Healthcare is expanding, both economically and conceptually. It has taken up much of the country’s GDP. It has also overtaken the zeitgeist of today’s generation.
Now healthcare encompasses all things cultural and political. Climate change is a health issue. Zoning ordinances prohibiting pharmacies and groceries in certain socioeconomic regions are a public health crisis. What we previously considered to be a decidedly non-medical issue now falls squarely within the purview of public health.
Healthcare is expanding, which many consider both necessary and long overdue. Persistent disparities in patient outcomes are often because of socioeconomic constraints. And today, they form much of the source of health inequities that we see in society.
But like most things in healthcare, identifying the problem does not equate to finding the solution. Indeed, we have known social factors affect health for centuries. Different cultures and classes throughout history have developed their own clinical practices to address these factors.
But they were never explicitly deemed to be healthcare issues. They had different labels: hygiene, cultured, mannered – just pick your favorite Nineteenth century British terminology. You will not have far to look.
So saying any study discovering social correlates of healthcare is novel is lazy and shortsighted. We have known of these relationships for a while. What is new is how we define them.
We now label them as explicitly healthcare issues. We think that by doing so, we are on the way to solving these problems. Instead, it will only convolute the issue and prevent any meaningful solutions from arising.
“Common sense is not so common”, quipped the French philosopher Voltaire. He was alluding to people’s inability to think clearly about a topic. What held true then holds true now. We just cannot seem to develop clear thinking in healthcare.
Instead, we rush to irrational extremes in public policy: masks, no masks, vaccines, no vaccines. When in reality, anyone with even a modicum of common sense would propose some level of compromise, some middle ground.
Of course, access to healthy food and pharmaceuticals affects public health. Of course, warmer temperatures place more stress on individual health and public health infrastructure.
Common sense does not need to be repackaged as evidence for us to acknowledge it. It is common sense for a reason; it is manifestly apparent. Yet, we conduct studies and perform statistical analyses to verify what we already know.
We find data that verifies otherwise common sense relationships in healthcare and call it clinical evidence. To what aim: So that we can expand healthcare to encompass public zoning projects or carbon emission projects?
This is not to say that such discussions are immaterial or inconsequential. They are quite important and they should be studied. But they should be studied theoretically to improve our general understanding of health and society. When we try to force theoretical findings into a public health agenda, the focus shifts away from the theory itself and toward how its application.
Most theories are accepted so long as they remain theories. But when theories are applied, the logic of science succumbs to the value judgments that inevitably form when applying it. In short, it no longer becomes about the science, but about how that science is applied. It becomes political posturing.
This is the logic that led us down a path of political polarization during the pandemic. And we are now applying the same faulty logic to other health issues in society. Yes, social factors affect healthcare. But rather than present the findings objectively, we co-opt the issue into a political stance by using the pretense of health to re-label the issue as a healthcare crisis by citing data that is more correlative and observational than truly causal.
All issues may be related medically, but not all issues need to be framed within healthcare itself. Some issues can affect public health, and not be overtly healthcare issues, nor should they be analyzed through the lens of healthcare alone.
Scope creep leads to diluted thinking and toward health policies that lack common sense. Instead, we should see things for what they really are. Healthcare is a behemoth. It forms a major financial burden on a society with an economy that no longer grows at a rate to sustain such burdens.
We would be better off narrowing healthcare to more tangible means that fit within existing financial frameworks. But if we continue to expand the reach of healthcare, then any improvements in patient outcomes will come at a heavy economic cost to society – and it may be more of a Pyrrhic victory than anything else.