Sunday, 22 April 2018

Health creation: the lost art of ‘comprehensibility, meaningfulness and manageability’


Last week saw me get back into a rhythm of reading and reflections, something I missed out on the week before. So I had a backlog of different reports, articles and papers to read. One of which was the report from those good folk at the Health Foundation: What makes us healthy? An introduction to the social determinants of health. The Health Foundation is an independent charity that aims to create the achievement of better health and better health care for those living in the UK. They believe good health and health care is key to a flourishing society. The report is a great read. In the past I have confidently stood up in the classroom and delivered a lecture on what might be meant by social determinants of health. I wish that I had this report to hand when I did so. Its entire 62 pages are crammed full of facts, statistics, case studies that made for compelling reading. 

The report describes the factors which in the daily lives of people are factors that can create and support health and wellbeing. This is an approach to health that draws on the work of the medical sociologist Aaron Antonovsky. He took a very different approach to public health research, and for the last 25 years of his life he developed what he called ‘salutogenic’ questions as to what creates health (salutogenesis) rather than look for the causes of disease (pathogenesis). Antonovsky believed in real life research, undertaking this with individuals, communities, populations as well as health and care systems. He was interested in understanding people’s ability to assess and understand the situation they were in; what might motivate them to move in a health promoting direction; and whether they had the capacity to do so. He called this continuum ‘comprehensibility, meaningfulness and manageability’.  

Of course it’s more complex than that. Sir Michael Marmot, Professor of Epidemiology and Public Health at UCL, noted that the conditions to which we are exposed influence our behaviour. Whilst most of us cherish the notion of free choice, our choices are constrained by the conditions in which we are born, grow, live, work and age. In the UK, 1 in 5 people live in poverty, and over 50% of these people live in working households. This statistic is even sadder when one considers that this is happening some 76 years after William Beveridge published his report on the welfare state. His report set out a number of recommendations for tackling unemployment, child care costs, improvements in the provision of good housing and the promotion of public health. It was a report that eventually led to the creation of the NHS.  

In a world where it possible to create bio-artificial ‘hearts in a jar’, we appear to have lost our way a bit when it comes down to looking after ourselves, our families and the wider population. Professor Ronald Li, working for a company called Novoheart are using stem cells to create the ‘heart in the jar’. They need just 2.5 ml of blood to do so. They create stem cells that can be turned into a miniature ‘clone’ of your heart which not only beats like yours does but will react to new drugs in the way that your heart would. The implications for developing new drugs way before they get to human trial stage are many. Developing new medicines is lengthy expensive and a very inefficient process. Typically it can cost £1.2 – £1.80 billion and take 10 years to develop a single new drug. 

Likewise biotech companies are ‘printing’ living tissues using specialised 3D printers. Such tissue could be used to produce skin grafts or cartilage for joints. Scientists at Arizona State University and the Chinese Academy of Sciences, recently programmed ‘nanobots’ (tiny bio-machines that can be sent into an individual’s blood stream) to shrink tumours by cutting off their blood supply. Although only tested on mice so far, human trials can’t be far behind.  The rise of nano-medicine is here to stay.

The ‘heart in the jar’ and other such developments, whilst solving many existing and emerging problems, may actually be contributing to the move away from self-resilience and the adoption of healthy behaviours and choices, towards a type of ‘hedonistic obsolescence’. And in the UK where a baby girl born in Richmond upon Thames is expected to live 17.8 more years in good health than a baby girl born in Manchester, there is still a real need to get back to basics when thinking about what might keep us healthy and able to enjoy a long, productive and fulfilling life