In Against Health: How Health Became the New Morality, Jonathan Metzl and Anna Rutherford Kirkland make a poignant statement regarding the current societal definition of “health,” and how we have transformed the definition to a term “replete with value judgments, hierarchies, and blind assumptions that speak as much about power and privilege as they do about well-being” (Metzl & Kirkland, 2010). This is to say that the term “health” has been transformed into something that is more a set of “moral assumptions,” and is used to make “moral judgments, convey prejudice, sell products, or even to exclude whole groups of persons from health care.” This relates specifically to SimStay in the sense that the aim of the current project is to provide patients with the opportunity to learn about their own health and hopefully develop a personal understanding of their bodies, and what they believe it means to be “healthy.”
Against Health is a compilation of chapters written by various authors who argue that health has transitioned into an ideal that is no longer concerned with the well-being of the individual, but a way for the collective to pass judgment and promote various agendas through the guise of concern for others. Examples include the arbitrary nature of mental health diagnosis, and the manipulation of information to promote ideas that breast-feeding is superior to formula feeding, or that personal choice should be submissive to popular opinion.
One powerful point made by Richard Klein in his chapter “What is Health and How Do You Get It?” is that “Each of us has to find his or her own road to health.” Klein goes on to write, “Only you can judge, however, what your body needs and what gives you pleasure.” The idea that an individual should base their health on what they judge as their needs and determine health based on what gives them pleasure is largely contradictory to the publicly held definition of health. Most would argue that health is something achieved through sacrifice of pleasurable indulgences, such as smoking or “unhealthy” diet choices. Ultimately, one of the key points made in Against Health is that the American definition of health is based on an unattainable ideal, and quoting Ivan Illich, “To hell with health, it is the most cherished and destructive certitudes of the modern world. It is a most destructive addiction.”
The idea that individuals should look at health as a collective combination of every aspect of their lives is in stark contrast to the idea that health is determined by the guidelines outlined by medical institutions and public opinion. An individual’s true “health” should be achieved based on the individual’s own perception of their body and lifestyle. In Vincanne Adams’ chapter “Against Global Health? Arbitrating Science, Non-Science, and Nonsense Through Health,” Adams makes the observation that “research priorities often trump the needs of patient care, even in the most ethical IRB-approved research studies.” This serves as a powerful statement on how society ultimately views health, not as a individual-specific trait, but as an often overlooked element in a larger representation of a population.
Against Health serves as an important reminder that the priority of this project should be patient empowerment. Empowerment in the sense that patients should be given information and the ability to play an active role in their “health.” Their treatment should not be wholly dictated by the public definition of health, or based on the definition of a physician, but should be based on the priorities of the patient. This is why one of the primary components of SimStay is to place high importance on the patient’s engagement in their care. They should not be forced into a decision simply because they do not understand what they are being told, or because they are uncomfortable questioning their provider. As Klein previously noted “Each of us has to find his or her own road to health.”