On a Proper Frame of Reference

At our recent Citizens for Democracy meeting we had a discussion of plans for medical care in the United States. As the discussion progressed I was struck by the extent to which other issues became important in the discussion, especially cost.
 
Human beings, I believe, have a proclivity for thinking about the immediate and working their way to tangential issues as necessity seems to demand. This style of thinking, which I shall call “inside out” may be found less appropriate as the magnitude of human concerns becomes global. In what follows I want to explore a bit what happens when we think “outside in” global concerns first.
 
Suppose we approach the issue of health care from a global perspective. First there is the issue of health itself. Health means different things on a global, as distinct from a a national, point of view. The health of Americans, for example, may depend far more on global pandemics spawned in the massive slums of Africa, Asia and Latin America, than it does on single payer versus multiple payer health care schemes. Mike Davis discusses the dire consequences of a bird flu pandemic in his book The Monster at Our Door: The Global Threat of Avian Flu which describes the potential, if not immanent, destructiveness of such a pandemic. This global perspective strongly suggests that we get clear about the social value of health care before we start talking about the cost of health care. This shift in priorities allows us to begin addressing the issue in terms of health rather than cost. It suggests that we in the United States need to address the social consequences of NOT having universal health care. This, in turn requires that we have a primary focus on the prevention of illness. One of the anomalies of U. S. health care is that the United States, despite its expenditure on medical services, ranks 50th out of 224 nations in life expectancy according to 2009 estimates from the CIA World Factbook.
From the point of view of the human species public sanitation, for example, has been responsible for saving more lives and extending the useful life span of more individuals than the introduction of life-extending devices, e.g. pace makers and stents, into the bodies of the elderly. A 2002 study of Medicare expenses for those 65 and older found costs averaged $37,581 during the last year of life versus $7,365 for non terminal years. If prevention were the primary target of health care large proportions of the population, including the poor, would be the focus of the heath care debate now going on, not who pays for what.

From a species point of view health is closely related to survival. This suggests that a major focus of health concern and investment should be on improving the health environment of the earth's multi-million resident slums. The world's largest slum is the 2.2 million Kibera slum of Nairobi, Kenya. As the world's population continues to grow, these will be the breeding grounds of major health calamities.
The potential (inevitability?) of these slums to breed global catastrophe raises a second fundamental health issue: overpopulation. We know that the more interaction between animals, the more likely it is that the pathogens that infect them will be transmitted. This fact is compounded by the ability of these pathogens to mutate often and unpredictably. The closer that humans live to each other, e.g, the slums or the more often they come in contact, e.g. the global movement of people, the more likely a global pandemic will be created. Population growth has to be seen as a primary health issue and addressed as such. The health of the human species has to be a primary focus for reducing human population. I say this because our species has demonstrated a remarkable ability to abstract, symbolize, understand and apply our experience. There is a deeper meaning to René Descartes' “I think therefore I am.” To my mind it can be understood as I think therefor I am human.

While the above comments are by no means exhaustive, they do point, in my judgment, to something like the health care debate we should be having. We have not even established the value of health care. We have let the market do that, which is heavily biased toward those who have the money, not toward meeting health needs. We need to break out of this small box of health versus cost to health for human survival and optimization. We need to confront those institutions, whether religious or nationalist, that advocate population growth, as threatening human health. In brief, we need to keep our eyes on the fundamental meaning of health for our species, consider more specific issues in these human terms and, finally, not confuse the immediate with the real. Mankind must learn that it is its own worst enemy and its only salvation.

Bob Newhard