Do We Have to Appeal to “Health?” Do We Have to Want It?

red_health_appleEarlier this week I read a great post by Patricia Marino on her smart blog The Kramer Is Now (thanks for the heads up, Sam!) about the overused concept of health.  She argues that the concept of health gets thrown around in a simplistic way in normatively complex situations (meaning: all the time).

She goes through its misuses in the context of sexual health, mental health, and “health health.”  Her main complaint: who ever thought there should be a one-size-fits-all approach to health? She says:

Aren’t you tired of the once-size-fits-all rhetoric of health? Low-fat or high-protein? What should each person weigh? How much exercise and how much? Why on earth assume there’s a single answer that applies to all people? Why can’t some people need a low-fat diet to feel good and others need a low-carb one?

And again, the problem goes beyond different means to ends — important though that is. Because  health health, like sexual health and mental health, is not a unified thing, and so it’s possible for people to make different judgments and accept different trade-offs.

For instance, surely if a drug makes you feel kind of shitty but will make you live longer that is a matter of which people can have multiple reasonable preferences? And same for feeling hungry all the time in pursuit of longevity? Can’t a person rationally choose pot smoking or sex with strangers, knowing these things will cause other problems?

Yet the medical establishment makes these trade-offs seem beyond the pale. We’re not even allowed to have the conversation. They set out the treatment and the rules, and if you don’t follow, you’re “non-compliant.”

What she’s calling for here is choice.  Surely we get to make choices about our health, what to pursue, what to leave.

When speaking of sexual health, Patricia Marino (in her smart, funny, and totally engaging way) says:

News flash: people are different and are fulfilled and pleased by different things! Yet there’s this relentless and ongoing attempt to say that some ways of doing it are just wrong. They’re not a “healthy” sexuality. “Promiscuity and hook-up culture: good or bad?” Can’t things be different for different people?

It makes so much sense.

And so we come to something that has been bugging me for a while: healthism and the health imperative.  It’s not just that there is a one-size-fits-all rhetoric about health, it’s that this harm is exacerbated by the additional assumption that we have to make healthy choices.

Says who?  I’ve heard the argument (just this week–thanks Craig!) that we owe it to our families and our children to make choices that will keep us on this earth, reasonably active and available to participate in life.  Let’s call them, healthy choices.  I’m not sure I agree that this is an imperative or that we owe anyone this.  At least, beyond being able to provide for our dependents, we have choices.

For most people, making choices that allow them to be active with kids, friends, grandkids, partners lines up with what they care about. So it makes sense.  But it isn’t required and they’re not doing anything wrong if they decide, to take one of Sam’s go-to examples, they’d rather read more books and see more plays than train for marathons or go to yoga classes.

I’ve also heard the argument (heck, I think I’ve even made the argument), that when healthcare is funded through the public purse, as it is in Canada, there is a public interest in keeping costs down, and one way to do that is to expect/require people to do things that maintain their health — get flu shots, eat “properly,” get “plenty of” exercise, seek medical attention sooner rather than later when they feel as if they are falling ill, quit smoking.

I feel the pull of this sort of argument. But again, I think it’s in line with what most people care about to do these things anyway.  It’s not required.  No one is doing anything morally wrong if they flout their health. And Patricia is right: there are so many different approaches to “health” that it’s difficult to mandate anyway. Running is good for us and bad for us. High protein is where it’s at!  High carb is where it’s at!  Vegan versus Paleo. HIIT, on the one hand, walking at a moderate pace for 30 minutes a day, on the other.  It all depends what you’re into and what you want to do.

Even when it comes to smoking, I may think it’s ill-advised for all sorts of reasons (based on what matters to me, which, among other things, is freedom from active addiction), but it’s hardly morally wrong (second hand smoke is a different issue but these days it’s rare to get exposed to it unless you’re standing around outside with a bunch of smokers).

Patricia gets nicely at what the problem is with throwing around “healthy” and “unhealthy” as ultimate normative arbiters of acceptable and unacceptable behavior:

Obviously, the concept of health has some real and important uses and I’m not suggesting doing away with the whole idea of some things being better and worse. I’m just saying that sometimes, what’s good is highly relative to the individual.

But it’s perfectly possible for someone to register that all is not well without appealing to health. A person whose anxiety is causing them pain and misery can easily express this dissatisfaction whether or not the anxiety is in the “non-healthy” category or range. So why not just go there directly?

That is, in some interactions, instead of a rhetoric of “healthy” and “unhealthy,” why can’t we just a rhetoric of how-you-doing?  “You doing OK?” “Something on your mind?” “Something not working for you?” “Can I help?”

See? Doesn’t require any interpersonal colonialism at all.

I agree. We don’t need to appeal to health nearly as much as we think we do. And we certainly don’t need to jump on other people who are making choices that aren’t in line with what we would choose, or interrogate them about what they really want.  Even if we opt instead for “how are you doing? Can I help?” a person can refuse our offer. And if they do, it’s time to back off.

19 thoughts on “Do We Have to Appeal to “Health?” Do We Have to Want It?

  1. This reminds me of one of my favourite Precision Nutrition coaching responses, “How’s that working for you?”

    That’s exactly the right question, let yourself be guided by a person’s individual choices and values, except when they actively want to engage you in a conversation about values and choices. That’s less often than you might think!

    Great post. Lots to think about here especially as it concerns questions of political philosophy, choice, and responsibility.

    1. Yes. Lots to think about. As a moral philosopher with an interest in choice, responsibility, and the way these act with social influence, I feel I’ve just barely scratched the surface here.

  2. Interesting post. I agree, there is not one-size-fits approach to health. And yes, people can choose not to worry about it, the trade-off being longevity, optimal health and mobility as they are older. Maybe it’s because I have a 9 year old and we have way too many pets in the house, or maybe because we watch too many documentaries about animals, but I think about it like this. We as humans, mammals, are supposed to get off our bums and move, expend energy. Most people are not active enough, period. And our bodies weren’t designed to be like this. If there were a care sheet for humans, like there are for pets, ours would read similarly to what the Drs. tell us: lead an active life, (and you can insert your idea of what a healthy diet is, because there are many ways around this…). Yes, we can choose to ignore it and assume we are exempt. I wouldn’t judge anyone for their decisions, or give them a lecture, it’s none of my business, but I don’t necessarily think it’s right either. I can’t imagine another animal ignoring one of their basic needs in life to survive and thrive, like we do.

    1. That’s such an interesting observation, to bring in a comparison with other animals and basic needs. Thanks for your thought-provoking comment.

  3. yes to all this! A woman I know who is ‘big’ is routinely accosted on the street by strangers who berate her for being ‘overweight’. I find this horrifying, not to say rude.

  4. I’m torn in so many directions about these issues, and I admit I am so far from figuring them out I might as well be living in outer space right now. My feeling that it would be wrong for me not to keep exercising, in order to avoid some rather nasty health consequences, so that I can be around for my daughter, is truly limited to me, in my own mind. I don’t mandate this “imperative”, if that’s what it is for me, for anyone else. When using big formidable words like “imperatives”, I think sometimes the meaning of some things which some people say can be lost. One can be a good parent to their child, although one will always make mistakes. But I honestly know alot of people who don’t really spend alot of time with their children and really aren’t very good parents at all, although they are not abusive in the ugliest sense of that word, at all. Using the language of imperatives makes it very difficult to comment on issues such as some people, for example, semi-unwittingly passing on some of the ugliest traits of their parents, which have deeply injured them, onto their children. So should these people be doing this? No. Is there a moral imperative upon them to reclaim themselves, to understand the ways in which they were hurt as children and to consciously allow their children to be free of such harmful constraints? Put this way, I don’t know. Regarding taking care of oneself generally – in a loving way to both others and yourself (if you don’t take care of your own sh&t, your worst will come out!) – I tend to believe that there is value in doing so and that to some degree people owe it to the people in their lives to do so. But a moral imperative to do so and a mighty hammer-type judgmment to be handed down if they do not ? I know that some people are intolerant and ridiculously judgmental in a truly offensive way, but this is really not what I’m trying to do or say. If you believe, Tracy, that this is where I was going , not so. So – I am just concerned about the use of language like imperatives and “health imperatives” and so on, as I don’t believe that this is necessarily the right language to use when approaching alot of day-to-day matters, including just generally looking after oneself and being there in a good way for the others in your life, if indeed you’ve chosen to let others into your life.

  5. Maybe the best way to explain what I really want to say is that while I do believe there is value in caring about our health and that there are even objective arguments to be made in its favour, I think that this is an area where personal choices must be respected. As for neglectful parents, again, while I believe there are objective facts of the matter that point to better and worse forms of parenting, I also think that there are lots of non-health conducive things to do with kids (like reading, art projects, traveling, learning to cook) that are perfectly legitimate choices. A good parent doesn’t *have* to toss a ball around with their kids or be able to run around and play tag. [disclaimer: I’ve never been a parent of a young child, though I’ve spent lots of time with kids].

  6. Tracy, of course there are non-health-related things a parent can do with their children. And of course I didn’t say or suggest that a parent, to be a good parent, must be able to play tag with their children. I’m talking about something very different here – I’m talking only about being just generally healthy – body, mind and soul, if possible, and to the degree realistically possible at any moment in time, just taking care of yourself generally, so that the best things about you are generally available to both yourself and to them. I think you’re railing against the as*h$les out there who judge with hammers and use words like imperatives when it comes to exercising. I know some of those people – very black & white, and incredibly intolerant. It’s hard not to go too far the other way when responding to such jerks, for sure.

    1. I’m actually not railing against anyone. I think you’re defending something like a value theory that’s called “perfectionism,” found in Kant’s work and later in the work of Tom Hurka (U of T philosopher). Kant strongly thought we have an obligation to promote our talents and that it would be against the categorical imperative if we didn’t do that. I can appreciate that view even if I don’t agree that it’s obligatory (rather it may point to a kind of ingratitude that’s not particularly flattering, but that’s a different discussion), and I don’t think I disagree with you. I value lots of the same things. I’m just not big on others making it their business.

      1. Oh man, it’s been so long that I’ve read or even thought of Kant…as for Tom Hurka, the name rings a bell. I think he may have given a talk to us when I was an undergrad, but I’ve never read anything by him. Perfectionism? Hmmm…didn’t even know there was a name for the kind of thing I was “defending” or maybe rather, attempting to express. But yeah, I actually do think quite strongly about concepts like “ingratitude” ior maybe better, “gratitude” and “grace”, in this connection, and the degree to which all of this attaches to any “should’s” or “obligations”, much less actual “imperatives”, is extremely problematic for me. It sounds like you’ve thought about these things a great deal more than me, that’s for sure. Is there really no connection at all between “making the best of yourself available to yourself and others” and any obligations at all, even to your children? That’s the one I’m really struggling with here!

  7. Just read up on “perfectionism”. Now I remember why I hated Ethics when I studied philosophy for those few years that I did. My brain for whatever reason just doesn’t work the right way to study these topics, so much so I end up not caring at all the more I read! No wonder I was so much happier with theory of mind, aesthetics, Kant studies (minus the second critique), etc.

  8. Lots of interesting things to think about here. I agree that health is definitely a marker of more than just not being sick. Your point about the argument in our society where our health care system got me thinking. I spend time with a lot of people who are very staunchly anti-universal health care for the main reason that they feel like healthy people shouldn’t be forced to pay into a system that benefits unhealthy people. They often criticize those people for being lazy and not motivated enough to take care of their health, which I have a big problem with because I assume that nobody would purposefully neglect their health and I don’t think that we should assume that sick people are lazy or that fat people are lazy or that people with diabetes eat too much (or that your health is a reflection of your worth/ character as a person). Now I’m ranting, but thank you for stirring up some thought in me (even if it means I might be arguing with some of my acquaintances the next time this all comes up).

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