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.

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