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• A plea for the progress of serious thinking about health!
  Clinton E Betts
  Published on: 13 December 2005
• Diseases of comfort or coercion?
  Mel Bartley
  Published on: 5 December 2005

• Published on: 13 December 2005

  A plea for the progress of serious thinking about health!

  • Clinton E Betts, Assistant Professor

  Dear Editor,

  I most certainly agree with the “reviewer’ comments” cited by the authors in the text of their paper; “The paper is timely and can be potentially useful for health policy makers” (p. 1032). However, “timely” in this case is a bit of an oddity. In response to a recent critique of progress that I had written (Betts, 2005) a rather noted philosopher, who is kind enough to review scholarly work for me fro...

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  Dear Editor,

  I most certainly agree with the “reviewer’ comments” cited by the authors in the text of their paper; “The paper is timely and can be potentially useful for health policy makers” (p. 1032). However, “timely” in this case is a bit of an oddity. In response to a recent critique of progress that I had written (Betts, 2005) a rather noted philosopher, who is kind enough to review scholarly work for me from time to time, asked me; “I would think that this language [of Progress] is pretty hollow now. Do your colleagues really believe it?” The point is, that serious thinkers have not “believed” in Progress since – well perhaps since Nietzsche (1990) suggested that;” “Mankind surely does not represent an evolution toward a better or stronger or higher level, as progress is now understood. This ‘progress’ is merely a modern idea, which is to say, a false idea.” (p. 4), over a century ago. Though, certainly since Ivan Illich gave the term iatrogenesis a whole new meaning. And yet virtually all of our social and political institutions, particularly those of health and welfare, are founded, perhaps even premised on the idea of Progress.

  One wonders then, why it has taken so long for many of us, who generally consider ourselves to be health practitioners of one kind or another, to catch on to this serious problem of Progress? Could it be that we have subscribed so heavily to a techno-rational science model, again particularly in the health and welfare industry, that all of our, so highly advertised, critical faculties have become stuck in a paradigm of delusion? Indeed, in a recent article by Roy (2005), a chemist by the way, aptly titled in my view; Scientism and Technology As Religions he claims that; “Science-and-technology is the most powerful force under human control; hence, scientific fundamentalism is the most dangerous.” (p. 836). Of course Roy isn’t the first to suggest that techno- rationalism (or scientism) may well constitute a religion of sorts, in fact, once again a century ago, Nietzsche claimed something similar, as have many others. In fact, more recently, Schaler (2002) has proposed that health itself had indeed become a religion, with “the medical profession as a priestly caste.” (p. 67).

  Those of us who do the work of healthcare (be it diagnosis, intervention, education, promotion and what not) must now begin some serious thinking, or at any rate begin to pay attention to some of the serious (anti-modern if you will) thinking that has characterized the 20th century. Perhaps we might begin with a question of the profoundest sort that has already, and again recently, been proposed by Joseph Heath (2004); “Is it possible to emulate many of the attractive features of western societies, while avoiding the social pathologies?” (p. 665-6). While I do agree with the authors’ claim that; “Public health needs to be more passionate about health issues associated with human progress and adopt a health promotion stance.” (p. 1033), we must also be careful for at least two reasons. The first concerns what both Fitzgerald (1994) and Fitzpatrick (2001) refer to as The Tyranny of Health, while the second is perhaps best summed up by Ulrich Beck regarding his theory of reflexive modernity (or second modernity); “Due to the close link between institutions that depend on one another to exist, it can be assumed that processes of change and transformation in particular parts of the structure will trigger problems in other parts (the side-effects of side-effects)…” (Beck & Lau, 2005, p. 533). Indeed, side effects are the order of the day, and nothing happens without them happening. The problem then, for those who claim to be engaged in the fixing of problems, is which side effects are good and which are bad. Or put differently, which are acceptable and which are not. Moreover, these are socio-political and socio-cultural issues of value, and they are anything but scientific. Finally, in the spirit of the authors’ well put claim that; “public health has to become more assertive and politically aware…” (p. 1033), with, perhaps, a continuing attention to Foucault, let us begin a plea for the progress of serious thinking about health, rather than maintaining the modern course of unhealthy Progress.

  References

  Beck, U. & Lau, C. (2005). Second modernity as a research agenda: Theoretical and empirical explorations in the ‘meta-change’ of modern society. British Journal of Sociology, 56(4), 525-557.

  Betts, C. E. (2005). Progress, epistemology and human health and welfare: What nurses need to know and why. Nursing Philosophy, 6, 174–188

  Fitzgerald F. T. (1994). The tyranny of health. N Engl J Med, 331, 196-198.

  Fitzpatrick M. (2001). The tyranny of health: Doctors and the regulation of life style. Routledge: New York.

  Heath, J. (2004). Liberalization, modernization, westernization. Philosophy and Social Criticism, 30(5-6), 665-690.

  Nietzsche F. (1990) The Anti-Christ (tr. R.J. Hollingdale). Penguin, New York.

  Roy, R. (2005). Scientism and technology as religions. Zygon, 40(4), 835-844.

  Schaler, J. A. (2002). Moral Hygiene. Society, May/June, 63-69.

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  Conflict of Interest:
  None declared.

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• Published on: 5 December 2005

  Diseases of comfort or coercion?

  • Mel Bartley, medical sociologist

  Dear Editor,

  The idea that the diseases of the future will increasingly have their aetiological roots in 'comfort' is at first sight an appealing and powerful one. However, to accept this idea uncritically could in fact be part of the problem. Just to take one example for brevity: the idea that everyone desperately wants to confine themselves to moving around in a motor car. I often have arguments with people who cl...

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  Dear Editor,

  The idea that the diseases of the future will increasingly have their aetiological roots in 'comfort' is at first sight an appealing and powerful one. However, to accept this idea uncritically could in fact be part of the problem. Just to take one example for brevity: the idea that everyone desperately wants to confine themselves to moving around in a motor car. I often have arguments with people who claim that the car is a precious guarantor of 'freedom'. One thing that argues against this is the difference in the effects on the prices of houses when it is proposed to build a road nearby versus what happens when improvements in local public transport take place. In the former case, house prices plummet. In the latter case, they generally tend to shoot upwards. In this way the market gives us a clear signal about preferences if people are really given a choice. The type of 'comfort' disease that arises from our ever diminishing levels of exercise is in part the result of an unholy alliance between the oil and motor vehicle industries, and governments who would rather not deal with unionised skilled labour forces needed to run transport systems. A furtive privatisation of transportation, by cutting services and forcing people into cars, took place long before what was left was officially privatised. A recent ONS report shows that households now spend on average over £50 per week on their motor cars, one of most expensive items in overall living costs, and around 1/3 of the total guaranteed income level for pensioner households. So I do not really think the pervasiveness of the car can be regarded in any simple way as the result of the human attachment to comfort.

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  Conflict of Interest:
  None declared.

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