Towards a healthatorship?

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Just a few months ago our priority in Europe were the holidays, the begin of the flu season and politically local elections in France, maybe a national government in Belgium, migrant crisis at the borders of Greece, and the presidential election in the US. Some democracy challenging evolutions in Hungary or Russia completed the self-energizing protests in Hong-Kong. 

Human rights were understood differently in different corners of the world and we asked ourselves how possible it is to see the truth through so many ways. It could be the clash between generations: while the youth was marching for climate, older generations were advocating for stronger armies and economies to produce more with less human investments. We have never had so many connecting tools (social media) to watch and eventually to understand these generations believes but even with this desire to be reunited, we’re still building up the self-development, the individual right or the own happiness. The idea of “I” became the rule even if the community marketing ideas were built around the concept of “We”. 

Meanwhile we all enjoyed a better life by living longer or having less fatal diseases. The norm was to chronicize the disease and through this medical approach to minimize its impact on our life. Medication was preferred in cases of chronic diseases even when lifestyle, according to World Health Organization, was the causing factor in least 80% of them (cardiovascular disease, stroke, diabetes type II to name a few). Could you blame us for it? We wanted to keep our health the same daily rhythm imposed by technology. As physicians, we faced much more informed patients even if not necessarily with evidence-based facts about vaccines, nutrition or other lifestyle chapters. The public health system was facing deficits because it was asked to deliver profits, but much as a company which welcomed the (health) failures called chronic diseases instead of investing in health promotion and efficient health interventions. The latter are more successful economically in the long term, and as a nation’s capacity of facing worldwide crisis: SARS-CoV, Ebola or MERS, to name the last health warnings.

A few years ago, in a Ted Conference speech, Bill Gates advised us to invest in health-related experts interventions instead of armies, which were efficient as fighting tools in the past, but which could be less efficient in a new world war. He even gave as an example of the Ebola crisis which was limited because it didn’t appear in urban areas. The Semmelweis reflex, or the tendency to reject new evidence or new knowledge – the importance of lifestyle in certain chronic disease-because it contradicts well accepted norms, beliefs, or paradigms, was working perfectly in our chronic diseases and public health politics. Not much as a surprise when the decisional norm in societies was the populism and not the expert’s word. We kept facing chronic diseases with physicians trained in the same way as one hundred years ago, even if in ultra-modern laboratories. We built elderly homes, where we almost abandoned our relatives instead of adding real life to their last years. Certain medical specialists were paid extremely well because of their expertise in technologized medicine. We invested less financially in emergency medicine, epidemiology or microbiology fields, not to even mention primary-care. 

As a lifestyle medicine trainer, you share from the beginning the importance of motivation in our long-term health decisions related to chronic diseases. We must understand that our patients are the experts of their lifestyle choices, which is less taken in account by our medical institutions. Knowing the habits of your patients, you know their reactions when they are facing an illness. Their habits are based on their cultural scripts, spiritual beliefs, education, health experiences and social media. How often are we questioned about these chapters of our lifestyle choices when we are in a medical office?

The actual pandemic is a mirror which shows the ugly face of our health reality: lost politicians, lack of efficient first line caretaker systems, hospitals as houses of disease, and elderly people victims of our incompetent chronic diseases management. Luckily, our human nature and surviving reflexes have made us to take some measures which will limit damages and set aside the reality mirror for a while.

If we want to be able to find the long-term solutions for the causes of the actual pandemic, we must give up the principles which we thought define modern democracy: charming and populist politicians, the freedom to travel anywhere, the right to be yourself no matter the costs, and maybe even the right to vote at term. If we want to survive and be able to live with future pandemics, we might accept a new living system in which the dictatorship could have a new ideology: everything in the name of our health. If you find the system repulsive or futuristic, you just need to look around you to see what we have accepted to stay healthy: confinement in our homes and limited movements around it, no travel, fear of personal contacts, closed churches and cultural institutions, government communication as press reference, essential commerce’s are considered just the basic needs and, of course, the pharmacies in a hope for a universal medication. 

Few years ago, James Hurowitz, an American physician, gave us an analysis of how we could live in a healthocracy as the result of capitalism, democracy and health as main ideologies. The model could have been seductive in the past and in certain cultures, but today there is need to re-healthisize the basis of our society: hospitals need to become houses of health (promotion), primary care to have a different financial model than the specialized medicine, emergency care to be the rapid health interventions teams of the country and chronic diseases treatments to be built around lifestyle as first interventions and afterwards medication. The elderly facilities must be rethought if we want to make them more than pre-cemeteries. The political system should be built with a team of health experts responsible about the health of a nation. The European Union, if she wants to keep itself legitimate, should be able to build a European medical intervention team or institution which could manage differently than today the health, financial and cultural impact of a future health crisis. As the Italian writer, Paolo Cognetti required in a recent interview to set up a European Union common Public Health system.

By lacking long-term goals built around the health of a nation and continent, we will just walk with a mask on our whole face, alone and with fear of a political system which will legitimate the dictatorship of health, however we will call it. Fear of illness will become our life and it is a question of time until opportunistic politicians will use this as an ideology to justify their democracy burning actions.