By Paul Draus
The phrase “Culture of Health” calls up mixed images for me. On the one hand, we can imagine a crass consumer version, where we are pitched products day in and day out as a means to cultivate slimmer, sleeker, more muscular or well-balanced versions of ourselves, and where we are also policed for unhealthy behaviors by experts and consultants of various kinds. From my perspective, the health product pitch is pretty much uninterrupted already, whether we are talking about pharmaceutical drugs to modulate our emotions or gyms to build our bodies. That’s not even touching on the health care industry, which offers itself as a solution to whatever ills we suffer. This brand-name version of the “Culture of Health” might simply be a thorough and continuous training of the self to seek out such approved solutions at every stage of our life course.
On the other hand, a culture of health might simply consist of a society that has its priorities figured out and allocates resources accordingly. Research on the “social determinants of health” (i.e., all the stuff that happens before we seek the help of physicians) clearly tells us that our individual health depends on many things other than our choices and behaviors, such as the environments that surround us and the structures and institutions that shape our opportunities for flourishing as well as our exposures to risk. A (lower case) culture of health that embraced these findings would place more emphasis on the way we design and build our systems, from the transportation network to the criminal justice system.
Most crucially of all, it would reorient the relationship of our economy to the natural environment, as outlined by Pope Francis in his 2015 encyclical “Laudato Si: On Care for Our Common Home.” In that writing, Francis articulates a vision that unites social justice and protection of the environment with a critique of capitalism and consumer culture. In Section IV, Decline in the Quality of Life and the Breakdown of Human Society, Francis writes:
“Human beings too are creatures of this world, enjoying a right to life and happiness, and endowed with unique dignity. So we cannot fail to consider the effects on people’s lives of environmental deterioration, current models of development and the throwaway culture.”
As a sociologist who studies the interrelationship between health and urban communities, often with a specific focus on substance abuse and crime, I try to call attention to the social breakdowns that impact behaviors, including health behaviors. According to journalist Johann Hari, “The opposite of addiction is not sobriety. It is human connection.” Or, as Wendell Berry once put it, “Health is Membership.” Berry began that profound speech, delivered more than 20 years ago, by stating simply, “From our constant and increasing concerns about health, you can tell how seriously diseased we are.” The word health, he pointed out, has the same root at the word “whole” and the word “holy”: “To be healthy is literally to be whole; to heal is to make whole.”
I worry sometimes that the cart of “health” is being put before the horse of a just society. It is revealing that the laundry list developed by the Robert Wood Johnson Foundation to describe an “American Culture of Health” mentions neither justice nor the environment. This to me is indicative of the separation of health from its true sources, both social and natural. It implies that we should seek to promote environmental sustainability and social inclusion because it will make us healthier—not because it is the right thing to do.
Paul Draus is Professor of Sociology and Health Policy Studies at the University of Michigan-Dearborn, as well as the Director of the master of public administration program. He also is a member of Authority Health’s Population Health Council.