I’ve been thinking about health quite a lot recently, and wondering what “being in good health” means. And I suppose that to me “good health” means something like being strong and active. Sick people, suffering from some disease or other, are usually weak and inactive. I’ve hardly ever been sick during my lifetime, and most of the periods of sickness were confined to my youth, when I would come down with things like measles or mumps or tonsillitis, usually contracted while at school (I never seemed to get sick when not at school).
“Health”, it seems to me, should in principle be measurable. And a week or so back I was proposing measuring the health of hospital patients by measuring how active they were (with diagnostic e-cigarettes). So I supposed that on entry into a hospital, road crash victims would be confined to bed, and doing nothing, and being subjected to intensive nursing care. But as they gradually recovered, and broken bones healed, they would gradually become more active. They’d sit up in bed. They might be able to begin to feed themselves. They’d talk. And read books. They’d generally become stronger and more active. Eventually they’d get up and walk around on crutches (possibly as far as the hospital gates, where they could smoke a cigarette). Shortly after that, they’d be released from the hospital to go home, where they might continue to need to receive some care or assistance from friends or family until they were fully recovered.
And when they were fully recovered they’d go back to drinking and smoking and eating fast food, and playing football and skiing and swimming and driving their Ferrari at 180 mph along motorways…
While they’re sick or injured in hospital, they’re in the care or doctors and nurses who restore them to health as far as they possibly can.
But once they leave hospital in good health again, preventive medicine – in the form of Public Health – acts to try to prevent them getting sick or injured again. And it increasingly does this by restricting or banning activities which are likely to make people sick or injured. Hence smoking bans, alcohol restrictions, and so on.
But the odd thing about smoking bans is that smoking is one of the activities that is least likely to result in sickness or injury, in the short term (and probably in the long term as well). The same applies to eating fast food. And the same also applies to alcohol, drunk in moderation.
It’s doing things like playing football and skiing and swimming and driving Ferraris at 180 mph that are most likely to cause immediate injuries which result in premature death or hospitalisation.
So why aren’t all sports restricted or banned? There would be a lot fewer broken bones, torn ligaments, and premature arthritis. Why aren’t swimming pools and beaches closed? Why isn’t motor racing banned, and road speeds limited to 20 mph everywhere, including motorways? Why isn’t foreign travel banned, in order to prevent people acquiring transmissible diseases like malaria or cholera or ebola?
Rather than engage in high risk sports, swimming, racing, and travel, shouldn’t people be encouraged to instead engage in low risk activities like sitting in pubs drinking beer and smoking cigarettes? That way they won’t end up in hospital quite so quickly.
Why does Public Health seek to restrict or ban the least dangerous activities rather than the most dangerous ones?
And if Public Health are concerned with preventing people getting sick or injured, is it because people spend far too much of their lives in hospitals? There are 137,000 overnight hospital beds in the UK. The population of the UK is 65 million people. So at any one time only 0.2% of the UK population are confined in hospitals. And over an average lifetime of 80 years someone can expect to spend an average 0.2% of 80 years – or 2 months – in hospital. And given 224,000 nursing home beds in the UK, they can expect to spend less than 3½ months in a nursing home. That is, they spend in total about 0.7% of their lives being cared for by other people. That doesn’t seem to be very much of a burden at all.
After a lifetime of smoking, drinking, driving, and travelling to foreign countries, this 70-year-old has so far spent just one single night in a hospital bed. And that wasn’t as an emergency admission after a road accident or cholera epidemic.
Final thought: Don’t healthy people always like to dice with death by doing things like motor racing, skiing, mountaineering, surfing, or scuba diving? Isn’t life always gambling with death?