Our health is dear to us. To an increasing extent, we are prepared to do a lot for it. Looking after our health is most effective when motivated by the pleasure we derive from it rather than by a fear of disease. If we combine a knowledge of how to put together a nutritionally sound menu with tasty preparation and attractive presentation of a meal, the favourable effect on our health is an agreeable bonus. If we understand why and how we should relax, we already feel calmer. The knowledge that this also reduces the chance of high blood pressure is important, but at most as an extra incentive.
Deliberately avoiding things which harm the health is often less easy.
Fear of disease is then frequently the motivating force, but even so only rarely is this sufficient. For example, although many people are well aware that smoking is bad for them, breaking the habit often proves to be too great a task. Evidently the knowledge of the long-term risks is outweighed by the immediate satisfaction associated with lighting a cigarette. It is primarily for us to decide what we will do with our bodies and our health.
What is health?
Are you healthy? You may not be ill, but are you actually in good health? The World Health Organization defines health as ‘A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’.
This is an ambitious definition, and on a worldwide scale most of the population falls short of it. At any given moment many of the people in the world do have some disease. In Third World countries infections and parasitic diseases are endemic, anaemia and skin disorders are common, and malnutrition is the most widespread disease of all. In poor countries the problem for most people is largely one of physical survival. In the West, however, we have wider expectations. We are concerned not only with physical good health, but with mental fitness – our ability to maintain emotional stability when life becomes difficult or stressful. We have a greater awareness, too, of the ways in which the health of society as a whole is influenced, and what we can do to create an environment that carries few health risks, an environment in which a healthy lifestyle becomes easier to achieve.
Good health is something we now almost take for granted, but even in the West this is a recent expectation. Only 40 years ago it was common for schoolchil-dren to have uncorrected squints, infectious diseases such as scarlet fever or impetigo, discharging ears and the scars of mastoid operations. Their parents suf-fered from hernias, varicose veins, prolapses and piles. In 1850 the average life expectancy was 30 years, and even at the turn of the century it was only 46. Now in most Western countries it is around 70 for men and 75 for women.
Improvements in health care
The dramatic improvements in health over the last century have been largely the result of successful battles against infectious diseases. One hundred years ago the foremost causes of death were tuberculosis, pneumonia, diarrhoea, dysentery, scarlet fever and their complications. But the diseases that killed our ancestors prematurely are rarely fatal now. These days it is the turn of degenerative diseases, such as coronary heart disease, arthritis and stroke. Modern medicine can claim only part of the credit for these successes. Immunization programmes have certainly played an important part by eliminating smallpox, for example, and virtually eradicating polio and diphtheria. So too has the availability of drugs to treat bacterial and parasitic infections. In Third World countries other significant advances include programmes to eliminate disease-carrying insects, and oral rehydration therapy for treating diarrhoeal disorders.
But it is the enormous improvement in social conditions that has contributed more than anything else to this twentieth-century health revolution. Better sanitation and housing, with less overcrowding, have helped to eliminate the conditions under which infections could spread easily and rapidly. Milk pasturization and improved social conditions have reduced the incidence of tuberculosis far more than the development of special drugs against this disease. Improved nutrition has increased our resistance to infection, made us less vulnerable to illness and reduced deficiency diseases to rarities. The increased availability of family planning and adequate antenatal and child care have meant that women’s health is not worn down by frequent childbearing, and that babies are born healthy and then monitored throughout childhood.
Health and physical characteristics
So, if you are ‘healthy’ you will be ill less often. But you will also live longer, grow taller and mature earlier. Until very recently, in most European coun-tries the children of manual workers were on average two or three centimetres shorter than children of professional middle-class people. As standards of nutrition have improved these class differences have lessened, and in regions where standards of living are uniformly high, such as Scandinavia, they have almost disappeared. Also, as standards of health improve, puberty comes earlier and the menopause correspondingly later. In the nineteenth century in England the average age at which menstruation began was 18, today it is between 11 and 14.
Improving the nation’s health
Although there is plenty you can do to ensure your own personal health, it is far more difficult for any one person to create a healthy environment in which to live. This aspect of health care must be a government responsibility. Any government has an obvious duty to provide the basic essentials of good health such as a safe water supply and adequate sewage disposal. But it also has a wider responsibility: to use its legislative powers to influence public attitudes and behaviour where these can affect the health of the population as a whole. There is good evidence that such intervention plays a crucial part in a nation’s health. For example ‘clean air’ legislation greatly reduced the incidence of chronic bronchitis in many industrial areas. The enforcement of speed limits, car seat belt regulations and drinking-driving restrictions have dramatically cut the number of deaths and injuries from road accidents.
Governments can provide incentives to promote good health, too. Heavy taxation and advertising restrictions may discourage smoking or prevent excessive drinking, and education can encourage women to attend antenatal and child-care clinics. But ultimately each of us is responsible for minimizing the risks of our own health.