fat to be fashion models. Fat people as in slightly above their so-called "ideal" weight. Fat people as in actually fat, as in the rightmost end of the BMI bellcurve. There's no magic weight above which all bets are off. In addition, even if you believe that being thinner is healthier than being fatter, fat people are not obligated to put all their effort (or even any effort at all, if they choose not to) into trying to lose weight.
    
    
    
11. All of the above are true for people with unusual bodies.
    
    Whether people identify as disabled, chronically ill, or just different, health is complex and personal and it's not up to well-meaning bystanders or the medical establishment to impose simplistic ideas of healthy on to anyone. Some people are healthy even when they don't look like the stereotypical idea of a healthy person. Some people find it much harder than average to live in generically healthy ways. Each person has the right to decide how much effort they want to devote to getting "better" (which may or may not be possible), and how much they want to strive to be or appear "normal".

This might have been neater with 10 things rather than 11, but hey.

Comments

[kaberett]

THIS IS SUPERB AND BRILLIANT AND I WISH TO SEND YOU CAKE OR SUITABLE ALTERNATIVES.

[liv]

Gosh, all-caps enthusiasm, that's just as good as cake. I am very flattered!

[naath]

YES, EXACTLY.

[wildeabandon]

I agree with this comment.

[lilacsigil]

It's posts like this that make me so glad that we have the internet now. I desperately needed to read things like this as a teenager, and it would have been so, so good for me.

[liv]

Thank you for this really encouraging comment. I don't think I knew all this when I was a teenager, I was struggling and muddling through trying to separate out health from beauty.

It seems to me like most of these statements are things people can agree to individually (only [8] is really controversial, I think) but many people tend to moralize about others' health and lifestyle as if the manifesto weren't true. So I wanted to write it out to be able to refer back to. It's very gratifying that you think it would have been good for your teenage self!

[doseybat]

*applause*

[liv]

Woo, thank you! I was expecting vehement denial more than applause, I think.

[tig_b]

This is great, especially no 7.

I finally have a physiotherapist who understands this - we just need to clone him so everyone who needs him can get appointments (and to stop the NHS managers complaining about his targets).

[liv]

Thank you! I think it's very understandable that people who work in health services, whether managers or practitioners, are going to put a high priority on trying to help / persuade all their patients to be as healthy as possible; that's their job, after all! But yes, it really does help when you're working with someone who understands that patients' priorities may not be the same as theirs.

[tig_b]

May I share this? With a link or anon as you prefer?

[liv]

Oh, please do link, I always enjoy getting my posts out to as many readers as possible. Thanks for checking!

[falena]

This is great, it totally needs to be shared *everywhere*. I certainly need to keep in mind a few of your points myself.

[liv]

Eee, thank you so much! And please do share it, I'm always happy to have more readers.

[pj]

Excellent post. I also needed to be reminded of this People have the right to take risks with their health from a voice other than the one in my head. I struggle a lot recently with my Mate going 'round to different doctors seeking a "cure" to something that only gets better through diet modification and lifestyle changes. There are some pill type things that may help and even doing all the above doesn't "cure", merely lessens. His absolute refusal to heed anything the doctors tell him regarding food choice and lifestyle has been rubbing my nerves. So I say in my head, "His choice, his body." Then I say, "Fuck his choice! I want him healthier/happier, I don't care if it is selfish!" Then I go back to me, "Bad me! Hos body not mine!" <---- See how being in my head can kinda suck? *laugh*

Anyway, thank you. Because sometimes I need the reinforcement from outside of myself.


Personal rant to commence below:

And I have a #12 about people who go on and on about pregnancy and birth and how they don't care "as long as the baby is healthy" and the utter rudeness of voicing such loudly and repeatedly around strangers. I get the "everyone is supposed to say it because everyone says it and it stems the fear of the uncontrollable", but it smacks of the idea that an unhealthy child is lesser - less health, less wanted. Having birthed such I do take offense that my child is considered "less than". I didn't look for a way to give him back or drop him on a doorstep upon discovery of his chronic illnesses. Nor do I see him as less deserving of being here than a healthy child. Yes, parents get to grieve the idea of a perfectly healthy kid they thought they were getting, but that is a far cry from grieving the presence of that child. Um, sorry - it's a tangent and too specific for your list, but I coughed it up because it is related to the moral value of health and the "othering" of chronically ill folk which includes children and the judging of their parents. /rant

[syllopsium]

There is a distinct difference between having the right to take risks with your health and not listening to the tradeoffs associated with that.

If you will take risks (and most people do, to a greater or lesser degree) you have the responsibility to minimise the effect of your choices on others, including looking for magic 'solutions'. smoking is an obvious case where your actions affect others but so is extreme sport when not properly planned and to open the can of worms that shouldn't be opened : obesity when taken to extremes where the person had the opportunity to reduce their weight. Other activities/conditions are similar when pushed beyond average boundaries.

[liv]

Thanks for this comment. It's definitely tough when it's someone you care about and they're not doing as much for their health as you'd like them to. I was mainly thinking about strangers trying to run people's lives from the internet, but it's so much more complicated between individuals.

And yeah, the as long as the baby is healthy thing bothers me quite a lot as well. I used to worry about it quite a bit when I was little, because I thought my asthma meant I wasn't "healthy", and I sort of inferred that that meant I must be a terrible disappointment to my parents. I think that could very well be a #12, not that specific phrase but something about valuing unhealthy people.

[403]

Well said, and I agree. *joins the applause*

[liv]

Aw, thank you!

[hairyears]

There is, of course, a corollary to judging people by appearances: someone I see as 'unhealthy' might well be doing far, far more work than I - so much so, that they are as healthy as they can possibly be, given their genes and their environment.

I am well aware that I am not as healthy as I could possibly be: there is a great deal more that I could do - and probably should do. Should I judge others?

I should *encourage* others; and I express concern where I think that it is due. But that's a different matter: or rather, a better use of my judgement, than being 'judgemental'.

[liv]

Mm, I definitely like the idea of encouraging rather than judging. Encouraging implies slightly closer relationships, when you actually know something about the choices someone is making and the background of those choices. That could be encouragement to make better choices, or more often support in the choices they've already made but find it hard to carry out because changing your habits can be pretty tough.

[syllopsium]

Actually, I really like this post and almost entirely agree with it.

Points 1) and 3) have to be taken into account in every situation.

Having said that, my (reasonably minor) disagreements are that 8) is also a multi-dimensional sliding scale and I do think that if you indulge in activity or behaviour that is defined as 'going beyond the average' you have a responsibility to consider the impact that it has.

This is already the case - certainly any extreme sport you care to mention will have a strong emphasis on keeping you safe, but more importantly (and implicitly) on not worsening the situation for others or un-necessarily involving emergency/support services. This is also incorporated into society : almost any mountaineering accident you care to mention will have a comment on how well equipped the participants were. This is the same in kayaking, roller derby, martial arts and probably lots of other activities.

That's also the reason I said that being fat is, in extremis, possibly a point where personal responsibility becomes a factor. By all means eat what you want, when you want, but if this involves reaching the far end of the bell curve (morbid obesity, not just being heavily overweight) this is likely to have an effect on others if you're hospitalised or need to be moved in an emergency.

When I input a lot of accident stats for nurses years ago, manual handling was in the top 3 causes of injuries. Some of that was related to moving patients.

Now 1) and 3) again - people have complex lives, other priorities and sometimes can't minimise their risk (1, 3), but when they can, they should perhaps consider how much it's possible to do so.

[liv]

I agree that in general it's a good thing for people to try to minimize risks, but that that's not the only consideration.

I also agree partially that people do have some obligation in not making things harder for medical and emergency services, but to my mind that's pretty far down on the list of moral imperatives, such that many other considerations may take priority. Also, a lot of the arguments you're making about getting extremely fat are much more directly applicable to driving. After all, driving carries a much greater risk of being in an accident than being fat does of cardiovascular problems or diabetes. If moving very large patients can result in injury, how about carrying out medical procedures in the middle of a busy road with a serious danger of or even an actual fire? And driving is a much more directly voluntary choice than becoming extremely fat, not to mention the negative effects on the rest of society caused by pollution and use of resources and so on.

[atreic]

This post is awesome :-)

[liv]

Eee, thank you. I'm glad you suscribed to the feed of this DW so you can come along and make super-encouraging comments!

[rmc28]

Thank you for this - it's a nice clear summary of Things I Already Agree With. Number 7 was especially pertinent for me last year (dieting in an attempt to lose weight was proving very bad for my mental health).

[liv]

Cool, I'm glad we're thoroughly in agreement! Though I'm sorry to hear that you found the weight loss attempt so tough.

[angelofthenorth]

Thanks for that. I'll try and get my friend tiredlegs to come and see what she has to say - she's training as a public health professional, and might have something interesting to add.

[liv]

That'd be cool. I am all in favour of tackling health issues at a societal level, not just concentrating on individuals, but I still hope public health folks are able to respect the autonomy and choices of each person.