A REVISION OF HEALTH - PUSHING BACK THE BOUNDARIES OF DISEASE
For as long as I remember medicine has taught me about disease: the characteristics of disease, the effects of disease, its signs and symptoms, how to diagnose it, and how to attack it.
Sadly, medicine rarely gets truly involved with the big picture of health, let alone the bigger picture of public health - a people’s ability and need to pursue happiness, have a roof over their head, feel safe, get education and nutrition, enjoy wealth and health... I wonder why I never defected!
During my early school years, senior surgical residents said they could cure a patient by removing a sick appendix or a gangrenous limb while the rest of us were destined to forever wallow in disease never able to claim a cure except for an occasional infection. I felt bad because I thought they were right.
Today, I see people with diabetes and heart disease living longer due to modern medical advancements that are mainly palliative, using significant amounts of drugs, and relying on high-tech invasive procedures. The cost of this intoxicating medicine, makes us believe it is the best and only way. Clones of drugs hit the market with new names and claims every year. Joints are replaced. Heart surgery is routine.
At the same time, research into chronic illness is forcing us to recede the limits of what we accept as normal. We are diagnosing the disease process earlier and earlier in its continuum. We have revised accepted levels of blood pressure, blood sugar, and cholesterol. Yet, because we focus on the disease model, we continue to apply expert palliation.
Something is obvious to me: research into chronic illness is bringing us closest to admitting that protection is the first cure. We’ve walked in a circle for our own benefit. Yet if we resist, or take healthful steps that are ever so small, we will never close the loop.
Diabetes, heart disease, and many cancers are linked to lifestyle. It is time we accept that we have institutionalized the promotion of disease, and at the same time we must claim our personal responsibility.
The medical model insists on creating more disease categories - childhood obesity, syndrome X, metabolic syndrome, insulin resistance - but turns a blind eye to the culture that breeds them. We must ponder, write about, and correct the systemic social constructs that drive the tide of these chronic diseases.
A community sustained by neighborhood centers, YMCA’s, playgrounds, farmers’ markets, arts, and recreation, stands in contrast with violent neighborhoods, unsafe or non-existent pedestrian walkways and sidewalks, and the standard unhealthy food served in schools. We must expand the limits of our vision to not just fight disease, but to protect health.
In the sterile atmosphere of the medical office, patients are exhorted to exercise and diet often in futility. As a family physician practicing in the 21st century, I recognize the body, mind, and spirit as allies in healing. And I will continue to take joy in cooking with my patients, in teaching food literacy, in promoting competence and life sustaining routines, in using all of our senses in support of healing and wellness.
Ana M. Negrón MD
Practice Wellness-Beyond a Wish
www.greensonabudget.org