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

[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.