Monday, April 13, 2020

The three principal conditions of good (physical and mental) health

The following is based on one section from Lawrence O. Gostin’s Global Health Law (Harvard University Press, 2014: 414-419). I have edited and re-written some of this material, while what remains—in quotes—is from his book.

The three principal conditions of good (physical and mental) health:
  • The first encompasses the full range of socio-economic and political determinants that undergird the generalized welfare, well-being, and self-fulfillment or happiness (or eudaimonia) and thus make up the “full set of conditions in which people live and work.” Prominent among these determinants are education, income, housing, social inclusion, personal liberties, and robust forms of social and economic equality which are best realized through democratic principles, methods, and processes: participatory, representative, or deliberative (ideally, and sometimes in praxis, all three are evidenced in mutual, complementary and systematic form). In this case, underlying or “upstream” determinants: poverty (absolute or relative inequality), racist discrimination, illiteracy, lack of adequate shelter, indeed, failure to satisfy what are commonly thought to be basic needs, are “are linked to more direct (or downstream) risk factors” such as smoking, alcoholism and drug addiction, exposure to environmental pollutants (especially air pollution), domestic violence, endangerment in the workplace, stress, and so forth any and all combinations of which can lead to injury, sickness, chronic illness, disease(s), depression (and other kinds of mental illness), high infant and maternal mortality rates and lowered life expectancy. The “safety net” metaphor does not fully capture the full panoply of necessary determinants and conditions here.
  • The “second essential condition for good health is the provision of health care services to all individuals,” universal health care, as we say. Such “comprehensive coverage includes clinical prevention (e.g., testing, counseling, and vaccinations), medical treatment for injury and disease, and supportive care” for those who are in pain or suffering in body and/or mind. “These services range from primary care to emergency and specialized services, through to rehabilitation and pain relief. Universal health coverage aims to make all vital health care services available, affordable, and accessible to the entire population—poor/rich, physically and mentally disabled, and urban/rural. Effective health systems require health care facilities (clinics, hospitals, nursing homes), human resources (e.g., doctors, nurses, health care and community workers), and essential medicines [and other therapies] to serve the full range of needs within the population.”
  • The third condition, inextricably intertwined with the previous two above, is the “provision of public health services,” supported in the first instance by a national or federal government, in cooperation and collaboration with states, local and community governments and decision-making institutions and bodies. This provision of public health services should be suffused with a humane spirit and heartfelt sense of humanistic social solidarity based on individual human dignity and our shared human condition (or vulnerabilities) and nature as human animals. “Classical population-based services include hygiene and sanitation, portable water, clean air, vector abatement, injury prevention, health education, and tobacco and alcohol control [and gun control?]. Conceived more broadly, they include built environments conducive to good health such as green spaces for recreation, [aesthetic enjoyment, rest, solitude, community gardening], walking and bike paths, access to nourishing foods [including grains, fresh fruits and vegetables] ….” Public health services as such are an indispensable part of an adequate public health infrastructure. A robust public health system is predicated on a “habitable, safe environment.”
  Suggested Reading (with an imposed constraint of 12 titles):
  • Berkman, Lisa F. and Ichiro Kawachi, eds. Social Epidemiology. New York: Oxford University Press, 2nd, 2014.
  • Bhopal, Raj S. Ethnicity, Race, and Health in Multicultural Societies: Foundations for Better Epidemiology, Public Health, and Health Care. New York: Oxford University Press, 2007.
  • Callahan, Daniel. The Five Horsemen of the Modern World: Climate, Food, Water, Disease, and Obesity. New York: Columbia University Press, 2016.
  • Daniels, Norman. Just Health: Meeting Health Needs Fairly. Cambridge, UK: Cambridge University Press, 2008.
  • Farmer, Paul, Jim Yong Kim, Arthur Kleinman, and Matthew Basilico, eds. Reimagining Global Health: An Introduction. Berkeley, CA: University of California Press, 2013.
  • Fidler, David P. International Law and Public Health: Materials on and Analysis of Global Health Jurisprudence. Ardsley, NY: Transnational Publ., 2000.
  • Gillett, Grant R. Bioethics in the Clinic: Hippocratic Reflections. Baltimore, MD: Johns Hopkins University Press, 2004.
  • Gostin, Lawrence O. Public Health Law: Power, Duty, Restraint. Berkeley, CA: University of California Press, 2000.
  • Gostin, Lawrence O. Global Health Law. Cambridge, MA: Harvard University Press, 2014.
  • Gostin, Lawrence O., ed. Public Health Law and Ethics: A Reader. Berkeley, CA: University of California Press, 2002.
  • Valles, Sean A. Philosophy of Population Health: Philosophy for a New Public Health Era. New York: Routledge, 2018.
  • Venkatapuram, Sridhar. Health Justice: An Argument from the Capabilities Approach. Malden, MA: Polity Press, 2011.
Relevant bibliographies freely available on my Academia page: (i) Transdisciplinary Perspectives on Addiction; (ii) Alternative and Complementary Medicine; (iii) Bioethics; (iv) Biological Psychiatry, Sullied Psychology and Pharmaceutical Reason; (v) Buddhism and Psychoanalysis; (vi) Death and Dying; (vii) Diseases, Epidemics, and Pandemics; (viii) Health: Law, Ethics and Social Justice; (ix) Psychoanalytic Psychology and Therapy; and (x) Sullied (Natural and Social) Sciences.


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