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Essays About Health: Top 5 Examples and 7 Prompts

Almost everyone would agree that health is the most important thing in life. Check out our guide on writing essays about health.

The concept of health is simple. It is the condition where you are well and free from disease or illness. When we are healthy, we are happier, more productive, and able to live a full life. There are many types of health, each helping us to survive and excel in different areas of our life, including physical, mental, spiritual, and emotional health.

In the same ways, there are different ways to stay healthy, such as exercise, socialization, and self-care. These areas of health may not all be equally important, but each of them plays a vital role in making us the best versions of ourselves we can be. You might also find our medical words list helpful.

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5 Top Essay Examples

1. essay on how to keep healthy by diwakar sharma, 2. what it’s like living with depression: a personal essay by nadine dirks, 3. the advantages of eating healthy food by lindsay boyers.

  • 4.  A Helping Hand: An Essay On The Importance Of Mental Health Parity by Sydney Waltner

5. ​​Stop Trying to be Happy: Improving Your Emotional Health by Jacquelynn Lyon

7 prompts for essays about health, 1. what is the most important type of health, 2. do television and video games negatively impact mental , 3. freedom and public health, 4. how can you live a healthier life, 5. what causes depression, 6. mental health and eating disorders, 7. is “spiritual health” really necessary.

“I think there is no use in earning money in such a way that denies our health. Money is not important than health as it cannot return health and fitness back once we are ill. Thus health is always preferred over money as good health keeps us happy and free from various health issues. If we are healthy we can earn whole life but can’t earn if the health gets deteriorated.”

Sharma discusses the importance of health and ways to stay healthy, including eating nutritious food, drinking water, keeping a good sleep schedule, and exercising. In addition, he notes that it is essential to prioritize your health; do not work too hard or chase money to the extent that it affects your health negatively. You can also check out these articles about cancer .

“I was pleasantly surprised when—after around three weeks—I started feeling results. My intense feeling of overwhelming sadness and hopelessness slowly started to lift and the fears I had about not feeling like myself dissipated. I had worried I would feel less like myself on fluoxetine, but instead for the first time, in a long time—I felt more like myself and able to function throughout the day. Receiving treatment and building healthy coping mechanisms has allowed me to continue to function, even when a depressive episode hits.”

Depression is one of the first things people think of concerning mental health. In her essay, Dirks reflects on her experiences with depression, recalling her feelings of hopelessness and sadness, putting her in a dull, lethargic mood. However, she got help by going to a doctor and starting medication and therapy. Dirks also lists down a few symptoms of depression, warning readers to get help if they are experiencing a number of them.

“A healthful diet is just as good for your brain as the rest of your body. Unhealthy foods are linked to a range of neurological problems. Certain nutrient deficiencies increasing the risk of depression. Other nutrients, like potassium, actually involved in brain cell function. A varied, healthful diet keeps your brain functioning properly, and it can promote good mental health as well.”

Boyers discusses some benefits of healthy eating, such as weight control, reduced risk of diabetes and cancer, and better brain function- an unhealthy diet is linked to neurological problems. She gives readers tips on what they should and should not eat in huge quantities, saying to avoid sugary foods and drinks while eating lean meat, fruits, vegetables, and whole grains. You might also be interested in these essays about nursing and essays about obesity .

4.   A Helping Hand: An Essay On The Importance Of Mental Health Parity by Sydney Waltner

“For three years I was one of those people hiding my illness. I was quietly suffering from depression and an eating disorder. My whole day revolved around my eating disorder and hiding it from everyone. This caused a lot of sadness, anger, and loneliness. I not only hid it from others, but I also tried to hide it from myself. I tried to convince myself that nothing was wrong because I did not fully understand what was happening.  I did not know what was making me hurt myself and why I could not stop.”

Waltner writes her essay about the importance of mental health and how it can also affect one’s physical health. She recalls her experiences with hiding her depression and eating disorder; they led to her immense suffering, but her parents discovered her illness before it was too late. She is grateful for how her life is now and encourages others to break the stigma around mental health issues and speak up if something is wrong with them. 

“Beautiful people, smart people, funny people, leaders, lawyers, engineers, professional clowns, everyone you’ve ever looked up to — they have suffered in their lives, and probably will continue to suffer at some point.”

The obsession with making yourself happy will forever have you either not valuing the present or will lead to despair when you do find it — and it’s still not enough. This cycle of self-abuse, dissatisfaction, and emotional isolation can paralyze us, hinder our actions, and mar our self-perception.

Lyon reflects on something she discovered in her first year of college: that it’s fine if you’re not always happy. She says that society’s pressure for everyone to be positive and happy 100% of the time is detrimental to many people’s emotional and mental health. As a result, she gives readers tips on being happy in a “healthier” way: happiness should not be forced, and you should not constantly compare yourself to others. 

Essays About Health: What is the most important type of health?

There are many types of health, each playing an essential role in helping us live well. If you were to pick one, which do you believe is the most important? You can choose mental well-being, physical well-being, or spiritual well-being. Use your personal experiences in defending your choice; be sure to support your stance with sufficient details. 

For a strong argumentative essay, write about the correlation between “screen time” or video games and television with mental health. Are they that bad for people’s mental health? Perhaps they are good for the mental health of some people. Research this topic and support your response with credible sources- there is no wrong answer as long as it is well-defended. For an interesting piece, conduct interviews to gather information.

Due to the COVID-19 pandemic, many argue that some freedoms must be given up for the greater good. These include mask mandates, vaccine mandates, and stay-at-home orders. Write about whether or not public health should be prioritized over “individual liberty” and why. If so, to what extent? Answer this question in your own words for a compelling argument.

Essays About Health: How can you live a healthier life?

Like many of our cited essay examples above, you can write your essay on how to stay healthy. Give your readers some mental, physical, or social guidelines for being healthier, and explain why they are important. You can even do a more well-rounded guide; give a few tips for each type of health if you wish. 

As stated previously, a prevalent health issue is depression, which can stem from various factors. Look into the different causes of depression and explain how they lead to depression. In this essay, you can share your research on social factors, economic factors, and health conditions that can make a person more susceptible to depression. As this is a medical-related topic, use credible sources for your research. 

Many believe there is a correlation between mental health and obesity, anorexia, and bulimia—research how mental health issues can cause these issues or vice versa, depending on what you find. In your essay, explain the link between mental health issues and eating disorders and how they can affect each other.

Essays About Health: Is “Spiritual Health” really necessary?

A type of health commonly listed is spiritual health, which many religious people value. Should it be classified as something different? Many believe the components of “spiritual health” already fall under mental, social, emotional, and social health, so there is no need to classify it as something different. Reflect on this issue and discuss your stance. 

For help with this topic, read our guide explaining “what is persuasive writing ?”

If you’re stuck picking an essay topic, check out our guide on how to write essays about depression .

what is health essay

Martin is an avid writer specializing in editing and proofreading. He also enjoys literary analysis and writing about food and travel.

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  • Health Essay

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Essay on Health

Health is wealth. It is the biggest asset we need every day to meet our goals. Previously, the definition of health was the proper functioning of our organ systems. As time passed, the definition has changed. Good health now includes the physical and mental wellbeing of a person. A person can be physically fit but mentally disturbed due to the circumstances he is facing. The same can happen when someone is suffering from physical illnesses but is mentally strong.

Maintaining proper health is the prime concern these days. This is a competitive era where you cannot stop. The moment you stop you will be replaced by a better option. This is why everyone is running in the rat race without thinking about their wellbeing. The compromise towards health becomes a costly affair later. In the cities, people are more affected by mental issues than physical ones. Constant stress and lack of physical activities contribute to the problem.

Proper health comprises many factors. It includes good food, proper routine, good sleeping habits, and eating habits. Apart from these personal traits, many external factors also control your wellbeing. People in the villages stay physically stronger due to freshness in the air, physical activities, and good food. People in the urban areas, on the contrary, prefer eating unhealthy food, lack physical agility, and cannot handle mental stress properly. In the same context, urban settlement has a better lifestyle and healthcare system. Considering all the components, a person needs to give equal importance to the factors and maintain a balance.

The elements of good health are physical and mental fitness. If both are maintained, a person will enjoy a better life. How can we achieve that state? First, we have to find out the factors influencing physical health. We have to learn about the lifestyle diseases that affect our health and check the ways to avoid or manage them. Secondly, we have to eat good food and maintain a healthy diet. We need to ensure a balanced diet and good food habits to provide nutrition to our systems. In this aspect, we also have to find out the harmful foods we generally prefer eating and avoid them. Regular exercise is the third most important part of good health. When we are physically active, our muscles remain functional. We get hurt very less and also recover faster. We can also maintain our body balance better when we are involved in physical activities.

The next phase is mental happiness. What makes us happy? One can be happy watching TV all the time. Sitting on the couch all day long can also make someone happy but is it a healthy choice? This type of lifestyle choice should be immediately avoided. Choosing a sedentary lifestyle is nothing but an invitation to different diseases. The current urban population is suffering from weight-related issues. Being overweight also makes the situation worse. Lifestyle diseases such as high blood pressure, diabetes, cholesterol elevation, cardiovascular diseases, etc develop at a young age.

We also need to make better choices when it comes to mental health. Playing sports with your buddies will help you relax and de-stress. You can also take a walk in the park and enjoy the greenery. Avoid spending more time on the screen and try to develop a hobby that suits you. In this way, you can become happier and stay healthier.

A person also needs to choose better social factors to remain free from social stigmas. Cognitive health and social health are equally important. Adding more stress will not be the solution. Keep exercising physically and mentally to remain fit and enjoy good health and longer life. Make your home stress-free with good habits and keep everyone healthy.

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FAQs on Health Essay

1. What are the Prime Elements Included in Good Health?

The prime elements of good health are physical health, mental health, and social health. A person needs to be physically and mentally fit in a healthy environment. A society should also provide a healthy environment for a person to remain stress-free and enjoy life. Even though an ideal society does not exist, it is not hard to maintain a healthy lifestyle. These elements should be maintained properly to enjoy overall good health and survive in this competitive world. It is important for all family members.

2. Why is Mental Health Also Important?

Previously mental health was not included in the wellbeing of a person. Now that we have found the direct relationship between physical and mental health, it has become an important factor to consider. Many surveys suggest that mental health in a society is ignored. People are less happy when they are surrounded by many responsibilities. Circumstances also make a person sad and mentally unfit. If this continues, a person becomes prone to physical illnesses. Stress is a major reason for mental illnesses. By educating people regarding the importance of mental health, we can avoid such issues.

3. How Can We Teach the Importance of Mental Wellness?

From the very beginning, kids should be taught what mental wellness is. They should play outside, have fun with their friends, play, get hurt, and learn what mental wellness is. Adults also need proper guidance to understand the importance of mental wellness. They should maintain a proper balance between personal and professional life to stay happy. All we have to remember is an individual laughing might not be happy. We need to find out what makes us happy.

By Francesca Colombo , Head, Health Division, Organisation for Economic Co-operation and Development (OECD) and Helen E. Clark , Prime Minister of New Zealand (1999-2008), The Helen Clark Foundation

The COVID-19 crisis has affected more than 188 countries and regions worldwide, causing large-scale loss of life and severe human suffering. The crisis poses a major threat to the global economy, with drops in activity, employment, and consumption worse than those seen during the 2008 financial crisis . COVID-19 has also exposed weaknesses in our health systems that must be addressed. How?

For a start, greater investment in population health would make people, particularly vulnerable population groups, more resilient to health risks. The health and socio-economic consequences of the virus are felt more acutely among disadvantaged populations, stretching a social fabric already challenged by high levels of inequalities. The crisis demonstrates the consequences of poor investment in addressing wider social determinants of health, including poverty, low education and unhealthy lifestyles. Despite much talk of the importance of health promotion, even across the richer OECD countries barely 3% of total health spending is devoted to prevention . Building resilience for populations also requires a greater focus on solidarity and redistribution in social protection systems to address underlying structural inequalities and poverty.

Beyond creating greater resilience in populations, health systems must be strengthened.

High-quality universal health coverage (UHC) is paramount. High levels of household out-of-pocket payments for health goods and services deter people from seeking early diagnosis and treatment at the very moment they need it most. Facing the COVID-19 crisis, many countries have strengthened access to health care, including coverage for diagnostic testing. Yet others do not have strong UHC arrangements. The pandemic reinforced the importance of commitments made in international fora, such as the 2019 High-Level Meeting on Universal Health Coverage , that well-functioning health systems require a deliberate focus on high-quality UHC. Such systems protect people from health threats, impoverishing health spending, and unexpected surges in demand for care.

Second, primary and elder care must be reinforced. COVID-19 presents a double threat for people with chronic conditions. Not only are they at greater risk of severe complications and death due to COVID-19; but also the crisis creates unintended health harm if they forgo usual care, whether because of disruption in services, fear of infections, or worries about burdening the health system. Strong primary health care maintains care continuity for these groups. With some 94% of deaths caused by COVID-19 among people aged over 60 in high-income countries, the elder care sector is also particularly vulnerable, calling for efforts to enhance control of infections, support and protect care workers and better coordinate medical and social care for frail elderly.

Third, the crisis demonstrates the importance of equipping health systems with both reserve capacity and agility. There is an historic underinvestment in the health workforce, with estimated global shortages of 18 million health professionals worldwide , mostly in low- and middle-income countries. Beyond sheer numbers, rigid health labour markets make it difficult to respond rapidly to demand and supply shocks. One way to address this is by creating a “reserve army” of health professionals that can be quickly mobilised. Some countries have allowed medical students in their last year of training to start working immediately, fast-tracked licenses and provided exceptional training. Others have mobilised pharmacists and care assistants. Storing a reserve capacity of supplies such as personal protection equipment, and maintaining care beds that can be quickly transformed into critical care beds, is similarly important.

Fourth, stronger health data systems are needed. The crisis has accelerated innovative digital solutions and uses of digital data, smartphone applications to monitor quarantine, robotic devices, and artificial intelligence to track the virus and predict where it may appear next. Access to telemedicine has been made easier. Yet more can be done to leverage standardised national electronic health records to extract routine data for real-time disease surveillance, clinical trials, and health system management. Barriers to full deployment of telemedicine, the lack of real-time data, of interoperable clinical record data, of data linkage capability and sharing within health and with other sectors remain to be addressed.

Fifth, an effective vaccine and successful vaccination of populations around the globe will provide the only real exit strategy. Success is not guaranteed and there are many policy issues yet to be resolved. International cooperation is vital. Multilateral commitments to pay for successful candidates would give manufacturers certainty so that they can scale production and have vaccine doses ready as quickly as possible following marketing authorisation, but could also help ensure that vaccines go first to where they are most effective in ending the pandemic. Whilst leaders face political pressure to put the health of their citizens first, it is more effective to allocate vaccines based on need. More support is needed for multilateral access mechanisms that contain licensing commitments and ensure that intellectual property is no barrier to access, commitments to technology transfer for local production, and allocation of scarce doses based on need.

The pandemic offers huge opportunities to learn lessons for health system preparedness and resilience. Greater focus on anticipating responses, solidarity within and across countries, agility in managing responses, and renewed efforts for collaborative actions will be a better normal for the future.

OECD Economic Outlook 2020 , Volume 2020 Issue 1, No. 107, OECD Publishing, Paris

OECD Employment Outlook 2020 : Worker Security and the COVID-19 Crisis, OECD Publishing, Paris

OECD Health at a Glance 2019, OECD Publishing, Paris

https://www.un.org/pga/73/wp-content/uploads/sites/53/2019/07/FINAL-draft-UHC-Political-Declaration.pdf

OECD (2020), Who Cares? Attracting and Retaining Care Workers for the Elderly, OECD Health Policy Studies, OECD Publishing, Paris

Working for Health and Growth: investing in the health workforce . Report of the High-Level Commission on Health Employment and Economic Growth, Geneva.

Colombo F., Oderkirk J., Slawomirski L. (2020) Health Information Systems, Electronic Medical Records, and Big Data in Global Healthcare: Progress and Challenges in OECD Countries . In: Haring R., Kickbusch I., Ganten D., Moeti M. (eds) Handbook of Global Health. Springer, Cham.

2. Improving population health and building healthy societies in times of COVID-19

By Helena Legido-Quigley , Associate Professor, London School of Hygiene and Tropical Medicine

The COVID-19 pandemic has been a stark reminder of the fragility of population health worldwide; at time of writing, more than 1 million people have died from the disease. The pandemic has already made evident that those suffering most from COVID-19 belong to disadvantaged populations and marginalised communities. Deep-rooted inequalities have contributed adversely to the health status of different populations within and between countries. Besides the direct and indirect health impacts of COVID-19 and the decimation of health systems, restrictions on population movement and lockdowns introduced to combat the pandemic are expected to have economic and social consequences on an unprecedented scale .

Population health – and addressing the consequences of COVID-19 – is about improving the physical and mental health outcomes and wellbeing of populations locally, regionally and nationally, while reducing health inequalities.¹ Moreover, there is an increasing recognition that societal and environmental factors, such as climate change and food insecurity, can also influence population health outcomes.

The experiences of Maria, David, and Ruben – as told by Spanish public broadcaster RTVE – exemplify the real challenges that people living in densely populated urban areas have faced when being exposed to COVID-19.¹

Maria is a Mexican migrant who has just returned from Connecticut to the Bronx. Her partner Jorge died in Connecticut from COVID-19. She now has no income and is looking for an apartment for herself and her three children. When Jorge became ill, she took him to the hospital, but they would not admit him and he was sent away to be cared for by Maria at home with their children. When an ambulance eventually took him to hospital, it was too late. He died that same night, alone in hospital. She thinks he had diabetes, but he was never diagnosed. They only had enough income to pay the basic bills. Maria is depressed, she is alone, but she knows she must carry on for her children. Her 10-year old child says that if he could help her, he would work. After three months, she finds an apartment.

David works as a hairdresser and takes an overcrowded train every day from Leganés to Chamberi in the centre of Madrid. He lives in a small flat in San Nicasio, one of the poorest working-class areas of Madrid with one of the largest ageing populations in Spain. The apartments are very small, making it difficult to be in confinement, and all of David’s neighbours know somebody who has been a victim of COVID-19. His father was also a hairdresser. David's father was not feeling well; he was taken to hospital by ambulance, and he died three days later. David was not able to say goodbye to his father. Unemployment has increased in that area; small local shops are losing their customers, and many more people are expecting to lose their jobs.

Ruben lives in Iztapalapa in Mexico City with three children, a daughter-in-law and five grandchildren. Their small apartment has few amenities, and no running water during the evening. At three o’clock every morning, he walks 45 minutes with his mobile stall to sell fruit juices near the hospital. His daily earnings keep the family. He goes to the central market to buy fruit, taking a packed dirty bus. He thinks the city's central market was contaminated at the beginning of the pandemic, but it could not be closed as it is the main source of food in the country. He has no health insurance, and he knows that as a diabetic he is at risk, but medication for his condition is too expensive. He has no alternative but to go to work every day: "We die of hunger or we die of COVID."

These real stories highlight the issues that must be addressed to reduce persistent health inequalities and achieve health outcomes focusing on population health. The examples of Maria, David and Ruben show the terrible outcomes COVID-19 has had for people living in poverty and social deprivation, older people, and those with co-morbidities and/or pre-existing health conditions. All three live in densely populated urban areas with poor housing, and have to travel long distances in overcrowded transport. Maria’s loss of income has had consequences for her housing security and access to healthcare and health insurance, which will most likely lead to worse health conditions for her and her children. Furthermore, all three experienced high levels of stress, which is magnified in the cases of Maria and David who were unable to be present when their loved ones died.

The COVID-19 pandemic has made it evident that to improve the health of the population and build healthy societies, there is a need to shift the focus from illness to health and wellness in order to address the social, political and commercial determinants of health; to promote healthy behaviours and lifestyles; and to foster universal health coverage.² Citizens all over the world are demanding that health systems be strengthened and for governments to protect the most vulnerable. A better future could be possible with leadership that is able to carefully consider the long-term health, economic and social policies that are needed.

In order to design and implement population health-friendly policies, there are three prerequisites. First, there is a need to improve understanding of the factors that influence health inequalities and the interconnections between the economic, social and health impacts. Second, broader policies should be considered not only within the health sector, but also in other sectors such as education, employment, transport and infrastructure, agriculture, water and sanitation. Third, the proposed policies need to be designed through involving the community, addressing the health of vulnerable groups, and fostering inter-sectoral action and partnerships.

Finally, within the UN's Agenda 2030 , Sustainable Development Goal (SDG) 3 sets out a forward-looking strategy for health whose main goal is to attain healthier lives and wellbeing. The 17 interdependent SDGs offer an opportunity to contribute to healthier, fairer and more equitable societies from which both communities and the environment can benefit.

The stories of Maria, David and Ruben are real stories featured in the Documentary: The impact of COVID19 in urban outskirts, Directed by Jose A Guardiola. Available here. Permission has been granted to narrate these stories.

Buck, D., Baylis, A., Dougall, D. and Robertson, R. (2018). A vision for population health: Towards a healthier future . [online] London: The King's Fund. [Accessed 20 Sept. 2020]

Wilton Park. (2020). Healthy societies, healthy populations (WP1734). Wiston House, Steyning. Retrieved from https://www.wiltonpark.org.uk/event/wp1734/ Cohen B. E. (2006). Population health as a framework for public health practice: a Canadian perspective. American journal of public health , 96 (9), 1574–1576.

3. Imagine a 'well-care' system that invests in keeping people healthy

By Maliha Hashmi , Executive Director, Health and Well-Being and Biotech, NEOM, and Jan Kimpen , Global Chief Medical Officer, Philips

Imagine a patient named Emily. Emily is aged 32 and I’m her doctor.

Emily was 65lb (29kg) above her ideal body weight, pre-diabetic and had high cholesterol. My initial visit with Emily was taken up with counselling on lifestyle changes, mainly diet and exercise; typical advice from one’s doctor in a time-pressured 15-minute visit. I had no other additional resources, incentives or systems to support me or Emily to help her turn her lifestyle around.

I saw Emily eight months later, not in my office, but in the hospital emergency room. Her husband accompanied her – she was vomiting, very weak and confused. She was admitted to the intensive care unit, connected to an insulin drip to lower her blood sugar, and diagnosed with type 2 diabetes. I talked to Emily then, emphasizing that the new medications for diabetes would only control the sugars, but she still had time to reverse things if she changed her lifestyle. She received further counselling from a nutritionist.

Over the years, Emily continued to gain weight, necessitating higher doses of her diabetes medication. More emergency room visits for high blood sugars ensued, she developed infections of her skin and feet, and ultimately, she developed kidney disease because of the uncontrolled diabetes. Ten years after I met Emily, she is 78lb (35kg) above her ideal body weight; she is blind and cannot feel her feet due to nerve damage from the high blood sugars; and she will soon need dialysis for her failing kidneys. Emily’s deteriorating health has carried a high financial cost both for herself and the healthcare system. We have prevented her from dying and extended her life with our interventions, but each interaction with the medical system has come at significant cost – and those costs will only rise. But we have also failed Emily by allowing her diabetes to progress. We know how to prevent this, but neither the right investments nor incentives are in place.

Emily could have been a real patient of mine. Her sad story will be familiar to all doctors caring for chronically ill patients. Unfortunately, patients like Emily are neglected by health systems across the world today. The burden of chronic disease is increasing at alarming rates. Across the OECD nearly 33% of those over 15 years live with one or more chronic condition, rising to 60% for over-65s. Approximately 50% of chronic disease deaths are attributed to cardiovascular disease (CVD). In the coming decades, obesity, will claim 92 million lives in the OECD while obesity-related diseases will cut life expectancy by three years by 2050.

These diseases can be largely prevented by primary prevention, an approach that emphasizes vaccinations, lifestyle behaviour modification and the regulation of unhealthy substances. Preventative interventions have been efficacious. For obesity, countries have effectively employed public awareness campaigns, health professionals training, and encouragement of dietary change (for example, limits on unhealthy foods, taxes and nutrition labelling).⁴,⁵ Other interventions, such as workplace health-promotion programmes, while showing some promise, still need to demonstrate their efficacy.

what is health essay

The COVID-19 crisis provides the ultimate incentive to double down on the prevention of chronic disease. Most people dying from COVID-19 have one or more chronic disease, including obesity, CVD, diabetes or respiratory problems – diseases that are preventable with a healthy lifestyle. COVID-19 has highlighted structural weaknesses in our health systems such as the neglect of prevention and primary care.

While the utility of primary prevention is understood and supported by a growing evidence base, its implementation has been thwarted by chronic underinvestment, indicating a lack of societal and governmental prioritization. On average, OECD countries only invest 2.8% of health spending on public health and prevention. The underlying drivers include decreased allocation to prevention research, lack of awareness in populations, the belief that long-run prevention may be more costly than treatment, and a lack of commitment by and incentives for healthcare professionals. Furthermore, public health is often viewed in a silo separate from the overall health system rather than a foundational component.

Health benefits aside, increasing investment in primary prevention presents a strong economic imperative. For example, obesity contributes to the treatment costs of many other diseases: 70% of diabetes costs, 23% for CVD and 9% for cancers. Economic losses further extend to absenteeism and decreased productivity.

Fee-for-service models that remunerate physicians based on the number of sick patients they see, regardless the quality and outcome, dominate healthcare systems worldwide. Primary prevention mandates a payment system that reimburses healthcare professionals and patients for preventive actions. Ministries of health and governmental leaders need to challenge skepticism around preventive interventions, realign incentives towards preventive actions and those that promote healthy choices by people. Primary prevention will eventually reduce the burden of chronic diseases on the healthcare system.

As I reflect back on Emily and her life, I wonder what our healthcare system could have done differently. What if our healthcare system was a well-care system instead of a sick-care system? Imagine a different scenario: Emily, a 32 year old pre-diabetic, had access to a nutritionist, an exercise coach or health coach and nurse who followed her closely at the time of her first visit with me. Imagine if Emily joined group exercise classes, learned where to find healthy foods and how to cook them, and had access to spaces in which to exercise and be active. Imagine Emily being better educated about her diabetes and empowered in her healthcare and staying healthy. In reality, it is much more complicated than this, but if our healthcare systems began to incentivize and invest in prevention and even rewarded Emily for weight loss and healthy behavioural changes, the outcome might have been different. Imagine Emily losing weight and continuing to be an active and contributing member of society. Imagine if we invested in keeping people healthy rather than waiting for people to get sick, and then treating them. Imagine a well-care system.

Anderson, G. (2011). Responding to the growing cost and prevalence of people with multiple chronic conditions . Retrieved from OECD.

Institute for Health Metrics and Evaluation. GBD Data Visualizations. Retrieved here.

OECD (2019), The Heavy Burden of Obesity: The Economics of Prevention, OECD Health Policy Studies, OECD Publishing, Paris.

OECD. (2017). Obesity Update . Retrieved here.

Malik, V. S., Willett, W. C., & Hu, F. B. (2013). Global obesity: trends, risk factors and policy implications. Nature Reviews Endocrinology , 9 (1), 13-27.

Lang, J., Cluff, L., Payne, J., Matson-Koffman, D., & Hampton, J. (2017). The centers for disease control and prevention: findings from the national healthy worksite program. Journal of occupational and environmental medicine , 59 (7), 631.

Gmeinder, M., Morgan, D., & Mueller, M. (2017). How much do OECD countries spend on prevention? Retrieved from OECD.

Jordan RE, Adab P, Cheng KK. Covid-19: risk factors for severe disease and death. BMJ. 2020;368:m1198.

Richardson, A. K. (2012). Investing in public health: barriers and possible solutions. Journal of Public Health , 34 (3), 322-327.

Yong, P. L., Saunders, R. S., & Olsen, L. (2010). Missed Prevention Opportunities The healthcare imperative: lowering costs and improving outcomes: workshop series summary (Vol. 852): National Academies Press Washington, DC.

OECD. (2019). The Heavy Burden of Obesity: The Economics of Prevention. Retrieved here .

McDaid, D., F. Sassi and S. Merkur (Eds.) (2015a), “Promoting Health, Preventing Disease: The Economic Case ”, Open University Press, New York.

OECD. (2019). The Heavy Burden of Obesity: The Economics of Prevention. Retrieved from OECD.

4. Why e arly detection and diagnosis is critical

By Paul Murray , Head of Life and Health Products, Swiss Re, and André Goy , Chairman and Executive Director & Chief of Lymphoma, John Theurer Cancer Center, Hackensack University Medical Center

Although healthcare systems around the world follow a common and simple principle and goal – that is, access to affordable high-quality healthcare – they vary significantly, and it is becoming increasingly costly to provide this access, due to ageing populations, the increasing burden of chronic diseases and the price of new innovations.

Governments are challenged by how best to provide care to their populations and make their systems sustainable. Neither universal health, single payer systems, hybrid systems, nor the variety of systems used throughout the US have yet provided a solution. However, systems that are ranked higher in numerous studies, such as a 2017 report by the Commonwealth Fund , typically include strong prevention care and early-detection programmes. This alone does not guarantee a good outcome as measured by either high or healthy life expectancy. But there should be no doubt that prevention and early detection can contribute to a more sustainable system by reducing the risk of serious diseases or disorders, and that investing in and operationalizing earlier detection and diagnosis of key conditions can lead to better patient outcomes and lower long-term costs.

To discuss early detection in a constructive manner it makes sense to describe its activities and scope. Early detection includes pre-symptomatic screening and treatment immediately or shortly after first symptoms are diagnosed. Programmes may include searching for a specific disease (for example, HIV/AIDS or breast cancer), or be more ubiquitous. Prevention, which is not the focus of this blog, can be interpreted as any activities undertaken to avoid diseases, such as information programmes, education, immunization or health monitoring.

Expenditures for prevention and early detection vary by country and typically range between 1-5% of total health expenditures.¹ During the 2008 global financial crisis, many countries reduced preventive spending. In the past few years, however, a number of countries have introduced reforms to strengthen and promote prevention and early detection. Possibly the most prominent example in recent years was the introduction of the Affordable Care Act in the US, which placed a special focus on providing a wide range of preventive and screening services. It lists 63 distinct services that must be covered without any copayment, co-insurance or having to pay a deductible.

what is health essay

Whilst logic dictates that investment in early detection should be encouraged, there are a few hurdles and challenges that need to be overcome and considered. We set out a few key criteria and requirements for an efficient early detection program:

1. Accessibility The healthcare system needs to provide access to a balanced distribution of physicians, both geographically (such as accessibility in rural areas), and by specialty. Patients should be able to access the system promptly without excessive waiting times for diagnoses or elective treatments. This helps mitigate conditions or diseases that are already quite advanced or have been incubating for months or even years before a clinical diagnosis. Access to physicians varies significantly across the globe from below one to more than 60 physicians per 10,000 people.² One important innovation for mitigating access deficiencies is telehealth. This should give individuals easier access to health-related services, not only in cases of sickness but also to supplement primary care.

2. Early symptoms and initial diagnosis Inaccurate or delayed initial diagnoses present a risk to the health of patients, can lead to inappropriate or unnecessary testing and treatment, and represents a significant share of total health expenditures. A medical second opinion service, especially for serious medical diagnoses, which can occur remotely, can help improve healthcare outcomes. Moreover, studies show that early and correct diagnosis opens up a greater range of curative treatment options and can reduce costs (e.g. for colon cancer, stage-four treatment costs are a multiple of stage-one treatment costs).³

3. New technology New early detection technologies can improve the ability to identify symptoms and diseases early: i. Advances in medical monitoring devices and wearable health technology, such as ECG and blood pressure monitors and biosensors, enable patients to take control of their own health and physical condition. This is an important trend that is expected to positively contribute to early detection, for example in atrial fibrillation and Alzheimers’ disease. ii. Diagnostic tools, using new biomarkers such as liquid biopsies or volatile organic compounds, together with the implementation of machine learning, can play an increasing role in areas such as oncology or infectious diseases.⁴

4. Regulation and Intervention Government regulation and intervention will be necessary to set ranges of normality, to prohibit or discourage overdiagnosis and to reduce incentives for providers to overtreat patients or to follow patients' inappropriate requests. In some countries, such as the US, there has been some success through capitation models and value-based care. Governments might also need to intervene to de-risk the innovation paradigm, such that private providers of capital feel able to invest more in the development of new detection technologies, in addition to proven business models in novel therapeutics.

OECD Health Working Papers No. 101 "How much do OECD countries spend on prevention" , 2017

World Health Organization; Global Health Observatory (GHO) data; https://www.who.int/gho/health_workforce/physicians_density/en/

Saving lives, averting costs; A report for Cancer Research UK, by Incisive Health, September 2014

Liquid Biopsy: Market Drivers And Obstacles; by Divyaa Ravishankar, Frost & Sullivan, January 21, 2019

Liquid Biopsies Become Cheap and Easy with New Microfluidic Device; February 26, 2019

How America’s 5 Top Hospitals are Using Machine Learning Today; by Kumba Sennaar, February 19, 2019

5. The business case for private investment in healthcare for all

Pascal Fröhlicher, Primary Care Innovation Scholar, Harvard Medical School, and Ian Wijaya, Managing Director in Lazard’s Global Healthcare Group

Faith, a mother of two, has just lost another customer. Some households where she is employed to clean, in a small town in South Africa, have little understanding of her medical needs. As a type 2 diabetes patient, this Zimbabwean woman visits the public clinic regularly, sometimes on short notice. At her last visit, after spending hours in a queue, she was finally told that the doctor could not see her. To avoid losing another day of work, she went to the local general practitioner to get her script, paying more than three daily wages for consultation and medication. Sadly, this fictional person reflects a reality for many people in middle-income countries.

Achieving universal health coverage by 2030, a key UN Sustainable Development Goal (SDG), is at risk. The World Bank has identified a $176 billion funding gap , increasing every year due to the growing needs of an ageing population, with the health burden shifting towards non-communicable diseases (NCDs), now the major cause of death in emerging markets . Traditional sources of healthcare funding struggle to increase budgets sufficiently to cover this gap and only about 4% of private health care investments focus on diseases that primarily affect low- and middle-income countries.

In middle-income countries, private investors often focus on extending established businesses, including developing private hospital capacity, targeting consumers already benefiting from quality healthcare. As a result, an insufficient amount of private capital is invested in strengthening healthcare systems for everyone.

what is health essay

Why is this the case? We discussed with senior health executives investing in Lower and Middle Income Countries (LMIC) and the following reasons emerged:

  • Small market size . Scaling innovations in healthcare requires dealing with country-specific regulatory frameworks and competing interest groups, resulting in high market entry cost.
  • Talent . Several LMICs are losing nurses and doctors but also business and finance professionals to European and North American markets due to the lack of local opportunities and a significant difference in salaries.
  • Untested business models with relatively low gross margins. Providing healthcare requires innovative business models where consumers’ willingness to pay often needs to be demonstrated over a significant period of time. Additionally, relatively low gross margins drive the need for scale to leverage administrative costs, which increases risk.
  • Government Relations. The main buyer of health-related products and services is government; yet the relationship between public and private sectors often lacks trust, creating barriers to successful collaboration. Add to that significant political risk, as contracts can be cancelled by incoming administrations after elections. Many countries also lack comprehensive technology strategies to successfully manage technological innovation.
  • Complexity of donor funding. A significant portion of healthcare is funded by private donors, whose priorities might not always be congruent with the health priorities of the government.

Notwithstanding these barriers, healthcare, specifically in middle-income settings, could present an attractive value proposition for private investors:

  • Economic growth rates . A growing middle class is expanding the potential market for healthcare products and services.
  • Alignment of incentives . A high ratio of out-of-pocket payments for healthcare services is often associated with low quality. However, innovative business models can turn out of pocket payments into the basis for a customer-centric value proposition, as the provider is required to compete for a share of disposable income.
  • Emergence of National Health Insurance Schemes . South Africa, Ghana, Nigeria and others are building national health insurance schemes, increasing a population’s ability to fund healthcare services and products .
  • Increased prevalence of NCDs. Given the increasing incidence of chronic diseases and the potential of using technology to address these diseases, new business opportunities for private investment exist.

Based on the context above, several areas in healthcare delivery can present compelling opportunities for private companies.

  • Aggregation of existing players.
  • Leveraging primary care infrastructure. Retail companies can leverage their real estate, infrastructure and supply chains to deploy primary care services at greater scale than is currently the case.
  • Telemedicine . Telecommunications providers can leverage their existing infrastructure and customer base to provide payment mechanisms and telehealth services at scale. As seen during the COVID-19 pandemic, investment in telemedicine can ensure that patients receive timely and continuous care in spite of restrictions and lockdowns.
  • Cost effective diagnostics . Diagnostic tools operated by frontline workers and combined with the expertise of specialists can provide timely and efficient care.

To fully realize these opportunities, government must incentivise innovation, provide clear regulatory frameworks and, most importantly, ensure that health priorities are adequately addressed.

Venture capital and private equity firms as well as large international corporations can identify the most commercially viable solutions and scale them into new markets. The ubiquity of NCDs and the requirement to reduce costs globally provides innovators with the opportunity to scale their tested solutions from LMICs to higher income environments.

Successful investment exits in LMICs and other private sector success stories will attract more private capital. Governments that enable and support private investment in their healthcare systems would, with appropriate governance and guidance, generate benefits to their populations and economies. The economic value of healthy populations has been proven repeatedly , and in the face of COVID-19, private sector investment can promote innovation and the development of responsible, sustainable solutions.

Faith – the diabetic mother we introduced at the beginning of this article - could keep her client. As a stable patient, she could measure her glucose level at home and enter the results in an app on her phone, part of her monthly diabetes programme with the company that runs the health centre. She visits the nurse-led facility at the local taxi stand on her way to work when her app suggests it. The nurse in charge of the centre treats Faith efficiently, and, if necessary, communicates with a primary care physician or even a specialist through the telemedicine functionality of her electronic health system.

Improving LMIC health systems is not only a business opportunity, but a moral imperative for public and private leaders. With the appropriate technology and political will, this can become a reality.

6. How could COVID-19 change the way we pay for health services?

John E. Ataguba, Associate Professor and Director, University of Cape Town and Matthew Guilford, Co-Founder and Chief Executive Officer, Common Health

The emergence of the new severe acute respiratory syndrome coronavirus (SARS-Cov-2), causing the coronavirus disease 2019 (COVID-19), has challenged both developing and developed countries.

Countries have approached the management of infections differently. Many people are curious to understand their health system’s performance on COVID-19, both at the national level and compared to international peers. Alongside limited resources for health, many developing countries may have weak health systems that can make it challenging to respond adequately to the pandemic.

Even before COVID-19, high rates of out-of-pocket spending on health meant that every year, 800 million people faced catastrophic healthcare costs ,100 million families were pushed into poverty, and millions more simply avoided care for critical conditions because they could not afford to pay for it.

The pandemic and its economic fallout have caused household incomes to decline at the same time as healthcare risks are rising. In some countries with insurance schemes, and especially for private health insurance, the following questions have arisen: How large is the co-payment for a COVID-19 test? If my doctor’s office is closed, will the telemedicine consultation be covered by my insurance? Will my coronavirus care be paid for regardless of how I contracted the virus? These and other doubts can prevent people from seeking medical care in some countries.

In Nigeria, like many other countries in Africa, the government bears the costs associated with testing and treating COVID-19 irrespective of the individual’s insurance status. In the public health sector, where COVID-19 cases are treated, health workers are paid monthly salaries while budgets are allocated to health facilities for other services. Hospitals continue to receive budget allocations to finance all health services including the management and treatment of COVID-19. That implies that funds allocated to address other health needs are reduced and that in turn could affect the availability and quality of health services.

Although health workers providing care for COVID-19 patients in isolation and treatment centres in Nigeria are paid salaries that are augmented with a special incentive package, the degree of impact on the quality improvement of services remains unclear. The traditional and historical allocation of budgets does not always address the needs of the whole population and could result in poor health services and under-provision of health services for COVID-19 patients.

In some countries, the reliance on out-of-pocket funding is hardly better for private providers, who encounter brand risks, operational difficulties, and – in extreme cases – the risk of creating “debtor prisons” as they seek to collect payment from patients. Ironically, despite the huge demand for medical services to diagnose and treat COVID-19, large healthcare institutions and individual healthcare practitioners alike are facing financial distress.

Dependence on a steady stream of fee-for-service payments for outpatient consultations and elective procedures is leading to pay cuts for doctors in India , forfeited Eid bonuses for nurses in Indonesia , and hospital bankruptcies in the United States . In a recent McKinsey & Company survey, 77% of physicians reported that their business would suffer in 2020 , and 46% were concerned about their practice surviving the coronavirus pandemic.

COVID-19 is exposing how fee-for-service, historical budget allocation and out-of-pocket financing methods can hinder the performance of the health system. Some providers and health systems that deployed “value-based” models prior to the pandemic have reported that these approaches have improved financial resilience during COVID-19 and may support better results for patients. Nevertheless, these types of innovations do not represent the dominant payment model in any country.

How health service providers are paid has implications for whether service users can get needed health services in a timely fashion, and at an appropriate quality and an affordable cost. By shifting from fee-for-service reimbursements to fixed "capitation" and performance-based payments, these models incentivize providers to improve quality and coordination while also guaranteeing a baseline income level, even during times of disruption.

Health service providers could be paid either in the form of salaries, a fee for services they provide, by capitation (whether adjusted or straightforward), through global budgets, or by using a case-based payment system (for example, the diagnostics-related groups), among others. Because there are different incentives to consider when adopting any of the methods, they could be combined to achieve a specific goal. For example, in some countries, health workers are paid salaries , and some specific services are paid on a fee-for-service basis.

Ideally, health services could be purchased strategically , incorporating aspects of provider performance in transferring funds to providers and accounting for the health needs of the population they serve.

In this regard, strategic purchasing for health has been advocated and should be highlighted as crucial with the emergence of the COVID-19 pandemic. There is a need to ensure value in the way health providers are paid, inter alia to increase efficiency, ensure equity, and improve access to needed health services. Value-based payment methods, although not new in many countries, provide an avenue to encourage long-term value for money, better quality, and strategic purchasing for health, helping to build a healthier, more resilient world.

7. L essons in integrated care from the COVID-19 pandemic

Sarah Ziegler, Postdoctoral Researcher, Department of Epidemiology and Biostatistics, University of Zurich, and Ninie Wang, Founder & CEO, Pinetree Care Group.

Since the start of the COVID-19 pandemic, people suffering non-communicable diseases (NCDs) have been at higher risk of becoming severely ill or dying. In Italy, 96.2% of people who died of COVID-19 lived with two or more chronic conditions.

Beyond the pandemic, cardiovascular disease, cancer, respiratory disease and diabetes are the leading burden of disease, with 41 million annual deaths. People with multimorbidity - a number of different conditions - often experience difficulties in accessing timely and coordinated healthcare, made worse when health systems are busy fighting against the pandemic.

Here is what happened in China with Lee, aged 62, who has been living with Chronic Obstructive Pulmonary Disease (COPD) for the past five years.

Before the pandemic, Lee’s care manager coordinated a multi-disciplinary team of physicians, nurses, pulmonary rehabilitation therapists, psychologists and social workers to put together a personalized care plan for her. Following the care plan, Lee stopped smoking and paid special attention to her diet, sleep and physical exercises, as well as sticking to her medication and follow-up visits. She participated in a weekly community-based physical activity program to meet other COPD patients, including short walks and exchange experiences. A mobile care team supported her with weekly cleaning and grocery shopping.

Together with her family, Lee had follow-up visits to ensure her care plan reflected her recovery and to modify the plan if needed. These integrated care services brought pieces of care together, centered around Lee’s needs, and provided a continuum of care that helped keep Lee in the community with a good quality of life for as long as possible.

Since the COVID-19 outbreak, such NCD services have been disrupted by lockdowns, the cancellation of elective care and the fear of visiting care service . These factors particularly affected people living with NCDs like Lee. As such, Lee was not able to follow her care plan anymore. The mobile care team was unable to visit her weekly as they were deployed to provide COVID-19 relief. Lee couldn’t participate in her community-based program, follow up on her daily activities, or see her family or psychologists. This negatively affected Lee’s COPD management and led to poor management of her physical activity and healthy diet.

The pandemic highlights the need for a flexible and reliable integrated care system to enable healthcare delivery to all people no matter where they live, uzilizing approaches such as telemedicine and effective triaging to overcome care disruptions.

Lee’s care manager created short videos to assist her family through each step of her care and called daily to check in on the implementation of the plan and answer questions. Lee received tele-consultations, and was invited to the weekly webcast series that supported COPD patient communities. When her uncle passed away because of pneumonia complications from COVID-19 in early April, Lee’s care manager arranged a palliative care provider to support the family through the difficult time of bereavement and provided food and supplies during quarantine. Lee could even continue with her physical activity program with an online training coach. There were a total of 38 exercise videos for strengthening and stretching arms, legs and trunk, which she could complete at different levels of difficulty and with different numbers of repetitions.

Lee’s case demonstrates that early detection, prevention, and management of NCDs play a crucial role in a global pandemic response. It shows how we need to shift away from health systems designed around single diseases towards health systems designed for the multidimensional needs of individuals. As part of the pandemic responses, addressing and managing risks related to NCDs and prevention of their complications are critical to improve outcomes for vulnerable people like Lee.

How to design and deliver successful integrated care

The challenge for the successful transformation of healthcare is to tailor care system-wide to population needs. A 2016 WHO Framework on integrated people-centered health services developed a set of five general strategies for countries to progress towards people-centered and sustainable health systems, calling for a fundamental transformation not only in the way health services are delivered, but also in the way they are financed and managed . These strategies call for countries to:

  • Engage and empower people / communities: an integrated care system must mobilize everyone to work together using all available resources, especially when continuity of essential health and community services for NCDs are at risk of being undermined.
  • Strengthen governance and accountability, so that integration emphasizes rather than weakens leadership in every part of the system, and ensure that NCDs are included in national COVID-19 plans and future essential health services.
  • Reorient the model of care to put the needs and perspectives of each person / family at the center of care planning and outcome measurement, rather than institutions.
  • Coordinate services within and across sectors, for example, integrate inter-disciplinary medical care with social care, addressing wider socio-economic, environmental and behavioral determinants of health.
  • Create an enabling environment, with clear objectives, supportive financing, regulations and insurance coverage for integrated care, including the development and use of systemic digital health care solutions.

Whether due to an unexpected pandemic or a gradual increase in the burden of NCDs, each person could face many health threats across the life-course.

Only systems that dynamically assess each person’s complex health needs and address them through a timely, well-coordinated and tailored mix of health and social care services will be able to deliver desired health outcomes over the longer term, ensuring an uninterrupted good quality of life for Lee and many others like her.

  • Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY) 2020;12: 6049–57.
  • WHO. Noncommunicable diseases in emergencies. Geneva: World Health Organization, 2016.
  • WHO. COVID-19 significantly impacts health services for noncommunicable diseases. June 2020.
  • Kluge HHP, Wickramasinghe K, Rippin HL, et al. Prevention and control of non-communicalbe diseases in the COVID-19 response. The Lancet. 2020. 395:1678-1680
  • WHO. Framework on integrated people-centred health services. Geneva: World Health Organization, 2016.

8 . Why access to healthcare alone will not save lives

Donald Berwick, President Emeritus and Senior Fellow, Institute for Healthcare Improvement; Nicola Bedlington, Special Adviser, European Patient Forum; and David Duong, Director, Program in Global Primary Care and Social Change, Harvard Medical School.

Joyce lies next to 10 other women in bare single beds in the post-partum recovery room at a rural hospital in Uganda. Just an hour ago, Joyce gave birth to a healthy baby boy. She is now struggling with abdominal pain. A nurse walks by, and Joyce tries to call out, but the nurse was too busy to attend to her; she was the only nurse looking after 20 patients.

Another hour passes, and Joyce is shaking and sweating profusely. Joyce’s husband runs into the corridor to find a nurse to come and evaluate her. The nurse notices Joyce’s critical condition - a high fever and a low blood pressure - and she quickly calls the doctor. The medical team rushes Joyce to the intensive care unit. Joyce has a very severe blood stream infection. It takes another hour before antibiotics are started - too late. Joyce dies, leaving behind a newborn son and a husband. Joyce, like many before her, falls victim to a pervasive global threat: poor quality of care.

Adopted by United Nations (UN) in 2015, the Sustainable Development Goals (SDG) are a universal call to action to end poverty, protect the planet and ensure that all enjoy peace and prosperity by 2030. SDG 3 aims to ensure healthy lives and promote wellbeing for all. The 2019 UN General Assembly High Level Meeting on Universal Health Coverage (UHC) reaffirmed the need for the highest level of political commitment to health care for all.

However, progress towards UHC, often measured in terms of access, not outcomes, does not guarantee better health, as we can see from Joyce’s tragedy. This is also evident with the COVID-19 response. The rapidly evolving nature of the COVID-19 pandemic has highlighted long-term structural inefficiencies and inequities in health systems and societies trying to mitigate the contagion and loss of life.

Systems are straining under significant pressure to ensure standards of care for both COVID-19 patients and other patients that run the risk of not receiving timely and appropriate care. Although poor quality of care has been a long-standing issue, it is imperative now more than ever that systems implement high-quality services as part of their efforts toward UHC.

Poor quality healthcare remains a challenge for countries at all levels of economic development: 10% of hospitalized patients acquire an infection during their hospitalization in low-and-middle income countries (LMIC), whereas 7% do in high-income countries. Poor quality healthcare disproportionally affects the poor and those in LMICs. Of the approximately 8.6 million deaths per year in 137 LMICs, 3.6 million are people who did not access the health system, whereas 5 million are people who sought and had access to services but received poor-quality care.

Joyce’s story is all too familiar; poor quality of care results in deaths from treatable diseases and conditions. Although the causes of death are often multifactorial, deaths and increased morbidity from treatable conditions are often a reflection of defects in the quality of care.

The large number of deaths and avoidable complications are also accompanied by substantial economic costs. In 2015 alone, 130 LMICs faced US $6 trillion in economic losses. Although there is concern that implementing quality measures may be a costly endeavor, it is clear that the economic toll associated with a lack of quality of care is far more troublesome and further stunts the socio-economic development of LMICs, made apparent with the COVID-19 pandemic.

Poor-quality care not only leads to adverse outcomes in terms of high morbidity and mortality, but it also impacts patient experience and patient confidence in health systems. Less than one-quarter of people in LMICs and approximately half of people in high-income countries believe that their health systems work well.

A lack of application and availability of evidenced-based guidelines is one key driver of poor-quality care. The rapidly changing landscape of medical knowledge and guidelines requires healthcare workers to have immediate access to current clinical resources. Despite our "information age", health providers are not accessing clinical guidelines or do not have access to the latest practical, lifesaving information.

Getting information to health workers in the places where it is most needed is a delivery challenge. Indeed, adherence to clinical practice guidelines in eight LMICs was below 50%, and in OECD countries, despite being a part of national guidelines, 19-53% of women aged 50-69 years did not receive mammography screening.4 The evidence in LMICs and HICs suggest that application of evidence-based guidelines lead to reduction in mortality and improved health outcomes.

Equally, the failure to change and continually improve the processes in health systems that support the workforce takes a high toll on quality of care. During the initial wave of the COVID-19 pandemic, countries such as Taiwan, Hong Kong, Singapore and Vietnam, which adapted and improved their health systems after the SARS and H1N1 outbreaks, were able to rapidly mobilize a large-scale quarantine and contact tracing strategy, supported with effective and coordinated mass communication.

These countries not only mitigated the economic and mortality damage, but also prevented their health systems and workforce from enduring extreme burden and inability to maintain critical medical supplies. In all nations, investing in healthcare organizations to enable them to become true “learning health care systems,” aiming at continual quality improvement, would yield major population health and health system gains.

The COVID-19 pandemic underscores the importance for health systems to be learning systems. Once the dust settles, we need to focus, collectively, on learning from this experience and adapting our health systems to be more resilient for the next one. This implies a need for commitment to and investment in global health cooperation, improvement in health care leadership, and change management.

With strong political and financial commitment to UHC, and its demonstrable effect in addressing crises such as COVID-19, for the first time, the world has a viable chance of UHC becoming a reality. However, without an equally strong political, managerial, and financial commitment to continually improving, high-quality health services, UHC will remain an empty promise.

1. United Nations General Assembly. Political declaration of the high-level meeting on universal health coverage. New York, NY2019.

2. Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. Health equity in England: the Marmot review 10 years on. Institute of Health Equity;2020.

3. National Academies of Sciences, Engineering, and Medicine: Committee on Improving the Quality of Health Care Globally. Crossing the global quality chasm: Improving health care worldwide. Washington, DC: National Academies Press;2018.

4. World Health Organization, Organization for Economic Co-operation and Development, World Bank Group. Delivering quality health services: a global imperative for universal health coverage. World Health Organization; 2018.

5. Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet Global Health. 2018;6(11):e1196-e1252.

6. Ricci-Cabello I, Violán C, Foguet-Boreu Q, Mounce LT, Valderas JM. Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review. European Journal of General Practice. 2015;21(3):192-202.

7. Valtis YK, Rosenberg J, Bhandari S, et al. Evidence-based medicine for all: what we can learn from a programme providing free access to an online clinical resource to health workers in resource-limited settings. BMJ global health. 2016;1(1).

8. Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America . Washington, DC: National Academies Press 2012.

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Concepts of Disease and Health

Health and disease are critical concepts in bioethics with far-reaching social and political implications. For instance, any attempt to educate physicians or regulate heath insurance must employ some standards that can be used to assess whether people are ill or not. Concepts of health and disease also connect in interesting ways with issues about function and explanation in philosophy of the biomedical sciences, and theories of well-being in ethics.

1. Introduction

2. naturalism and constructivism, 3. problems for constructivism, 4.1 forms of naturalism, 4.2 specifying causes, 4.3 functions, 4.4 normality and variation, 5.1 health and biology, 5.2 embedded instrumentalism, 6. conclusions, other internet resources, related entries.

Doctors are called on to deal with many states of affairs. Not all of them, on any theory, are diseases. A doctor who prescribes contraceptives or performs an abortion, for example, is not treating a disease. Some women cannot risk pregnancy for health reasons, and historically both pregnancy and childbirth have been major killers. Nevertheless,they are not disease states, and modern women typically use contraception or abortion in the service of autonomy and control over their lives. In addition, it is very difficult to find a philosophically or scientifically interesting cleavage between diseases and other complaints (Reznek 1987, 71–73).

One dominant strand in modern medicine sees a disease as essentially a process that recurs across individuals in slightly different forms: a disease is an abstract kind that is realized in different ways (Carter 2003: Whitbeck 1977). But since a disease is a biological insult, distinguishing it from injury is very difficult. Perhaps injuries are not processes in the relevant sense but events. This essay assumes that the conceptual issues raised by illnesses, injuries and other medical conditions are similar enough to let us put this demarcation problem aside. Disability is another important and neglected topic in health and well-being. It will be addressed here only slightly, since the contemporary debates on disease and disability tend to go on in isolation from each other. Only rarely do authors such as Glackin (2010) tackle both. It is worth noting, though, that the disability debate is typically framed in a way that closely resembles the debate over disease. Medical model adherents judge disability to be the product of a functional impairment or failure in human physiology. This resembles what will be called below the naturalistic model of disease, at least as regards assessment of bodily impairment. It contends that people with disabilities, like people with diseases, are rendered worse off in virtue of these functional impairments, and the explanatory burden of their disadvantage is borne chiefly by the failure of their physiology or psychology to perform a natural function. A concept of disability as dysfunction has been resisted by rival pictures of disability that have made headway in recent decades.

According to the rival “social model”, disability is not a departure from normal or healthy human functioning which makes an atypical condition a “bad difference” from the norm; rather it is a “mere difference” (Barnes 2016). Although disabilities may make people worse off in general, this is due to the way society is set up, rather than any physical impairment. Disability in itself is just variation, analogous to features like sexuality, gender and race. The social model was pushed by disability activists who defined disability as “the disadvantage or restriction of activity caused by a contemporary social organisation which takes little or no account of people who have physical impairments and thus excludes them from participation in the mainstream of social activities” (UPIAS 1975, quoted in Shakespeare 2010). The scientific basis for this position appeals to the idea that “the partitioning of human variation into the normal versus the abnormal has no firmer footing than the partitioning into races. Diversity of function is a fact of biology” (Amundson 2000, p. 34). The resulting partition, it is held, is a reflection of social norms rather than underlying physical impairments. This position resembles what will here be termed the constructivist position with regard to health.

Health has received less philosophical attention than disease, and this essay will correspondingly have less to say about it. The conceptual terrain in the case of health is a little more complex than that of disease; one way of thinking about health says that it is just the absence of disease, so if disease is biological malfunction or abnormality, it follows that a healthy person is someone whose biological systems are all in order. But another way of looking at health insists that it is not just the absence of disease but the presence of something more; a positive state. The constitution of the World Health Organization (WHO) defines health “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO 1948). According to views like this, we should think in terms not of health and disease alone, but in terms of health, disease and normality. This essay will look at theories of health after first discussing disease. The focus throughout is on individuals, although some theorists (e.g. Inkpen 2019) have argued for a seeing humans and their associated microbiomes as part of an ecosystem that can be evaluated, like other ecosystems, as healthy or not.

The tendency in recent philosophy has been to see disease concepts as involving empirical judgments about human physiology and normative judgments about human behavior or well-being (Bloomfield 2001, Boorse 1975, Ereshefsky 2009, Culver and Gert 1982, Thagard 1999). First, we have beliefs about the natural functioning of humans – both our common sense expectations about the body and scientific theories of human biology. Second, we make judgments about whether some particular condition or way of life is or is not undesirable, in some relevant way. This second set of concerns obviously involves normative criteria, to do with the extent to which a life is unnatural, undesirable or failing to flourish in some way. (There is not a clear consensus among writers here.) One important and controversial question is whether the judgments we make concerning our biology are also normative in some way. A further large question concerns the relationship between the two types of judgments, in both medicine and common sense.

Another strain in recent scholarship suggests that our normative judgments alone determine who falls under the concepts of health and disease. This view has been less influential in philosophy, but commands widespread adherence in other areas of the humanities and social sciences (e.g. Kennedy 1983, Brown 1990). Kitcher (1997, 208–9) summarizes the debate as follows:

Some scholars, objectivists about disease, think that there are facts about the human body on which the notion of disease is founded, and that those with a clear grasp of those facts would have no trouble drawing lines, even in the challenging cases. Their opponents, constructivists about disease, maintain that this is an illusion, that the disputed cases reveal how the values of different social groups conflict, rather than exposing any ignorance of facts, and that agreement is sometimes even produced because of universal acceptance of a system of values.

Kitcher’s objectivism is nowadays more often called naturalism, and that usage is followed here. The simple naturalist/constructivist opposition has also been complicated by more recent work and some of those nuances will be introduced here. The next section starts with forms of constructivism and the difficulties they face. Then naturalism will be similarly treated, before the discussion moves to health.

Kitcher’s claim that an objectivist analysis, as he puts it, is “grounded” on facts about the human body is perhaps not as clear as it might be. Before arriving at some qualifications, then, we should have straightforward statements of naturalism and constructivism in hand. (Although, since the qualifications are not yet in place, perhaps no theorist would fully endorse these bald versions of the positions.) There are also taxonomies that cut finer. Broadbent (2019, p.93) argues that naturalism and normativism are only two of the distinctions we need to inform the debate. He thinks of them as “diagonal opposites on a 2×2 matrix of possible positions, being Value-Independent Realism and Value-Dependent Anti-Realism respectively.” Broadbent also recognizes Value-Dependent Realism and his own Value-Independent Anti-Realism. Whether or not constructivist analyses should really be seen as anti-realist in a metaphysical sense is not always clear, though. For reasons outlines below, the philosophical commitments of constructivist views are sometimes hard to grasp.

At the bottom of the naturalist conception of disease (most influentially stated by Boorse (1975) and defended in Boorse (1997, 2014) is that the human body comprises organ systems that have natural functions from which they can depart in many ways. Some of these departures from normal functioning are harmless or beneficial, but others are not. The latter are ‘diseases’. So to call something a disease involves both a claim about the abnormal functioning of some bodily system and a judgment that the resulting abnormality is a bad one. Boorse uses‘illness’ to describe the concept of a disease that causes one’s life to deteriorate. This language is not universal, but the distinction between bodily malfunction and normative judgement is widely used. Naturalists contend that the determination of bodily malfunction is an objective matter to be determined by science. They may also argue (Boorse 1997) that determining whether a malfunction is detrimental to human well-being is also an objective matter, but often they concede that normative considerations are the basis for that judgment. So the naturalist position is that a disease is a bodily malfunction that causes one’s well-being to lessen. This malfunction could take many forms: it is not a necessary part of the naturalist case that diseases constitute a natural kind.

Rather, they could be a set of naturally occurring processes that are held together in virtue of our interest in grouping them as a class. Kinds that work like this include “weed” or “vermin” (Murphy 2006): the existence of the superordinate class depends on human interests but the subordinate members are natural kinds whose natures can be investigated scientifically.

Constructivism, however, argues that human interests do not just define the superordinate class of diseases. It is human interests, not biological malfunctions, that explain the judgments that subordinate members have the relevant biological character. Although constructivists accept that disease categories refer to known or unknown biological processes they deny that these processes can be identified independently of human values by, for example, a science of normal human nature. Constructivist conceptions of disease are normative through and through, although the precise account of the relevant norms will vary between scholars. Analytically, it seems that constructivism is distinct from the claim that disease is normative. However, constructivism and normativism do go together. One reason for this often a professed skepticism about the existence of a non-normative concept of malfunction. More broadly, constructivists may think of disease labels as instruments of social control and reflections of biologically ungrounded reactions to human difference. There may also exist, though this is less often brought to the fore, importantly different stresses on the kinds of value judgements that different theorists think are part of disease categories and their application. Typically, the relevant normative claim is taken to apply to the life of the person whose health is under discussion – it is bad for you to be that way. But in some contested cases the judgments are often held to be wider value-disvalue claims about society more broadly – it is bad for us if you are that way. To make things even more complicated, theorists will sometimes hold that the second type of judgement is what is really doing the work, but it masquerades as the first type. Arguments about disease concepts, as we shall see, are often bound up with political and social controversies in which diagnostic labels are impugned as instruments of oppression or social control.

The key constructivist contention, as seen in the remark by Amundson quoted above, is that there is no natural, objectively definable set of human malfunctions that cause disease. Rather, constructivists assert that to call a condition a disease is to make a judgment that someone in that condition is undergoing a specific kind of harm that we explain in terms of bodily processes. But the bodily processes are not objectively malfunctioning; rather, they are merely judged by us to be unusual or abnormal because they depart from some shared, usually culturally specific, conception of human nature. The crucial difference between the positions then is that for naturalists, diseases are objectively malfunctioning biological processes that cause harms. For constructivists, diseases are harms that we blame on some biological process because it causes the harm, not because it is objectively dysfunctional.

However, constructivism is hard to define satisfactorily, for two reasons. First, its core claim is a denial of the naturalist thesis that disease necessarily involves bodily malfunction. Since there are many views one might hold about the nature of the biological processes involved in disease that are compatible with the denial of malfunction, the positive constructivist claim varies across theories and is often elusive. Reznek (1987) for example, explicitly denies that malfunction is a necessary condition for disease. He does assert (ch 9) that diseases involve “abnormal” bodily processes, but he does not say what that means. Constructivists often, as we will see later, argue that disease judgments appeal to biological processes that are to be understood in terms of human practices rather than membership in some putatively biologically definable class of abnormalities or malfunctions. We have decided that some harmful conditions are the province of the medical profession, and those are diseases.

That brings up the second reason why constructivism can be an elusive target: it has often rested on (perfectly reasonable) claims about the role that value judgments have played in medical practice, or on the prevalence of culturally specific disagreements about abnormal human behavior or physiology. This means, as we shall see, that constructivists, especially in the social sciences, do not tend to offer necessary and sufficient conditions. Rather, they often seek to reconstruct the concept of disease as revealed by our practices. Constructivism, therefore, often looks like a thesis about how inquiry is carried on: first we identify a condition we disvalue, then we look for a biological process that causes it and say that, whatever it is, it is abnormal. This stress on our practices is a common constructivist trope, whereas objectivists more often seek to analyse a concept that will clarify what disease really is, however fumbling and biased our attempts to uncover it may have been.

That both medical practice and lay thought shape disease concepts is undeniable. Because of this, we need to introduce a second distinction. Both naturalism and constructivism can take either a revisionist or a conservative form. A conservative view says that our folk concept of illness should constrain a theoretical picture of health and disease worked out by scientists and clinicians. A revisionist thinks that our existing concepts should be amended in the light of what inquiry uncovers. One could be a conservative or revisionist naturalist, as well as a conservative or revisionist constructivist.

Health and disease, like many other concepts, are neither purely scientific nor exclusively a part of common sense. They have a home in both scientific theories and everyday thought. That raises a problem for any philosophical account: suppose we try to say what health and disease really amount to, from which it follows that the scientific concept should fit the facts about world. If the picture we end up with deviates too far from folk thought, should we worry? You might think that everyday language puts constraints on a concept of health that need to respected, and that if we move too far from ordinary usage we have stopped talking about health and started talking about something else. Furthermore, it is not really possible to argue that scientific and vernacular uses of the concepts are fully independent, since the development of science influences everyday thought, and many scientific concepts begin in pre-scientific contexts and carry the marks of those origins deep into their careers.

Although there is a thriving body of work that tries to analyse the concept of disease – as we’ll see in a moment – other theorists dispute the prospects for a successful analysis of the concept of disease. Schwartz (2007) contends that the biomedical sciences do not share a general concept of disease that is coherent enough to be analyzed. He recommends seeing the proposed analyses as introducing new concepts of disease that are related to existing usage but not bound by it. Concepts so introduced may work in some contexts but not others, and different concepts of disease could be needed for different medical purposes. Hesslow (1993) argues that diseases are not interesting theoretical entities in medicine and are irrelevant to most clinical decisions. These focus on how to improve a patient’s condition and do not need to depend on a judgment of disease.

Furthermore, the concept of disease that is currently employed in most areas of medicine has undergone a process of development. For much of the modern era there has been a dialectic between two concepts of disease. On the one hand, there has been the idea that a disease is just an observable suite of symptoms with a predictable course unfolding. This notion dates back to Sydenham in the late seventeenth century. Kraepelin applied it to psychiatry as the basis for differential diagnosis, for example between subtypes of what was later called schizophrenia (1899, 173–175). The approach was supplanted as medicine matured by the concept of diseases as destructive processes in bodily organs which “divert part of the substance of the individual from the actions which are natural to the species to another kind of action” (Snow 1853, 155; for discussion see Whitbeck 1977, Carter 2003, Broome 2006). This is perhaps still the core medical conception of disease. It seeks explanations that cite pathological processes in bodily systems. More recent medicine has tended to weaken this slightly by adopting what Green (2007, ch, 2) calls an ‘actuarial’ model of disease. This model takes the presence of elevated risk, for example as indicated by high blood pressure, to be a disease even in the absence of overt symptoms or a clearly destructive pathological process (see also Plutynski 2018, ch. 2).

Medicine recognizes illnesses like hypertension and Cushing’s disease that are the outcome of systems in a poorly regulated state that is stable, albeit suboptimal. The idea of a specific pathogenic process in medicine includes dysregulation, but this may not accord with folk thought.

Modern medicine looks naturalistic about disease. One question, then, concerns the extent to which common sense and biomedical concepts are related. Perhaps both have naturalist commitments, or perhaps common sense is driven by values and medicine is not, or perhaps physicians are really constructivists who are self-deceived or arguing in bad faith.

There is little reason to expect scientific and common sense concepts to agree in general, so if medicine and everyday thought disagree about disease, we may ask which concept should be adopted. If we wish to distil a concept that can play a role in medical inquiry, we may side with the scientists. But such proposals, which argue for a sharp separation between scientific and folk uses, are not neutral pieces of observation about the language. They are proposals for purging science from commonsense constraints that hinder its development. A revisionist view of this sort, in this case, says that our concepts of health and disease might be a necessary starting point but should not constrain where the inquiry ends up. Other forms of revisionism are possible. A revisionist naturalist argues that we should follow the science where it takes us and come up with concepts that further scientific inquiry, for example, even if that means that we eventually use the language in ways that look bizarre from the standpoint of current common sense. But a revisionist constructivist could argue that our thought, whether medical or lay, should be reformed in the service of other goals, such as emancipation for hitherto oppressed groups. Such revisionist thought was important in overturning the psychiatric view, dominant until the 1970s, that homosexuality is a mental illness. Activists argued that homosexuality was diagnosed for offensive moral reasons and not for medical ones and the classification of homosexuality as a disease was changed as a result of lobbying on moral grounds rather than on the basis of any new discovery. Naturalists will respond that this was not an example of using constructivism for emancipatory ends, but of bringing psychiatrists to understand that they were not obeying their own naturalist principles about mental disorder, and showing them that there was no good reason to retain the diagnosis. Much debate between naturalists and constructivists involves competing histories in just this way. Constructivists strive to uncover the role that moral and social values have always played in medical diagnosis and argue that our disease categories are hence not properly naturalistic. Naturalists, though they must concede that many diagnoses have been based on moral values that we would now renounce, still insist that the concept of disease, when correctly applied, as it often is, is thoroughly naturalistic and not impugned by past failures by the medical profession to live up to its own scientific ambitions.

Naturalists tend towards conceptual conservatism. They typically appeal to our intuitions about illness as support for their own emphasis on underlying bodily malfunction. This assumes that our current concept is in good shape, that common sense and medicine share a concept of disease, and that medicine should respect lay intuitions about what is or is not a disease. Like many philosophers who think about other concepts with both scientific and common sense uses, conservative naturalists about disease think that folk concepts specify what counts as health and disease. The job of medicine is to look at the world and see if anything in nature falls under the concept as revealed by analysis (cf the “Canberra plan” of Jackson 1998) For revisionists, this understanding of common sense in its relation to science is needlessly submissive to folk intuitions. A more revisionist view takes the relevant concepts to be defined by their role in scientific theories – Boorse (1997) has argued that disease is a term of art in pathology.

Revisionist naturalists argue that facts about physiological and psychological functioning, like other biological facts, obtain independently of human conceptions of the world. Our intuitions might tell us that a condition is not a disease. But scientific inquiry might conclude that people with the condition are really suffering from a biological malfunction. In that case, a conservative would recommend finessing the analysis to ensure that the concept of disease does not cover this case. A revisionist would say that we must bite the bullet and judge that this case falls under the concept even if that judgment is counterintuitive. A revisionist naturalist regards health and disease as features of the world to be discovered by biomedical investigation, and therefore loosely constrained, at best, by our everyday concepts of health and disease. Lemoine (2013) argues that conceptual analysis always involves a stipulative element concerning controversial or borderline cases. Because contending parties will be led by their intuitions to see different stipulations as reasonable, conceptual analysis will be very unlikely to decide between competing analyses that are all reasonably successful at capturing core cases. He suggests that instead philosophers should aim to naturalize disease by trying to first understand general features of theories in the medical sciences and then looking for perspicuous and coherent accounts of different disease types, with a view to eventually establishing an overall picture of the role disease thinking plays in medicine. This approach treats diseases as putative natural kinds and could be highly revisionist, while also leaving open the possibility that some diagnoses represent contingent historical outcomes that have left us with an incoherent category. Fuller (2018) follows Lemoine in dissenting from traditional conceptual analyses. He argues that we should try to work out what kinds of things diseases are rather than worrying about the concept. Fuller reviews the ontological options and asks first about instances of disease – what kinds of things are they? – rather than the concept, but, looking at chronic disease, he goes ‘bottom-up’, by attempting to work out what instances of chronic disease have in common and making inductive generalizations about them. Fuller thinks of diseases – at least chronic ones but perhaps acute cases too – as dispositions (cf Hucklenbroich (2014).

Lange (2007) starts his account of disease from a similar impulse, insisting that diseases play an absolutely essential role in explaining a patient’s symptoms. He argues that this explanatory role is characteristic of natural kinds elsewhere in science, and warrants thinking of diseases as natural kinds. Lange views diseases as natural kinds of incapacities. Stegenga (2018, ch.2.5), discussing Lange’s urging that we dissolve broader disease categories in favour of finer-grained biological descriptions, argues that we should see this as an eliminativist position, since it dispenses with the concept of disease altogether and replaces it with diverse successor concepts. Any theory of disease could advocate for descriptions at finer grains, while retaining a broad category, as Stegenga says, for education and public communication even if it has no real scientific application. The extent to which we should see a theoretical reform as eliminativist or merely very revisionist is hard to answer. In both cases we might secure an epistemic advance, but one might worry that our new vocabularies will deprive people of their ability to understand themselves by replacing a familiar vocabulary with a remote, scientific one tailored to the demands of experts.

Constructivists are usually revisionists. They tend to say that concepts of health and disease medicalize behavior that breaks norms or fails in some way to accord with our values; we don’t like pain, so painful states count as diseases: we don’t like fat people or drunks, so obesity and alcoholism count as diseases. Constructivists will often make this case with special vigor when it comes to mental disorder. The critique of the concepts that guide disease applications is central to constructivism.

Constructivists are often social scientists and their interests may not map neatly on to philosophical concerns. They are not usually interested in conceptual analysis so much as in tracing the social processes by which categories are formulated and changed over time. Conrad (2007, 7–8), for example, says he is “not interested in adjudicating whether any particular problem is really a medical problem… I am interested in the social underpinnings of this expansion of medical jurisdiction”.

But constructivists often present their theories as unmasking common sense or medical conceptions of disease, and hence as a kind of revisionism. They may accept that diagnoses of ill-health involve objective facts that people appeal to, or presume that they can appeal to, when they say that somebody is sick. The assumption might be that germs or other medically relevant causal factors are present in a person and have given rise to visible phenomena that indicate ill-health. But a constructivist will claim that the actual, often unacknowledged, judgments driving the initial assertion that someone is unhealthy are derived from social norms. We may discover facts about obesity and its relationship to blood pressure or life expectancy. But the constructivist says that our search for the relevant biological findings is undertaken because we have already decided that fat people are disgusting and we are trying to find a set of medically significant properties in order to make our wish to stigmatize them look like a medical decision rather than a moral or aesthetic one. The crucial constructivist claim is that we look for the biological facts that ground disease judgments selectively, based on prior condemnations of some people and not others. Because they claim that social norms rather than disinterested inquiry drive medicine (and especially, psychiatry), constructivists tend to be revisionists about folk concepts, seeking to bring to light the unacknowledged sources of our concepts of health and disease. But constructivism could be a conservative view, aimed at uncovering our folk theory of health and disease. A constructivist who takes this view says that our folk concept of disease is that of a pattern of behavior or bodily activity that violates social norms.

The most philosophically sophisticated recent constructionist view is Glackin’s (2019, p.260). He distinguishes the constitution question, which asks for the physical basis of a person’s condition, from the status question, which asks what makes a physical configuration a disease? This way of carving the terrain, and the importance of both status and constitution, is standard among most people who write about disease. The distinctive feature of social construction, in Glackin’s sense, is the priority of value judgements. Glackin uses the grounding relation to supply an answer to the problem of the relation between constitution and status. That is, the frame for grounding is fundamentally evaluative; the normative has a metaphysical priority. As Glackin (p. 262) puts it, disease states are grounded by the underlying biology or behaviour, but this grounding relation exists in virtue of a set of normative facts that provide the frame (in the sense of Epstein 2015: a set of possible worlds that fix the grounding conditions for social facts).

One could be a constructivist about some diseases, and a naturalist about others. For example, one could be a naturalist about bodily disease but a constructivist about psychiatry. Thomas Szasz (1960, 1973, 1987), for instance, is usually read as a constructivist who denies that mental illness exists. But in fact Szasz has a very strict objectivist concept of disease as no more than damage to bodily structures.

Szasz argues that mental disorders cannot exist because they are not the result of tissue damage. He is a naturalist about disease, which leads him to deny that mental illness is real and to offer a critical analysis of our psychiatric practices. And indeed claims that we are merely taking conduct we don’t like and calling it pathological are more plausible in psychiatry than in other parts of medicine, since there is a long history of psychiatrists who have done just that. Samuel Cartwright argued in 1843 that American slaves who tried to escape were afflicted with “drapetomania” or the “disease causing slaves to run away” (Cartwright 2004, 33); slaves were also found uniquely prone to “dyesthaesia Aethiopica”, which made them neglect the property rights of their masters (Brown 1990). Nineteenth century physicians regularly practiced cliterodectomy to cure women of sexual desire, which everybody knew never afflicted normal females of good family (Reznek 1987, 5–6). More recently, Soviet psychiatrists found that political dissidents suffered from “sluggish schizophrenia”. And Horwitz and Wakefield (2007) have suggested that depression has been severely overdiagnosed by recent generations of American psychiatrists, leading to the pathologizing of ordinary sadness.

Our current taxonomy of illness could involve both naturalist intuitions about some conditions and constructivist rationalizations about others. You could use this depiction of everyday thought as a premise in an argument for revisionism, on the grounds that our folk concepts are too confused to serve as constraints (Murphy 2006 makes this argument with respect to psychiatry).

Constructivism seems correct about some putative diseases; that is, societies have at times thought that some human activities were pathological because of values rather than scientific evidence. However, it is another task to show that constructivism is correct about our concept of disease. And this would be true even if there were no diseases; it might still be the case that our concept of disorder is naturalist even if nothing falls under it.

The chief problem for constructivism is that we routinely make a distinction between the sick and the deviant, or between pathological conditions and those that we just disapprove of. Our disease concepts cannot just be matter of disvaluing certain people or their properties. It must involve a reason for disvaluing them in a medical way rather than some other way. Illness has never been the only way to be deviant. So Szasz is just wrong to claim that “when a person does something bad, like shoot the president, it is immediately assumed that he might be mad” (1974, 91). Most of the time when people do bad things nobody doubts their sanity, just their morals. Physically or mentally ill people, even if they are seen as norm-breakers, are seen as a distinctive class of norm-breakers. What’s distinctive about them?

The problem is that we routinely judge that people are worse off without thinking they are ill in any way – for example, the ugly, the poor, people with no sense of humor or lousy taste or a propensity for destructive relationships. We don’t treat these judgments of comparative disadvantage as a prelude to medical inquiry, so why do we do so in some other cases?

Notice that the problem is not just one of establishing that someone is badly off or is in some other disvalued state. Rather, the trouble is caused by the requirement that someone is badly off in a specific, health-related or medically significant way. Rachel Cooper, for example (2002, 272–74), analyzes the concept of disease as a bad thing to have that is judged to require medical attention. She deals with the objection that specifying when someone is badly off is very difficult. Cooper admits that it is a hard problem, but replies that it is a widespread problem, one which crops up in many areas of moral philosophy.

This response is correct as a general point but does not touch the present objection. The objection is not that it is hard to say when someone is badly off, but that it is hard to isolate the specific class of ways of being badly off that we regard as medically relevant without relying on a notion of natural malfunction. Glackin (2019, p.272–3), however, denies that this is a problem at all. He argues that to justify treating some conditions as medical issues, and "others as social or legal, rather than medical, all a normativist needs to say is that this is morally speaking the right thing to do." For Glackin, we can defend the claim that someone is sick by saying that according to our values they are sick, and no more need be said.

Other scholars do think there is more to say. John Harris, for example, posits an “ER test” (2007, 91) according to which we can think of a disorder as a condition that makes someone worse off and is such that emergency room personnel would be negligent if they did not remedy it if they could. But as it stands the ER test is much too broad. Taken literally the ER tests requires medical personnel to teach the local language to immigrants whose lives are worsened by a lack of competence in it. A general theory of ill-being would be as desirable as a theory of well-being. But without further elaboration it would not discriminate between medical and non-medical forms of ill-being. Like Cooper, Harris faces the difficulty of specifying what is distinctively medical about the conditions that we expect medical personnel to treat: of course, a thesis about what counts as a medical intervention that was put in terms of combating disease or pathology would be circular. Reznek (1987, 163) argues that we can delimit a purely medical sphere “enumeratively without reference to the concept of disease – in terms of pharmacological and surgical interventions.” However, as we saw at the start of this essay, a lot of medical attention is directed at conditions which we do not call diseases. Prescribing contraceptive pills is a pharmacological intervention, but it is not directed against a disease; going on the pill is not like beginning a course of anti-malarial tablets.

The naturalist answer to the question what makes some medical interventions directed against disease is that conditions which doctors treat are diseases in so far as they involve natural malfunctions. The constructivist view is that the class of what we call malfunctions is picked out by its involvement in medical practice, and not the other way round. Cooper and Harris try to base their analysis on our practices, but they are unable to distinguish medical practices from non-medical ones.

Broadbent (2019) has a value-independent account, but it is also avowedly anti-realist about disease and so can be treated here. Broadbent calls his view of disease subjective but he has a different way of dealing with the problem of specifying the human response that is characteristic of disease judgments. His theory is that health and disease are secondary qualities like color “that depends on, or perhaps is partly constituted by, the dispositions of observers or thinkers to have certain perceptual or cognitive reactions” (p.108). What human observers bring to physiological states of affairs is not value judgments, but a disposition to track them as making characteristic contributions to survival and reproduction. Broadbent is alert to the issue that there might be cross-cultural differences in judgments about health and disease, but regards these as compatible with very broad agreement on the extension of healthy and diseased states, just as he thinks there is sufficient agreement on spectral phenomena to speak of color in different contexts. The same treatment would need to be given with respect to judgments within a society that vary over time, assuming that objects can change color as a society alters its color categories.

So apart from Glackin there seems to be agreement that the constructivist needs to explain how the judgments that we direct at putative sick or healthy people form a special class of judgments. And that explanation has to show, in addition, why we think the conditions that we single out as diseases with those special judgments are candidates for a particular set of causal explanations. It’s all very well to point out, as Reznek does (p.88) that an etiology only explains a pathology if we have already decided that it is a pathology. This is correct, but it dodges the conceptual question of why we first decide that only some people or conditions are pathological. The naturalist says this: we think some people are worse off because of a special kind of causal process, namely a disturbance of normal physical or psychological function. It is that causal judgment that has conceptual priority, even if, as a matter of timing, the violation of a norm is what is detected first. Note that it does not refute naturalism to point out that the concept of disease is sometimes misapplied, so that we think people are sick but discover that they are not. In such cases (e.g. homosexuality) the explanation for why it happened may be that our values caused the initial judgment, but that does not show that the concept of disease is constructivist, rather than naturalist. No concept is correctly applied every time.

Reznek, for instance, argues that to judge “that homosexuality is a disease we first have to make a value-judgment. We have first to judge that we would be worse off being homosexual” (1987, 212). Reznek then says that we could discover that homosexuality is not a disease if we find out that it develops by a normal psychological process. Reznek calls this is a form of constructivism (or normativism, in his terms) because value judgments have conceptual priority: but in fact in the case he describes it seems that value judgments are actually only heuristics, drawing our attention to whether something might be wrong with someone. If the initial judgment can be overturned by a biological discovery, then it seems that biological facts are necessary for a final judgment. That is to say that our concept of disease necessarily involves both biological and evaluative judgments. That is a version of naturalism, since the biological facts are the ultimate foundation for the judgment. Indeed, naturalism seems to explain why constructivist interpretations are sometimes correct. We say now that homosexuality was never a disease, and was just diagnosed on moral grounds, because it was not caused by malfunctions according to any even moderately correct theory of human biology or psychology. Values stopped people from getting the science right, but homosexuality was correctly understood, and no longer seen as a disease, when the science was done in a properly disinterested way.

Naturalism embodies the important insight that we do in fact think that disease involves a causal process that includes biological abnormalities. It does not mean, however, that all diseases have to receive the same biological explanation. The class of diseases will include a variety of different conditions that receive different causal explanations. That is, even if diseases are natural kinds, the superordinate category of disease may not be. Not just any sort of story about the causes of abnormal behavior will do, and it is difficult to reach a satisfactory specification of the sorts of causes that common sense might recognize. We also distinguish, based on our common sense understanding of human biology, between pathological and non-pathological versions of the same outward phenomena. Because aging is normal we acknowledge that an elderly person will differ from a young adult, so our assumptions about normality are sensitive to background conditions. But when aging is abnormal, we call it a disease. Hutchinson-Gilford progeria syndrome, for instance, causes children to undergo all the stages of human aging at a bizarrely accelerated rate. They nearly always die by seventeen, far gone in senescence. Even though we don’t know much about it, we think of Hutchinson-Gilford as a disease not just because we don’t like being old but because we think it is different from getting old in a way that must be caused by some underlying pathology. The concept of disease necessarily requires, just as naturalism insists, that a condition have a causal history involving abnormal biological systems. So let’s turn to naturalism, and see whether it should be a conservative or revisionist position.

4. Naturalism

When we have decided that someone’s biological systems do not function properly, we still face the question, how should we think about that person’s condition? Naturalists usually admit that there is more to the concept of disease than biological malfunction even if they think that biological malfunction is a necessary condition for disease. This involves a two-stage picture (Murphy 2006, ch 2) which inverts the constructivist portrayal of our practice. Naturalists who buy the two stage picture think that, first, we agree on the biological facts about malfunction. At the second stage we make the normative judgment that the person with the malfunction is suffering in some way. (This is the order of conceptual priority, not the chronological sequence in which judgments are made.) Spitzer and Endicott (1978, 18) for example, say that disease categories are “calls to action”; assertions that something has gone wrong within a person’s body in a way that produces consequences we think we need to remedy (see also Papineau 1994).

Normative considerations, on this account, inform our judgments about disease but do not have the conceptual priority accorded them by constructivists. We make judgments that someone is suffering in ways we associate with inner malfunction. We also see people who are suffering but who we don’t think are ill or injured, because we do not regard their bodily dysfunction as symptoms of disease: vaccination, surgical incisions, ear-piercing or childbirth are examples. Or imagine a skin condition that in some cultures causes the sufferer to be worshiped as a god, or become a sought-after sexual partner. The two-stage picture is designed to distinguish between the physical abnormality and the difference it makes to the life of the person who has it. The idea is that whether someone’s body is not functioning correctly is a separate question from whether it is bad to be like that. Stegenga (2018, p.23) calls such a theory a hybrid account, as it argues both that "there is a constitutive causal basis of disease and a normative basis of disease." He also adds a fourth alternative, which he calls eliminativist, arguing for replacing the notion of disease with successor notions tied more closely to the science. This goes beyond what has here been called revisionist naturalism, in that it advocates getting rid of the disease concept altogether, rather than just liberating it from commonsense constraints. Hybrid accounts have been very popular among naturalists since at least the dissemination of Wakefield’s (1992) influential discussion of mental disorder

The second stage, the question about whether life is worsened by a malfunction, is omitted by simple naturalism. Simple naturalists say that all there is to disease is the failure of someone’s physiology (or psychology) to work normally. The view has fewer adherents, but as noted above, Szasz (1987) uses simple objectivism about disease to justify his claims that mental disorder is a myth, and Boorse has long advocated such a view, as does Williams (2007). The popularity of hybrid accounts, though, is a problem for scholars like Glackin (2019, p. 258), who argues that the debate exists between “normativists, who think the concept is inherently evaluative, and naturalists who think it is purely empirical”. But it is possible to think that there is an empirical question about the causal basis of disease and a further normative question about the judgments made on that basis, which hybrid theorists also think are necessary for disease.

We have arrived at a generic naturalism that says judgments of illness are sensitive to causal antecedents of the right sort, as well as to value judgments about the effects of those causes. What are the right causal antecedents? Culver and Gert’s (1982) requirement that the antecedents be a “nondistinct sustaining cause” is a biologically noncommittal criterion. Culver and Gert analyze the concept of a malady, which involves suffering evils, or increased risk of evil, due to “a condition not sustained by something distinct” from oneself (1982, 72). The cause can be physical or mental, (p.87), provided it is a sustaining cause that is not distinct from the sufferer (p.88). A wrestler’s hammerlock, because its effects come and go with the presence or absence of the cause itself, is an example of a sustaining cause. But because the wrestler is a distinct entity from the sufferer, someone in a hammerlock does not have a malady. If the cause is inside the body it is nondistinct just in case it is difficult to remove (e.g. a surgical implement left behind in the body) or it is biologically integrated in the body (e.g. a retrovirus). This is an attractively simple solution but it is too inclusive. Culver and Gert (p.71) say that loss of freedom, opportunity or pleasure count as evils. But if that is so, then black citizens of South Africa and Mississippi (among many other places) used to suffer from maladies, since they were unfree, unhappy and oppressed. And they suffered these evils because of black skin, which was a nondistinct sustaining aspect of their nature. But it wasn’t a disease. Of course, the presence of racism, backed up by coercive social structures, was also necessary, but aspects of the environment are implicated in many maladies.

This counterexample is instructive, however, since there are two ways of amending the proposal in the light of it. First, perhaps the principle of nondistinct sustaining causes fails to capture our intuitions about causes of disease. A second possibility is that the principle is a good causal condition, but that the account of evils is too broad, and needs to be restricted to a more intuitively medical set of evils, rather than the broader class of impediments to well-being. The section on health will go over the terrain that’s relevant for the second option; the current discussion is about the causal condition. Boorse (1975, 1976, 1977, 1997) and his followers have opted for a more restrictive view of the causes of disease. They contend that disease necessarily involves biological malfunction. Boorse distinguished “disease” from “illness”. The former is the failure to conform to the “species-typical design” of humans, and the latter is a matter of judgments that a disease is undesirable, entitles one to special treatment, or excuses bad behavior. An account of malfunction must be parasitic on a theory of function. Boorse thinks a function is a ‘species-typical’ contribution to survival and reproduction (1976, 62–63). Disease is failure to function according to a species design, in which functional efficiency is either degraded below the typical level or limited by environmental agents (1977, 550, 555, 567; 1997, 32). Boorse understands this as functioning “more than a certain distance below the population mean” (1977, 559) for the relevant set of humans. (Since not all members of a species have the same design in every respect, we need to specify reference classes according to biologically relevant subgroups.) This cutoff point, he thinks, can only be specified as a matter of convention, but this conventional element does not threaten the objectivity of diagnoses. Responses to Boorse since the original theory was formulated have concentrated on two issues. First is the apparent existence of states like tooth decay that are widespread, so apparently statistically normal, yet definitely pathologies. The second is the“line-drawing problem” Schwartz (2007) which comes in two related guises: how we are to reference classes and how we can distinguish between normal and abnormal levels of functional efficiency.

Boorse’s position has been very influential and shaped the entire recent literature. Williams (2007) retains the spirit of the proposal but departs from it in arguing that disease is realized not in systemic malfunctions but failures of interacting cellular networks; he regards applications of disease language to organs, for example, as not strictly speaking correct. Most theorists, though, have continued to emphasis malfunction in physiological mechanisms more broadly. In psychiatry, for instance, Wakefield (1992, 1997a, 1997b), follows Boorse (1976) in assuming that humans have a species-typical design, which he assumes is a product of natural selection. Wakefield applies the picture to both mental and physical illness: in Wakefield’s version we first judge that a psychological mechanism is not performing the function for which natural selection designed it; second, we judge that the malfunction is harmful. An appeal to natural function, by adding extra commitments to the idea of a cause of illness, rules out skin pigment as a cause of evil.

Cooper (2002, p.265) suggests that a straightforward appeal to dysfunction must be qualified in light of some apparent counterexamples. A woman taking contraceptive pills, for example, may be interfering with typical functioning, but ingesting contraceptives is not a disease. (Boorse would have to call it a self-inflicted disease that does not make the woman ill.) Cooper also raises the problem of individuals with chronic conditions that are controlled by drugs. She argues that these are cases of diseased subjects who nonetheless function normally and suggests that the analysis must be amended to talk of a disposition to malfunction. But, as Cooper sees, the big problem faced by Boorsian accounts is that of coming up with an acceptable conception of normal function in the first place.

There are two problems that we can distinguish here. The first is whether a non-normative account of malfunction is possible, about which much debate has taken place. A second problem has come into focus more recently. If there is a positive scientific account of function and malfunction that is pertinent to disease, which science owns it? The debate deriving from Boorse’s work has assumed that physiologists and pathologists have the last word here. Following Boorse, Hausman (2015, p. 9) is explicit that physiologists and pathologists are the relevant medical specialists whose judgments we care about. Lemoine and Giroux (2016) question the great stress on physiology to the exclusion of other medical specialties in Boorse – they think he has backed the wrong doctors. Lemoine and Giroux think we should see physiology as the science of how organisms work considered as assemblies of organ systems. But they think that the science of health and disease is defined by broader medical considerations that go beyond the physiological. Tied up with this is a broad consensus that the correct explanation of disease states is mechanistic, though this too has been challenged in the name of more abstract explanations from different parts of medicine (Darrason 2018).

The Boorsian analysis is of a commonsense concept of disease which bottoms out in a notion of malfunction as the cause of illness. The view is that conceptual analysis determines the empirical commitments of our disease concepts and then hands over to the biomedical sciences the problem of finding biological functions and malfunctions. Some recent theorists, notably Wakefield, have argued for an evolutionary account of function as that which has historically been spread by natural selection. Others have argued that the biomedical sciences employ a different conception of function. Besides identifying the right concept of function for the job, other problems affect the whole naturalist community. A reliance on scientific, functional decomposition as the ultimate justification of judgments of health and disease requires a revisionist, rather than a conservative, account. Also, it may not always be possible to settle contested cases by an appeal to a notion of normal human nature, because that notion is itself contested.

First, why suppose that the relevant concept of function is an adaptive one, and that dysfunction is a failure of a biological system to fulfill its adaptive function? This analysis of function is often termed the etiological account, and although it is widespread in philosophy of biology it seems to be conceptually tied to fitness rather than health (Méthot 2011). Advocates of a thoroughgoing evolutionary approach to medicine (such as Gluckman, Beedle and Hanson 2009) can be read as providing a framework within which we can make sense of a number of processes that have an effect on health and disease, but not as offering analyses of health and disease that are tied to fitness. Gluckman et al. (p.5) consider the difference between lactose intolerance, which develops after weaning and is normal for most human populations, and congenital hypolactasia, a condition in which newborns cannot digest maternal milk. The former is a consequence of the absence of pastoralism in most historical human populations and does not affect fitness in those populations, whereas the latter would have been fatal in the past and thus was selected against. However, they do not define disease in terms of fitness-lowering: they note rather that an evolutionary perspective can make us sensitive to hitherto neglected causes of pathology and also sensitive to over-hasty judgments of pathology in cases where the condition is normal among populations with a given evolutionary trajectory.

Wakefield’s approach is not that of a thoroughgoing evolutionary theorist of disease in that sense. Rather, he plugs an etiological account of function into a Boorsian model, and his approach has been developed with little attempt to argue that medicine does in fact use an evolutionary, teleological account of function. In opposition, Schaffner (1993) has argued that although medicine might use teleological talk in its attempts to develop a mechanistic picture of how humans work, the teleology is just heuristic. It can be completely dispensed with when the mechanistic explanation of a given organ or process is complete. Schaffner argues that as we learn more about the causal role a structure plays in the overall functioning of the organism, the need for teleological talk of any kind drops out and is superseded by the vocabulary of mechanistic explanation, and that evolutionary functional ascriptions are merely heuristic; they focus our attention on “entities that satisfy the secondary [i.e. mechanistic] sense of function and that it is important for us to know more about” (1993, 390).

In effect, Schaffner is arguing that the biomedical sciences employ a causal, rather than a teleological, concept of function. This is in the spirit of Cummins’s (1975) systemic analysis of function as the causal contribution a structure makes to the overall operation of the system that includes it. Cummins’s concept of function is not a historical or evolutionary concept. According to Cummins, a component of a system may have a function even it was not designed or selected for. Wakefield has tied disease conceptually to an evolutionary concept of function as a naturally selected capacity. It is doubtful if this connection can be found in either science or common sense about disease. Perhaps in some areas of biology functional ascription is indeed teleological. However, most theorists who have attended to biomedical contexts agree with Boorse and Schaffner that the function of an organ or structure can be understood without thinking of it as an adaptation. Lange (2007) explicitly follows the systemic approach to function. He argues that diseases are incapacities that explain symptoms in causal-analytic terms.Medical understanding requires that functional structures can be identified and analyzed in terms of their contribution to the overall maintenance of the organism as a living system. However, it is also clear that the contribution of some systems – especially reproductive ones – have a purpose that is not tied to homeostatic regulation and organisation in this way, which complicates the picture. Theorists who prefer a causal-historical account to a teleogical one argue that explanation in medicine takes a model of the normal realization of a biological process and uses the model to show how abnormalities stem from the failure of normal relations to apply between components of the model. This requires a non-historical function concept, one that is at home in causal-mechanistic, rather than evolutionary, explanation. Proponents of a teleogical account can respond that those systems, even if they admit of mechanistic explanation, only exist in the first place because they have facilitated survival and reproduction, and that the etiological perspective provides an overall conceptual framework.

An evolutionary approach faces problems in specifying what the overall evolved function of a system might be and showing how functions contribute to it. First, it is very difficult to assess the relevant evidence that a given biological systems is — as in Wakefield’s treatment — the product of natural selection (Davies 2001, Chapter 5). Since many ailments do not prevent one from living and having children, it is even harder to show that a disease is necessarily the product of a malfunction that lowers fitness or — as in Boorse — interferes with survival and reproduction. Another problem for Wakefield is that if you regard evolutionary dysfunction as partly constitutive of disease then if an illness depends on structures that have no evolved function, it cannot really be an illness. A biological structure might be a spandrel or a by-product, or have some other non-selective history. Such a structure cannot malfunction in Wakefield’s sense, and so it cannot be diseased in the primary, evolutionary sense.The idea would have to be weakened to suggest that it is diseased in a derivative sense in virtue of its implications for other selected effects elsewhere in the system

Objections to an evolutionary notion of medical malfunction do not show that there is anything wrong with the general idea of basing judgments of health and disease on a scientifically established picture of the normal functional decomposition of human beings. However, on this account, it becomes harder to retain the conservative project that looks for the natural phenomena that fall under, and are therefore constrained by, our folk concepts of health and disease. Wakefield, for instance, thinks some psychiatric diagnoses flout our intuitions by attributing disorder on the basis of behavior alone without looking for malfunctioning mental mechanisms (1997a). He appeals to intuitions to derive necessary and sufficient conditions for the folk concept of mental disorder, and assumes that science should search for the psychological processes that fit the concept thus defined. But it is one thing to take intuitions as a starting point, and another to say that they are hegemonic. Boorse, too, adduces everyday linguistic usage and commonsense intuitions as evidence, even though he claims to be discussing the clinical concepts of health and disease.

A revisionist can say that a condition we currently disvalue but do not regard as a disease may turn out to involve malfunction and hence to be a disease, whatever our intuitions say. Conversely, we may think something is a disease but we might be wrong, just as we were wrong about drapetomania or masturbation, which do not causally depend on any biological malfunction. Conservatives resist this possibility. Wakefield claims that we have intuitions about human nature that make it “obvious from surface features” whether underlying mechanisms are functional or dysfunctional (Wakefield 1997b, 256). But it is an empirical discovery whether one’s physiology or psychology is functioning properly, not something to be decided from the armchair, or even from inspecting surface features. A conservative may, though, seek to distinguish debunked intuitions that can be explained away (perhaps as products of local norms, as in the masturbation case) from more resilient intuitions that survive debunking and can still feature as constraint on analysis.

However, once we hand over the task of uncovering malfunction to the sciences we can no longer make common sense the ultimate arbiter, unless we wish to explicitly import, into the concept of disease, considerations derived from folk theories of what normal human nature amounts to.

It seems that the analysis of disease as depending on malfunctioning biological components requires a functional decomposition of human biology. If that decomposition is to be independent of what we think people should be like, it should not be regulated by common sense theories of human nature, but discovered by science. We must be able to ascertain, within acceptable limits of variation, the biological standards that nature has imposed on humans. The goal of finding out how a biological system works is fixed by our interests in health and well-being, but the naturalist’s assumption is that the goal is met by discovering empirical facts about human biology, not our own, culturally defined, norms. So, we diagnose someone as suffering from mesenteric adenitis not just because they are in discomfort due to fever, abdominal pain and diarrhea, but because the lower right quadrant of the mesenteric lymphatic system displays abnormal inflammation. This thickening of the nodes is not just the objective cause of the discomfort, it is an objective failure of the lymphatic system to make its normal contribution to the overall system. For the naturalist’s program to work, the biological roles of human organs must be natural facts just as empirically discoverable as the atomic weights of chemical elements. That may result in the overturning of common sense.

This raises a further issue. It is widely believed that function concepts are intrinsically normative, since they are teleological (for a recent review see Barnes 2016). Therefore, the objection continues, claims about natural functional and malfunction introduce normative considerations into the foundations of medicine, which are supposed to be purely scientific.

A response might be to maintain that whether or not functional claims should be seen as normative, it is not the socially relative normativity appealed to by constructivists. The crucial point is that in the life sciences, some biological system can fail to behave as a theory predicts without impugning the prediction: we can say that the system is malfunctioning. This contrasts with other sciences, in which, if a system fails to behave as predicted, the fault lies with the science, not the system.

Griffiths and Matthewson (2018) attempt to rehabilitate an evolutionary account of function in this context. They tie a selected effects interpretation of function to life history theory, with the advertised aim of providing an explication of pathology that grounds it in a mature science rather than trying to recover some commonsense, or even medically prevalent, concept of disease. Their key contention is that this gives them a scientifically sound way to make discrimination that would otherwise be puzzling, such as the distinction between disease states and senescence, and the means to sort populations into principled reference classes. The resulting picture (Matthewson and Griffiths 2017) is one which generates a variety of evolution-based ways in which organisms can "go wrong". This sets up a taxonomy of opportunities for intervention: some organisms are malfunctioning; others are working properly but in the wrong environment; others are badly off because the environment is inhospitable even though it is normal for them and they are working as they have evolved to; still others generate a development pathway based on misleading information about what optimal development will require. This way of setting up the issues is strongly revisionist, and arguably is no longer an attempt to define disease at all as most of the scholars we have discussed would understand it. Matthewson and Griffiths argue for the congruence of this account with our best science and its stress on the continuity of human and non-human biology.

Supporters of an evolutionary account of function advertise the ease with which an account of malfunction follows from the theory as one of its virtues. Their idea is that we can say when a system is malfunctioning by observing that it is not carrying out the job which natural selection designed it to perform. In contrast, it is widely believed that systemic accounts of function cannot deal with malfunction at all. The argument goes like this: what a system is taken to do is relative to our explanatory interests, and that a putative malfunction can just be understood as a contribution to a different property of the system. Davies (2001) argues that the first of these claims can be defeated by restricting functional ascriptions to hierarchically organized systems in which lower level capacities realize upper level ones. That gives us a characterization of function independent of our explanatory interests.

Godfrey-Smith (1993) argues that systemic concepts of function do permit attributions of malfunction. He argues that a token component in a system is malfunctioning when it cannot play the role that lets other tokens of the same type feature in the explanation of the larger system. Davies (2003, 212) denies this. He says that functional types are defined in terms of what they can do and that if a component cannot carry out its normal contribution to the overall system then it ceases to be a member of a type. However, Davies’ objection appears to fail, at least in medical contexts, if we can identify components apart from their functional roles. Suppose we can identify biological components in terms of their anatomical position and relationships to other organs. If so, we can say that an organ in the position characteristic of its type remains a member of that type even though it has lost some capacity characteristic of that type, and hence is malfunctioning. Reasoning like this permits doctors to identify organs as normal or abnormal during autopsies, even though every system in a corpse no longer possesses its normal function in Davies’s sense.

This leaves unaddressed the issue of how we determine what normal function is. Wachbroit (1994) argues that when we say that an organ is normal, we employ a biomedical concept of normality that is an idealized description of a component of a biological system in an unperturbed state that may never be attained in actual systems. Boorse (1977, 1997) insists that the notion of normality in biomedical concepts is statistical — how things usually are in a reference class, but this view faces the problem of specifying the reference classes in an informative way. But given the amount of variation within a species, it will always be hard to find reference classes which share a design. As Ereshefsky (2009) puts it, Boorse assumes that statistical normality coincides with the kind of normality that medicine cares about, but this looks wrong. Wachbroit (1994, 588) argues convincingly that the role of normality in physiology is like the role that pure states or ideal entities play in physical theories.

Statistically, a textbook heart, for example, may be very rare indeed. But it is the account of the organ that gets into the physiology textbook. The textbook tells you what a healthy organ is like by reference to an abstraction – an idealized organ. This concept of normality is not justified by appeal to a conceptual analysis that aims to capture intuitions about what’s normal. It draws all its authority from its predictive and explanatory utility: against the background of assuming normal heart function, for example, we account for variation in actual hearts (a particular rhythm, say), by citing the textbook rhythmic pattern (which may be very unusual statistically) and identifying other patterns as arrhythmic. The point of textbook depictions of human physiology is to identify an ideal system that enables us to answer “what if things had been different questions” (Woodward 2003, Murphy 2006). The role of an idealization, in this system, is to let us classify real systems according to their departure from the ideal. So normal human biological nature, in this sense, is an idealization designed to let us impose order on variation.

Variation in biological traits is ubiquitous, and so establishing whether a mechanism is functioning normally is difficult: nonetheless, biologists do it all the time. As Boorse notes, many objections argue that pathological states are aspects of natural variation and conclude that there is no clear distinction between the normal and the pathological. But he contends that is a non-sequitur, since the existence of widespread and extensive variation is compatible with the existence of pathological states. Boorse (2014, p. 696–8) and Matthewson and Griffiths (2017) both point out that biologists often judge that members of a species come in forms that are not normal variants but pathological states.

However, how we ascertain what is pathological remains to be determined. Not all diagnoses can be tied to a break between normal and abnormal functioning of an underlying mechanism, such as a failure of the kidneys to conserve electrolytes. Nor can we always discover some other abnormality, such as the elevated levels of helicobacter pylori bacteria that have been found to be causally implicated in stomach ulcers (discussed in detail by Thagard 1999). Some conditions, such as hypertension, involve cutting between normal and pathological parts of a continuous variation, even in the absence of clear underlying malfunctions that separate the populations. The Boorsian tradition has tried to deal with the problem of variation by tying assessments of function and malfunction to reference classes, which Boorse (1977) treated as natural classes of organisms that share a uniform blueprint. Kingma (2007, 2010) has recently argued that reference classes cannot be established without normative judgements, contra Boorse, who takes them to be objectively discoverable parts of the natural order. Kingma contends that Boorse’s account of function needs to capture not only the qualitative causal contribution made by a system to overall functioning, but also the quantitative features of its contribution: a healthy heart is not just a pump, but a pump that works at a given rate. In addition, a system must be capable of working in a variety of situations, including rare ones that require a physiological response to a crisis. Kingma argues that Boorse’s biostatistical theory cannot capture statistically unusual yet functional situations, and concludes that we need to appeal to situation-specific functions. (Cf. Canguilhem (1991 p. 196), who argued that disease is only abnormal relative to a clearly defined context.)

Kingma also points out that organs can become diseased even if they do act in a situationally appropriate way. Liver damage due to paracetamol overdose is obviously not healthy, she says, but the liver is not doing anything situationally inappropriate. That is, a reduced level of function in the context of paracetamol overdose is the situationally appropriate way for the liver to perform. Kingma offers Boorse a dilemma. First, he can either abandon the notion of situationally specific functions. This means failing to recognize the dynamic nature of physiology and leading to absurdities such as the claim that a gut which is not currently digesting because it is empty of food is, in fact, diseased. Or, second, Boorse can acknowledge situation-specific functions, in which case he must say that some systems are healthy (because they are acting as they should in that situation) even though our intuitions insist that they are unhealthy, because there are diseases that are statistically the norm in some situations. Hausman (2011) responds that from a Boorsian perspective the crucial question is whether the normal response – the organism doing its job under stress – renders the system incapable. The digestive system may respond appropriately to poison but in doing so it becomes incapable of normal function on average. If a victim of a poisoning were to a eat a large unpoisoned meal, her digestive system would function much less well than that of the average unpoisoned person in similar circumstances.

Following Boorse, Hausman assumes that there is an average range of performance within a normal population in normal circumstances that can tell us what physiological profile a healthy system ought to have. His reply is developed and expanded by Garson and Piccinini (2014). The issue is whether these normal circumstances can be specified without begging the question, or whether Wachbroit is correct to think of medical normality as an idealization that is unrelated to statistical normality. On any approach, a worry is that if we cite behavioral factors in establishing normality they will reflect contested conceptions of human flourishing. Distinguishing failures to flourish from functional abnormalities will always be a special problem for psychiatry. For example, judgments of irrationality are central to many psychiatric diagnoses, and our standards of rational thought reflect not biological findings but standards derived from normative reflection. The possibility of psychiatric explanation employing the methods and models of physical medicine, then, depends on how much of our psychology is like the visual system – i.e. decomposable into structures to which we can ascribe a natural function (Murphy 2006). Within medicine more generally, the prospects for a general naturalism about disease depend on our ability to understand human biology as a set of structures whose functions we can discover empirically, and our capacity to understand disease causally as the product of failures of those structures to perform their natural functions.

More could be said on all these topics, but the essay will now shift to discuss health. A simple account of health might hold it to be simply the absence of disease, so that if we agree everything is functioning as it should – subject to the complications outlined above, then one is healthy. But most discussions of health insist that health is not just the absence of disease but something more.

As noted above, conceptions of health, like conceptions of disease, tend to go beyond the simple condition that one is biologically in some state. In the case of health, one view is that a healthy individual is just someone whose biology works as our theories say it should. This is the counterpart, in theories of health, to simple objectivism about disease. It is defended at length by Hausman (2015) who calls it “functional efficiency”. As with disease, however, most scholars who write about health add further conditions having to do with quality of life. For instance, Hausman argues that what we are concerned to measure is the contribution that functional efficiency makes to overall well-being. We track not health but the things that make health important. Hausman thus distinguishes disease, health and the value of health. Other scholars draw a similar threefold distinction in different ways. One might have a partly evaluative view of health, like a hybrid view of disease, while also thinking that health should be distinguished from a broader concept like well-being or flourishing. Such views dispute the line we find in Boorse and Hausman that a non-evaluative conception of health is viable. Alexandrova (2018), for instance, argues that health is one of many partly normative concepts that give rise to what she calls “mixed claims“ in the social sciences, that relate, empirical variables to normatively derived variables. The definition and measurement of health, she insists, must depend on normative judgments about what it takes to be healthy.

What kinds of normative claims are relevant? Carel (2007, 2008) thinks that the important thing about health is one’s lived experience of one’s own body, and in particular, that one should not feel estranged or alienated from one’s body. Carel argues that health should be understood phenomenologically as the experience of being at home in one’s lived body, rather than merely the normal functioning of the body seen as a biological unit.

From the naturalist perspective, one problem with this proposal is that it ignores the fact that one can feel perfectly at ease with one’s lived body even if one harbors, unaware, a diseased system. Indeed, Carel argues that someone who is ill can be, in her sense, healthy, if they are adapted to their bodily predicament; from her perspective, objections like the one just mentioned miss the point, since they privilege a biological perspective rather than a phenomenological one. Her project is avowedly revisionist: she wishes to replace existing concepts of health with views that aim to capture the experience of being healthy (or unwell).

Carel’s stress on experience is directly challenged by views like Gadamer’s. He insists (1996, 113) that it is absurd to ask someone if they feel healthy, since health is “not a condition that one introspectively feels in oneself. Rather, it is a condition of being involved, of being in the world, of being together with one’s fellow human beings, of active and rewarding engagement in one’s everyday tasks”. Gadamer’s healthy person is someone who is in harmony with their social and natural environment, and disease is a disturbance of this harmony. Canguilhem (1991, 2012) thinks of health as flexibility, in the sense that a healthy organism can tolerate environmental impacts, adapts to new situations and possesses a store of energy and audacity. This is not something that can be measured by physiology (2012, p.49). Canguilhem’s approach suggests what is wrong with Gadamer’s objection to phenomenological accounts of health. A phenomenological account does not have to hold, as Gadamer seems to have supposed, that there is a special feeling that is the feeling of being healthy. Rather, for a view like Canguilhem or Carel’s, healthy people experience the world as an arena to express themselves in rather than a bunch of threats. Antonovsky (1987) puts this in terms of a sense of coherence which enables one to understand the environment and mobilize internal resources against external stressors. It may well be that perspectives like Carel’s are neglected in contemporary medicine, and that they are especially important in disability studies. However, it does not follow that the concepts of health and disease, rather than aspects of our practices that employ those concepts, should be reformed along the lines she suggests. In general, though, accounts of health, compared to those of disease, are less concerned with trying to capture a scientific or clinical concept.

Gadamer’s view is reminiscent of what Richman (2003) calls “embedded instrumentalist” theories, which claim that health is indexed to goals: how healthy you are depends on how well you can fulfill your goals. Such theories are very popular. Nordenfelt (1995) considered two versions of this approach. One version defines the goals relevant to health as needs, which are understood as having a biological basis. Another view defines goals in terms of the ambitions and desires of the individual. Nordenfelt (1995, 90) argues that a healthy person is one who can satisfy her “vital goals”, which are those that are necessary and sufficient for her to be minimally happy.

Embedded instrumentalist theories of health have an obvious appeal. Once we argue that health involves judgments about how well a person’s life is going, we need a way to evaluate that, and an immediately attractive idea is that someone’s life goes well if they can achieve their ambitions or satisfy their goals. An apparent difficulty, however, is that much the same terrain is covered by theories of well-being, and while people think that being healthy is important to their well-being (Eid and Larsen 2007), they do not identify the two. Rather, they think of health as a component of well-being or a contributor to it.

Some embedded instrumentalist theories, though, appear to be in danger of defining health in such a way that it is synonymous with well-being. Richman (2003), for example, develops his view, (the “Richman-Budson view”) to deal with objections that Nordenfelt raises against goal-based views, such as the worry that someone with very low ambitions will count as healthy just because she is easily satisfied. Richman (2003, 56–57) supposes that someone is healthy if she can strive for a consistent set of goals that would be chosen by an idealized version of herself if she were fully aware of her “objectified subjective interest” (p.45). That is, they are the goals she would choose if she had complete knowledge of herself and her environment and perfect rationality.

In this case it seems that a theory of health is in danger of becoming a general theory of well-being, and Richman does not discuss the relationship between the two. A further complication is the relationship between medical interventions designed to cure diseases, and other medical interventions which are “enhancement technologies” (Elliott 2003). The line between enhancement and therapy is very hard to draw: Harris (2007, 21) for example, uses the example of vaccination, which is both a therapeutic protection against infection and an enhancement of our natural immune system. Perhaps, too, many of us would benefit from a boost to our powers of concentration, or a lift in our mood, which pharmaceuticals might supply. But neurological enhancements, unlike vaccines, can help us to meet our goals without guarding against disease. Perhaps what is needed is a weaker view of the relation between health and goal-directedness, such as that offered by Whitbeck (1981, 620). Whitbeck defines health in terms of the psychophysiological capacities of an individual that support her “goals, projects and aspirations in a wide variety of situations”. This view loosens the tight Richman-Budson connection between health and goal-directed action, and suggests a view on which we can see biological capacities as at the core of health in so far as they help people’s lives to go better. So there seems to be a broad but not unanimous view that whatever one thinks about the value-ladenness of health we need a threefold distinction between disease, health (which may or may not be partly evaluative, and some properties of a person’s life that enable us to evaluate how well it is going for them. Not all such properties are health problems – someone who is oppressed is not unhealthy simply in virtue of being oppressed (though oppression can certainly cause health problems) – oppression itself can be distinguished from the health problems that may follow from the nature of oppression

Schroeder (2013) has taken issue with the whole idea of defining health as a property or state of an individual. He argues in contrast that “health” is a fundamentally comparative term like “tall”. Two human beings can both be tall even if one is taller than the other, whereas it makes no sense to think of two straight lines, one of which is straighter than the other. Schroeder argues that if we see health as fundamentally comparative or relational we can recast several conceptual, ethical and policy debates. For example, instead of thinking in terms of non health-related differences among the healthy we could think in terms of gradations of health. Schroeder also thinks that his approach makes intergenerational or cross-temporal comparisons easier, since we can say that a medieval serf was healthy in their time, but nonetheless less healthy than a modern person who is, by our standards, chronically ill. An approach like this might offer some traction on the reference class problem outlined above.

Naturalism and constructivism have been distinguished for analytic purposes in this essay but they are not always easy to tell apart in practice. The difficulty comes from the fact that there is widespread agreement that our thinking about disease pays attention to both human values and biological phenomena, and it is not always easy to tell how a theorist explains the interactions of these factors, nor whether a given analysis is descriptive or prescriptive. For naturalists the relevant biological processes are departures from good human functioning, construed in one of several ways about which controversy rages, but to be determined by the relevant science. These biological problems result in what we judge to be difficulties in living, which may or may not be partly constitutive of disease, just as positive qualities may or may not be partly constitutive of health. For a constructivist, it is the problems people face in their lives that take priority. Their biological underpinnings are ones we count as abnormal because we have judged them to be both relevant to the conditions we disvalue and also the subject matter of a specific, medical, class of interventions, therapies and other practices. The obstacle to a successful development of naturalism is the problem of establishing a satisfactory, science-based, distinction between normal and abnormal human functioning. Overcoming this difficulty will require a closer engagement by theorists of disease with the relevant debates in the philosophy of biology.

For constructivists, the big problem is to say why we judge some human phenomena to be symptoms of disease whereas others are taken as evidence that someone is criminal or ugly or possessed by demons or something else we do not admire. It is not generally true that we think that if someone’s life goes badly it is because he or she is unhealthy, so constructivists owe us an account of what makes a certain class of judgments distinctively medicalized.

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How to cite this entry . Preview the PDF version of this entry at the Friends of the SEP Society . Look up topics and thinkers related to this entry at the Internet Philosophy Ontology Project (InPhO). Enhanced bibliography for this entry at PhilPapers , with links to its database.
  • President’s Council on Bioethics
  • Center for Bioethics , University of Pennsylvania
  • Joint Centre for Bioethics , University of Toronto

causation: and manipulability | disability: definitions and models | disability: health, well-being, personal relationships | feminist philosophy, interventions: bioethics | human enhancement | mental disorder | social norms | teleology: teleological notions in biology | well-being

Acknowledgments

The editors would like to thank Patrick S. O’Donnell for bringing several typographical errors in this entry to our attention.

Copyright © 2020 by Dominic Murphy < dominic . murphy @ sydney . edu . au >

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Writing Guide

Writing serves as a useful skill for anyone in the field of public health — students and professionals alike. Public health students must enroll in writing-intensive courses that require essays and research papers. Once students graduate, they put their skills to use writing reports on community health. They may compose presentations, research studies, or press releases, depending on their jobs. Those who stay in academia continue to write research papers throughout their careers.

Students should begin cultivating a clear and concise writing style long before they graduate.

They should also learn how to use standardized citations. Understanding how to properly cite sources will help students as they conduct research and publish their findings. Citations also help students and researchers avoid plagiarism.

This guide explains how to write a public health report, a research paper, and an exam essay. The page also advises students on how to conduct research online and find trustworthy sources. Students can review citation style guides and public health writing samples.

Featured Online Programs

Types of writing public health students will do in school, personal statements.

When applying to a public health program, schools often require students to submit personal statements. Schools may either ask students to write a general personal essay answer a certain prompt. Usually, prompts center around applicants’ interest in public health or about the public health field in general. Students might come across a prompt similar to this one: “Identify a public health issue in the U.S., and how you would work to rectify it as a public health professional.” Alternately, students may encounter this common topic: “What drove you to pursue a career in public health?”

Schools look for essays that are honest, well-written, and well-organized. Students should get the reader’s attention with an anecdote illustrating their commitment to public health. Was it an experience with adversity or discrimination that prompted you to pursue this career? Did you learn about the importance of public health while volunteering or traveling? Include those details in the story.

Students should also demonstrate their current knowledge of public health. They may write about their career goals as well. However, students should avoid writing exaggerations, falsehoods, or superlatives. People who read admissions essays can typically sense when applicants are stretching the truth. If the school makes the personal statement optional, students should still consider writing one. A personal statement demonstrates commitment and hard work, and may help make up for flawed or weak admissions materials.

In some public health courses, professors require students to answer essay questions during exams. This can be intimidating since students do not usually know the prompt until they actually start the exam. Students have a limited amount of time to write the essay, typically one or two hours. Students should allot their time accordingly. Some students do not plan their work before they begin writing; this can lead to sloppy essays with weak supporting points, disorganized information, and tangents unrelated to the prompt.

For a 60-minute time frame, students may give themselves 10 minutes to brainstorm, plan, and outline.

During the brainstorming process, students should write their thesis statement.

Then they should jot down three points that support the thesis. These ideas will serve as the three body paragraphs. Students may give themselves five minutes to write the introduction, 30 minutes to write the body, and then five minutes to write the conclusion. They then have 10 minutes to proofread. Students often inadvertently miss this step, but proofreading may make or break the essay.

Students should begin planning long before the day of the essay. Students ought to review the material well enough to be prepared for any prompt. They should carefully look over their lecture notes to determine which points the professor emphasized during classes. These points will likely prove significant when it comes time for the exam. Students should also make sure that they actually answer the prompt instead of rushing and jumping to assumptions.

Research Papers

In a research paper, students examine the existing research, theories, case studies, and ideas about a particular topic. Students have several weeks to write research papers, which may seem like a huge amount of time. However, research papers demand a lot of work, so students should start early. Professors rarely assign strict, narrow prompts for research papers. Instead, they usually give students a topic or range of topics, and students choose their focus. Public health topics may include how poverty or race affects access to healthcare; opioid abuse; the social consequences of HIV/AIDS; childhood obesity; or maternal mortality in third world countries.

Students should start by brainstorming a list of points and ideas they will investigate. Then comes the most time-intensive and significant part of a research paper: the research itself. Students ought to use multiple different resources to help them craft their arguments. Options include online databases, academic journals, and their college library. Make sure you keep track of citations and sources as you go.

Students should also make sure their essays are well-structured. A well-written thesis unites the main points of the paper. Unlike essays, research papers usually include more than five paragraphs. Students may break down their arguments into different sections. A research paper must include a works cited or bibliography that credits all sources. The exact length of the paper and number of sources depends on the professor’s expectations.

Over the course of their academic careers, public health students write many kinds of essays. Professors often assign persuasive essays, in which the student must make a convincing argument; expository essays, in which the student explores and explains an idea; narrative essays, in which the student tells a story; comparative essays, in which the students analyzes two different viewpoints; and cause and effect essays, in which the student must explain the logic behind why certain events or phenomena occur.

  • Narrative: In a narrative essay, the author tells a meaningful story. Studying public health, you probably won’t write many narratives. However, narrative essays can support an argument or prove a point. For instance, if you argue that every community should have a free clinic, you might tell a personal story about your experience growing up in a low-income neighborhood with no access to healthcare. Make sure your essay demonstrates a clear plot, follows an organized structure, and includes many details.
  • Expository: When professors assign expository essays, they expect students to explain or describe a concept. These essays help professors evaluate whether students have a firm grasp on a topic. Expository essay often include five paragraphs: an introduction with a thesis statement, three main points backing that thesis statement, and a conclusion. Students should do plenty of planning and research before writing to ensure they adequately address the prompt and include enough evidence.
  • Persuasive: Persuasive essays appear commonly in academic assignments. Students first develop an argument as a thesis statement. Then, they generate a cogent defense of that argument by researching supporting evidence. Students should be able to anticipate arguments against their thesis statement and include counterpoints. In persuasive essays, students not only demonstrate their knowledge of the course material, but also prove their critical thinking skills by developing their case.
  • Comparative: A comparative essay requires students to compare and contrast two ideas, viewpoints, or things. For example, public health students may compare two texts, theories, public health systems, or positions on an issue. First of all, students should create a list of similarities and differences between the two items. After that, they can develop a thesis statement on whether the similarities outweigh the differences or vice versa. Finally, they should organize the essay. They can either defend their thesis statement by listing each point of comparison, or they can split the essay in half by discussing subject one and then subject two.
  • Cause and Effect: These essays require students to explain how one event or theory leads to a specific consequence. For instance, a public health student might argue that abstinence-only education in public schools leads to a higher rate of teenage pregnancies. Students should remember that just because one event follows another, those two events do not necessarily influence one another. In other words, correlation does not equal causation. In the analysis portion of the essay, students must explain specific reasons why they think the two events are connected using data and other evidence.

Citations Guide for Public Health Students

In public health writing, just as any other discipline, students must cite their sources. If students use ideas, theories, or research without crediting the original source — even unintentionally — then they have plagiarised. An accusation of plagiarism could follow the student throughout their education and professional career. Professors may fail students who plagiarise, sinking their GPA. Plagiarism accusations can also ruin a student’s credibility. Fortunately, students can avoid plagiarism by properly giving credit for their data and ideas. Common citation styles include those listed below.

American Psychological Association (APA) Style

Students in the social sciences use APA style when writing their essays and research papers. Business and nursing students also commonly use APA style. APA prefers active voice over passive voice, as well as concise language over flowery words. Research papers written in APA style should include a title page, abstract, and a reference page. In-text citations list the author’s name, year of publication, and page number if applicable. Below is an example of how to cite a source using APA style.

In-text citation:

In Milwaukee, poor neighbourhoods were segregated by design (Desmond, 2017, p. 249).

On the works cited page:

Desmond, M. (2017). Evicted: Poverty and profit in the American city . London: Penguin Books.

Chicago Manual of Style (CMS)

History students and students of the natural sciences typically use Chicago, or Turabian, style in their research. Papers written in Chicago style include three sections: the title page, the main body, and a references page. This style also uses footnotes to source information and provide more context. In-text citations list the author’s name, the date of publication, and the page where the student found the data. Unlike APA style, though, the in-text citation does not use a “p.” before the page number. See the example below:

In Milwaukee, poor neighbourhoods were segregated by design (Desmond 2017, 249).

Desmond, Matthew. Evicted: Poverty and Profit in the American City . London: Penguin Books, 2017.

Modern Language Association (MLA) Format

Students of the humanities — including literature, foreign languages, and cultural studies — use MLA style in their research papers. Unlike APA and Chicago style, MLA style does not require students to add a title page. MLA papers also do not include an abstract. Students only need to include the paper itself and a works cited page that corresponds with in-text citations. When adding citations in the body of the text, MLA includes the author’s last name and the page number in parentheses. This style does not list the publication year. You can find an example of MLA citation below:

In Milwaukee, poor neighbourhoods were segregated by design (Desmond 249).

Associated Press (AP) Style

Journalists use Associated Press, or AP style, in their work. AP style standardizes grammar and spelling usage across news media and mass communications. Students rarely use AP style, unless they are writing an article in their subject area for a newspaper or magazine. AP style prioritizes brevity and conciseness above all else. Therefore, it includes several rules that differ from other writing styles. For instance, AP style eliminates the last comma in a list of items (for example: “She dressed in capris, a tank top and sandals”). Since students and professors do not use AP style for academic papers, AP style does not include a reference page like other style guides. Instead, AP style simply uses non-parenthetical in-text citations.

“People who live in low-income communities lack opportunities to exercise,” said Lydia Homerton, professor of public health at Hero College.

The Best Writing Style for Public Health Majors

Professionals in the public health field use APA, the most common style in the social sciences. Professors expect students to use APA style as well. Public health research follows a standardized system of citing sources, making it easier for students and professionals in the field to conduct further research. Students should add a title page and abstract before the essay, as well as a list of references in the back.

Common Writing Mistakes Students Make

Active vs. passive voice.

When writing essays and research papers, students should use active voice and avoid passive voice. Learning the difference between passive and active constructions can be tricky. First of all, students should be able to identify the subject in a sentence. The subject is the noun performing an action. Take this sentence: “The woman catches the keys.” In this case, the woman is the subject of the sentence because she is the one performing the action, catching. The sentence “The woman catches the keys” is active because it focuses on the subject and the action. You can identify an active sentence by checking if the first noun is a subject performing an action.

By contrast, examine this sentence: “The keys were caught by the woman.” The first noun, “keys,” is not performing an action. Instead, it is being acted upon. The subject performing the action — the woman — is at the end of the sentence and not the beginning. This sentence uses passive voice instead of active voice. Some passive sentences do not include a subject at all. For example, “The keys were caught.”

Active voice makes writing more concise and easy to understand. Active sentences often include more information, especially about the subject performing an action. In research papers, students should use active voice whenever possible. However, sometimes it is clear that the author is the one performing the action, so active voice is not necessary. For instance, a researcher might write “the experiment was conducted Friday” instead of “I conducted the experiment Friday.”

Punctuation

Incorrect punctuation confuses readers. The wrong punctuation can change or obfuscate the meaning of a sentence, paragraph, or the entire essay. Publishers, professors, and other researchers often look down on papers with incorrect grammar, even if the content includes important or accurate research. Consequently, students should always use proper grammar in their essays.

The wrong punctuation can change or obfuscate the meaning of a sentence, paragraph, or the entire essay.

While students make many different errors with punctuation, most common errors revolve around colons and commas. Understand the difference between colons and semicolons. Both punctuation marks separate two parts of a sentence. Students should use colons when introducing a list. (“He ate lots of meat: pork, chicken, steak, veal, and duck.”) Colons can also introduce an appositive or new idea. (“She finally gave him the gift: a new computer.”) Semicolons, on the other hand, connect two complete, independent sentences. These sentences should be separate but related. (“He ate a lot of meat; he was ravenous.”)

Students should also take care to avoid comma splices. A comma splice occurs when writers connect two independent sentences using a comma. The following sentence includes a comma splice: “She danced with her boyfriend, he was very clumsy.” Instead, students could add an “and” to connect the two sentences. (“She danced with her boyfriend, and he was very clumsy.”) Alternately, writers could connect the sentences with a semicolon. (“She danced with her boyfriend; he was very clumsy.”) Lastly, writers could separate the two sentences with a period.

Proper grammar helps readers understand your essays. Proper grammar also gives your essay credibility. If you have a perfectly-argued essay, but your paper includes multiple grammar mistakes, the reader will likely be skeptical of the entire argument.

Understand the difference between there/their/they’re. “There” refers to a place. (“The dog is over there.”) Their shows possession. (“This is their house.”) “They’re” is a contraction for “they are.” (“They’re eating at the diner.”)

Also learn the difference between it’s and its. “It’s” is the contraction for “it is.” (“It’s hot outside.”) “Its” shows possession. (“The bird eats in its cage.”)

Make sure your sentences include proper subject-verb agreement. In other words, if the subject of a sentence is plural, the verb should also be plural. For example, use “The boy and his sisters are eating breakfast” instead of “The boy and his sisters is eating breakfast.”

Writing Resources for Public Health Students

  • Guide to Improving Scientific Writing in Public Health : This guide from the World Health Organization and the Pan American Health Organization teaches students how to write about complicated scientific material in a way that’s easy for readers to understand. The guide includes tips on vocabulary and format.
  • Argument, Structure, and Credibility in Public Health Writing : Written by a professor at Harvard’s School of Public Health, this essay breaks down how to make effective arguments in public health writing. The page includes flow charts and figures to help illustrate exactly how public health essays should be organized.
  • Purdue Online Writing Lab APA Style Guide : Purdue’s Online Writing Lab includes style guides for all writing and citation styles, including APA. The style guides help students understand how to format papers, use in-text citations, and create reference pages.
  • Award-Winning Health Articles : One of the best ways to improve your writing is to read good examples. This page lists nine award-winning public health writing samples.
  • The Women’s and Children’s Health Policy Center Writing Skills Guide : This website links to several modules on writing public health documents. Lessons include policy briefs and memos.

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Definition of Health Essay Sample, Example

There are two theories of the progression of this word. Firstly, it is thought that “health” as a term derives from the Proto-Germanic word “haliþaz,” man or hero. Later, with Old English, the word transformed into “hæleþ,” with the meaning of man, hero, or fighter. Finally, in Middle English, the word became “haleth,” which has the same definition as in Old English. According to another form of etymology for “health,” the word came from the Proto-Germanic term “haliaz,” which is defined as whole or hale. This transferred to the West Proto-Germanic language as “hailiþō,” “hǣlþ” in Old English, and “healthe” in Middle English—all with the same meaning. According to the first theory, “health” is “Cognate with West Frisian held (“hero”), Dutch held (“hero”), German Held (“hero”), Danish helt (“hero”), Swedish hjälte (“hero”), Norwegian hold (“hero”) ( Wiktionary ). As you can see, the progression of the word “health” is a bit muddled, and not exactly linear in meaning.

However, in modern English, it is understood to be a mass noun referring to “The state of being free from illness or injury,” figuratively as “A person’s mental or physical condition,” and as a saying, with it being “Used to express friendly feelings towards one’s companions before drinking” ( Oxford Dictionaries ). This is far from the definitions and the contexts it was used in some of etymological theories of its Proto-Germanic, Old English, and Middle English origins.

Though these are standard definitions of “health,” the word also correlates to many disciples. For instance, The World Health Organization in 1948 proposed that health relates to “physical, mental, and social well-being, and not merely the absence of disease and infirmity” ( World Health Organization ). However, later the Organization revised its definition as, “The extent to which an individual or group is able to realize aspirations and satisfy needs and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities” ( WHO Regional Office for Europe ). It is easily noticed that this pivotal Organization changed its definition to a more holistic statement as time went on.

In relation to psychology, which focuses more on mental health (which also interacts with our physical system), the word “health” is prominent. According to Psych Central , “Mental health and wellness is the state at which one feels, thinks, and behaves. Mental health can be viewed on a continuum, starting with an individual who is mentally well and free of any impairment in his or her daily life, while someone else might have mild concerns and distress, and another might have a severe mental illness. Mental health is just as vital as physical health” ( Psych Central ). As you might have noticed, mental health is not so black and white. It is difficult to determine the exact sanity or insanity of a person; however, we can generalize about how a person stands in terms of mental health.

“Health” is a fairly old word, deriving from the Proto-Germanic language, which continued on in Old English and in Middle English. There are two versions of its etymology, but at present there is usually one generalized definition of the word by the World Health Organization. Health encompasses physical, psychological, and social wellbeing.

“Health.” Wiktionary , en.wiktionary.org/wiki/health.

“Health | Definition of Health in English by Oxford Dictionaries.” Oxford Dictionaries | English, Oxford Dictionaries, en.oxforddictionaries.com/definition/health.

World Health Organization (1958). The first ten years of the World Health Organization. Geneva: WHO .

World Health Organization. Regional Office for Europe (1984). Health promotion : a discussion document on the concept and principles : summary report of the Working Group on Concept and Principles of Health Promotion, Copenhagen, 9–13 July 1984(ICP/HSR 602(m01)5 p). Copenhagen: WHO Regional Office for Europe .

“What Mental Health Means to Me.” Psych Central , 10 May 2013, psychcentral.com/blog/what-mental-health-means-to-me/.

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90+ Strong Health Essay Topics And How To Handle Them

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Table of Contents

what is health essay

You can write about healthy lifestyle, rehabilitation after traumas, childcare, common or rare diseases, global advances in health and medicine, environmental health issues, and more.

How to deal with essay on health?

Your essay will be the most impressive if you choose a topic that is familiar to you or you can write about something you have experience with. It will be easier for you to do a health essay paper and build a convincing argument. Another approach is choosing a topic which is not familiar to you but in which you are interested in. It would be a great opportunity for you to educate yourself.

If you pick an interesting essay topic idea which is too broad to cover in your essay, you should do additional keyword research and look for some specific aspects of this topic to narrow it.

Keep in mind that you should look for a narrow topic which has enough available resources that you can use for researching it.

Before you start writing, make sure you have found enough evidence and examples to support your argument. A good idea is to create a working outline or a mind map for your essay that will guide your writing and help you stay focused on your key points.

First, create a strong thesis statement and think about several main points to support it.

If you are looking for health topics to write about and are not sure what to write about, here we have gathered a lot of exciting ideas that you won’t find on any other essay writing services.

Feel free to use them as inspiration own topic ideas or for writing your essays.

Health topics to write about

  • How Can We Help Children Maintain a Healthy Body Weight?
  • Ethical and Legal Issues of Surrogate Pregnancy.
  • How Dangerous are Long-term Consequences of Anorexia?
  • Principles of Preventing Medical Errors in Hospitals.
  • How Can Doctors Promote Healthy Lifestyle?
  • Why is Homeopathy a Pseudo-Science?
  • What Are Side Effects of Blood Transfusion?
  • Types of Eating Disorders.
  • Can a Vegan Diet Be Healthy?
  • The Best Strategies to Maintain Healthy Body Weight.
  • Psychological Issues of Breast Cancer.
  • Importance of Organ Donation after Death.
  • Can Cloning Help Save Lives?
  • Ethics in Human Experimentation.
  • Symptoms of Heart Attacks in Women.
  • Is It Possible to Cure Diabetes in the Future?

Interesting health topics to write about

  • What is the Difference Between Western Medicine and Alternative Medicine?
  • Health Consequences of Eating Disorders.
  • Bioprinting as the Future of Organ Transplants.
  • Use of Stem Cell Technologies for Cancer Treatment.
  • Ethical and Social Issues of Cosmetic Surgery.
  • How Does Advertising Influence Healthy Food Choices?
  • Role of Nutrition Education in Promoting Healthy Diets.
  • Fast Food Consumption and Obesity.
  • How Can Exercise Help Senior Improve Strength and Balance?
  • Advantages and Disadvantages of Weight Loss Surgery.
  • Obesity as a Medical and Social Problem.
  • Strategies for Heart Disease Prevention.
  • How Long Can Humans Actually Live?
  • Pros and Cons of Clinical Trials.
  • Alternative Ways to Treat Depression.
  • Is There a Cure for HIV or AIDS?

Controversial health essay topics

  • Is There a Link Between Sugary Drinks and Cancer?
  • Health Consequences of Caffeine.
  • Can Little Kid Food Habits Signal Autism?
  • Should Euthanasia Be Legalized?
  • Pros and Cons of Medical Marijuana.
  • Is Alternative Medicine Dangerous?
  • Is Doing Sports always Healthy?
  • Which Diet Is Better: Low-Fat or Low-Carb?
  • Discuss Measures for Prevention of Communicable Diseases.
  • Social Determinants That Influence People’s Well-being.
  • Are Doctors Responsible for the Opioid Epidemic?
  • Is Religion a Mental Disorder?
  • Is Nuclear Waste Really Dangerous for People?
  • Is a No-Carb Diet Safe?
  • Are We Too Dependent on Antibiotics?
  • Are Natural Medicines a Good Alternative to Pharmaceutical?
  • Can Blockchain Help Improve the Trust in the Accuracy of Clinical Trials Data?

Mental health argumentative essay topics

  • Influence of Environmental Factors on Mental Health.
  • Drug Misuse and Mental Disorders.
  • Social Effects of Mental Disorders.
  • Alcohol Addiction and Psychiatric Disorders.
  • Symptoms, Causes, and Treatment of Teen Depression.
  • How to Protect Your Mental Health from Social Media Dangers.
  • Effects of Social Isolation and Loneliness on Severe Mental Disorders.
  • Negative Effects of Total Isolation on Physical and Mental Health.
  • Mental Health Benefits Associated with Physical Activity.
  • Association between Exercise and Mood.
  • Mental Health Problems of Homeless People.
  • Stress as a Risk Factor for Mental Disorders.
  • Effect of Disposer to Violence on Mental Disorders.
  • Common Mental Disorders in the USA.
  • Depression and Anxiety Disorders among Adults.
  • Cognitive-Behavioral Therapy for Anxiety Disorders.
  • Economic Burden of Depression and Anxiety Disorders.
  • Influence of Anxiety Disorders on the Quality of Life.

Health care essay topics

  • Advantages and Challenges of E-health Technology.
  • Application of Big Data to the Medical Care System.
  • Risk Connected with Untested Methods of Alternative Medicine.
  • Controversial Issues in the US Medical Care System.
  • Telemedicine and Other Disruptive Innovations in Health Care System.
  • How Can We Achieve Health Equity?
  • Impact of Racism on the Well-Being of the Nation.
  • School-based Health Care and Educational Success of Children.
  • Role of School-based Health Care in Preventing Dropout.
  • What Can Be Done to Curb Rising Suicide Rates?
  • Do Adults and Senior Still Need Vaccines?
  • What Human Rights Issues Have an Impact on Public Health?
  • What Measures Should Be Taken to Prevent Heat-related Deaths?
  • Discuss Healthy Housing Standards.
  • What Are Common Strategies for Prevention of Chronic Diseases?

Health essay topics for high school students

  • Can Computers Displace Doctors?
  • Can People Become Immortal?
  • Can Happiness Cure Diseases?
  • How to Prevent Teen Pregnancy?
  • The Biggest Health Challenges Facing Youth.
  • Importance of Balanced Diet for Teenagers.
  • Does Being Healthy Make You Happy?
  • Why Is Exercise Important to Teenagers?
  • Why Is Obesity Becoming an Epidemic?
  • How to Become a Healthy Person.
  • Importance of Healthy Lifestyle for Teens.
  • Negative Impact of Smoking Teenagers.
  • How Does Stress Affect Teenagers?
  • Why Do Teenagers Experiment with Drugs?
  • How to Develop Healthy Eating Habits.

Need a health essay overnight? Here’s a deal! Buy argumentative essay help by choosing any topic from our list and handing it to our writers. Complete confidentiality and the brilliant result are guaranteed.

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Home — Essay Samples — Life — Healthy Lifestyle — What Does It Mean to Be Healthy

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What Does It Mean to Be Healthy

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Published: Sep 1, 2023

Words: 558 | Page: 1 | 3 min read

Table of contents

Physical wellness: the foundation of health, mental and emotional equilibrium, social connections and community, harmony between mind, body, and environment, the dynamic nature of health, in conclusion.

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what is health essay

English Compositions

Short Essay on Health [100, 200, 400 Words] With PDF

In today’s lesson, I will discuss how you can write short essays on Health within different word limits. All the essays will be written here with a simplistic approach for a better understanding of all students. 

Feature image of Short Essay on Health

Short Essay on Health in 100 Words

Health is an important aspect of one’s life. A person is considered healthy when he or she is free from illness or injury. Health can be categorised as physical health, mental health, emotional health, social health, et cetera. However, all these categories are interrelated.

While low physical activity can impact overall mental health, mental stress can adversely affect heart health and poor emotional health can deteriorate one’s quality of life. Being in good health enables a person to function optimally and live their life happily.

Some of the basic rules for maintaining good health include going to bed and waking up on time, exercising regularly, eating healthily and drinking at least eight glasses of water daily. 

Short Essay on Health in 200 Words

Health is one of the most important aspects of one’s life. One can be a billionaire but if he is not in good health, he can not enjoy the luxuries that money can buy. Thus, health is considered as the real wealth. Health can be categorised as physical health, mental health, emotional health, social health, et cetera.

However, all these categories are interrelated and impact each other. For example, not exercising regularly can make a person irritable and cause mental health problems, while chronic stress can lead to health diseases and diabetes. Poor emotional and psychological health can also make people withdrawn and impact their overall health. 

Being in good health enables a person to function optimally and live their life happily. When one feels healthy and is not troubled by pain or discomfort in the body, he can be more active, participate in various activities and be more present in the daily happenings. Being mentally in good health is also very important as suffering from anxiety, depression and other issues can severely deteriorate one’s quality of life.

One can easily improve his health by making some changes in his lifestyle. Some of the basic rules for maintaining good health include going to bed and waking up on time, exercising regularly, eating healthily and drinking a lot of water. 

Short Essay on Health in 400 Words

Health is a key aspect of one’s life. A person is considered healthy when he is free from all illness and injury and can conduct his life well. One can be a billionaire but if he is not in good health, he can not enjoy the luxuries that money can buy. Thus, health is considered as the real wealth and being in good health is very important. Health can be categorised as physical health, mental health, emotional health, social health, et cetera.

Everyone can be healthy but good health does not come without the necessary discipline and care. Going to bed and waking up on time, exercising regularly, avoiding junk food, eating healthily, drinking a lot of water and getting some sunlight are a few good habits that can improve one’s health. However, it cannot be achieved in a day. One needs to change their lifestyle and practice healthy habits daily. 

Sometimes, one’s external environment can also be the reason for their poor health. Living in shabby conditions, breathing in heavily polluted air, consuming unhygienic food and contaminated water can more often than not, result in bacterial, fungal and viral diseases. Hence, cleanliness is an important factor if one wants to be healthy. One should also take care of their diet and include greens and other nutritious food, limit their caffeine intake, stop smoking and drinking as well as follow the basic health protocols. 

Good health is necessary if one wants to achieve their goal in life. One cannot study well or work hard when they are not feeling at ease or are suffering from pain. Adopting a healthy lifestyle makes us healthy and boosts our energy as well as immunity. Thus, good health is the key to enjoying a good life. 

In this session above, I have mentioned everything that could be necessary to write short essays on Health. Through the simple words and sentences, I hope now you have understood the entire context. If you still have any doubts regarding this session, kindly let me know through some quick comments. If you want to read more such essays on various important topics, keep browsing our website. 

Join our Telegram channel to get the latest updates on our upcoming sessions. Thank you. 

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Sandro Galea M.D.

COVID-19 Was a Turning Point for Health

Our new book focuses on the lessons of the pandemic..

Posted February 15, 2024 | Reviewed by Michelle Quirk

  • To think comprehensively about COVID-19 is to think not just about the past but also about the future.
  • The narratives we accept about the pandemic will do much to shape our ability to create a healthier world.
  • Understanding the pandemic, and learning from it, means coming to terms with the emotions of that time.

In 2021, the United States was at a turning point. We had just lived through the acute phase of a global pandemic. During that time, the country had experienced an economic crisis, civil unrest, a deeply divisive federal election, and a technological revolution in how we live, work, and congregate. The emergence of COVID-19 vaccines allowed us, finally, to look ahead to a post-pandemic world, but what would that world be like? Would it be a return to the pre-COVID-19 status quo, or would it be something radically new?

It was with these questions in mind that, in 2021, I partnered with my colleague Michael Stein to write a series of essays reflecting on the COVID-19 pandemic. Our aim was to engage with the COVID moment through the lens of cutting -edge public health science. By exploring the pandemic’s intersection with topics like digital surveillance, vaccine distribution, big data, and the link between science and political decision-making , we tried to sketch what the moment meant while it unfolded and what its implications might be for the future. If journalism is “the first rough draft of history,” these essays were, in a way, our effort to produce just such a draft, from the perspective of a forward-looking public health. I am delighted to announce that a book based on this series of essays has just been published by Oxford University Press: The Turning Point: Reflections on a Pandemic .

The book includes a series of short chapters, structured in five sections that address the following themes:

This section looks at the COVID-19 moment through the lens of what we might learn from it, toward better addressing future pandemics. It tackles challenges we faced in our approach to testing, our successes and shortcomings in implementing contact tracing, the intersection of the pandemic and mass incarceration, and more. Many of these lessons emerged organically from the day-to-day experience of the pandemic, reflecting “unknown unknowns”—areas where we encountered unexpected deficits in our knowledge, which were revealed by the circumstances of the pandemic. Chapter 8, for example, explores the necessity of public health officials speaking with care, mindful that our words may be used to justify authoritarian approaches in the name of health, a challenge we saw in the actions of the Chinese government during the pandemic.

Our understanding of large-scale health challenges like pandemics depends on more than collections of data and a timeline of events. It depends on our stories. The narratives we accept about the pandemic will do much to shape our ability to create a healthier world before the next contagion strikes. This section explores the stories we told during COVID-19 about what was happening to us and looks ahead to the narratives that will likely define our recollections of the pandemic moment. It addresses narratives around the virtues and limits of expertise, the role of the media as both a shaper of stories and a character in them, the hotly contested narrative around vaccines, and the role scientists, physicians, and epidemiologists played in shaping the story of the pandemic as it unfolded.

This section explores how our values informed what we did during COVID-19 through the ethical considerations that shaped our engagement with the moment. These include the ethical tradeoffs involved in questions of digital surveillance, scientific bias, vaccine mandates, balancing individual autonomy and collective responsibility, and the role of the profit motive in creating critical treatments. At times, these reflections reach back into history, grappling with past moments when we failed in our ethical obligations to support the health of all, as in a chapter discussing how the legacy of medical racism shaped our engagement with communities of color during the pandemic. Such soul-searching is core to our ability to evaluate our performance during COVID-19 and face the future grounded in the values that support effective, ethical public health action.

As human beings, we do not process events through reason alone. We are deeply swayed by emotion . This is particularly true in times of tragedy like COVID-19. Understanding the pandemic, and learning from it, means coming to terms with the emotions of that time, the feelings that attended all we did. Grief and loss, humility and hope, trust and mistrust , compassion and fear —both individual and collective—were all core to the experience of the pandemic. The simple act of recognizing our collective grief, as several chapters in this section try to do, can help us move forward, acknowledging the emotions that attend tragedy as we work toward a better world.

To think comprehensively about COVID-19 is to think not just about the past but about the future. We seek to understand the pandemic to prevent something like it from ever happening again. This means creating a world that is fundamentally healthier than the one that existed in 2019. This final section looks to the future from the perspective of the COVID-19 moment, with an eye toward using the lessons of that time to create a healthier world, as in Chapter 50, which addresses the challenge of rebuilding trust in public health institutions after it was tested during the pandemic. The section also touches on leadership and decision-making, shaping a better health system, shoring up our investment in health, the future of remote work, and next steps in our efforts to support health in the years to come.

I end with a note of gratitude to Michael Stein, who led on the development of this book. It is, as always, a privilege to work with him and learn from him. I look forward to continued collaborations in the months and years to come, and to hearing from readers of The Turning Point as we engage in our collective task of building a healthier world, informed by what we have lived through and looking to the future.

A version of this essay appeared on Substack.

Sandro Galea M.D.

Sandro Galea, M.D., is the Robert A. Knox professor and dean of the Boston University School of Public Health

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This Is What Happens to Your Brain When You're in Love

Illustration by Julie Bang for Verywell Health

Key Takeaways

  • When you first fall in love, your brain releases chemicals and hormones that make you feel a rollercoaster of emotions.
  • These hormones also cause behavioral changes. You might change your habits to spend more time with your partner or change your style to better fit your partner's.
  • Shared laughter and intentionally activating the brain’s reward system are important for long-term relationships.

Romantic love can make you feel safe and out of control at the same time, much like you’re on drugs.

In a 2008 TedTalk called “ The Brain in Love ,” the biological anthropologist Helen Fisher described romantic love as an “obsession,” “drive,” and “addiction.”

Fisher and her colleagues conducted multiple functional MRI (fMRI) studies that examined brain scans of people who said they were in love. They found that certain parts of the brain, specifically the right ventral tegmental area and the right caudate nucleus, were activated when the participants were shown pictures of the individuals they were in love with.

These parts of the brain are involved in the reward system and the release of dopamine , a brain chemical known as the “happy hormone.”

Lucy L. Brown, PhD , a neuroscientist who worked with Fisher and co-founded the website The Anatomy of Love, told Verywell that love is similar to a “drug high.”

“As a matter of fact, it is using the same system that cocaine uses to make us feel high,” Brown said.

What Happens to Your Brain When You’re in Love?

Brain chemicals like the “love hormone” oxytocin , vasopressin, norepinephrine, and opioids are stimulated when you’re in love.

Norepinephrine, which plays a role in your body’s fight-or-flight response, is accountable for the elevated heart rate, sweating, and anxiety when you first fall in love. But vasopressin and oxytocin are the hormones that help form a deep connection and motivate defensive behaviors that protect your partner or family from danger.

These hormones all interact with dopamine, which is essential for feeling the high and dive of romantic love, according to Brown.

“Another way to think about it is that romantic love is really a survival system. It’s part of that basic set of behaviors that we need to survive, and along with the sex drive, to pass on our genes,” Brown said.

Love doesn’t only cause hormonal changes in your brain and body, but it also activates behaviors that facilitate a relationship, according to a recent study published in Behavioral Sciences . You might be more willing to change your routine to prioritize your partner or even change your clothing, mannerisms, and values to make yourself more desirable to your loved one.

“Oxytocin and dopamine work together to make our loved one take on a ‘special meaning.’ It makes information about our loved ones particularly important for the brain,” Adam Bode, B Psych (Hons)/ LLB , the lead author of the study and a PhD candidate in biological anthropology at Australian National University, told Verywell in an email.

This study was the first to examine the relationship between romantic love and the behavioral activation system, which is involved with rewards and motivation.

“While romantic love is normally associated with strong emotions, at its simplest, it’s really about behavior. We experience strong thoughts and feelings for the purpose of making us behave in a particular way around our loved one,” Bode said.

What Keeps Long-Term Couples Together?

For couples to stay together, they need more than just brain chemistry.

Robert W. Levenson, PhD , a psychology professor at UC Berkeley who studied a group of about 150 long-term first marriages for over 20 years, said that the ability of couples to soothe each other and calm down when things get heated is important for strong marriages.

“Humor, if used skillfully, is one of these ways that we do calm each other down, and it can be very effective,” Levenson told Verywell.

When you say you’re looking for someone with a good sense of humor, Levenson said, it can mean that you’re looking for someone who “has the skills to help calm my nervous system down.”

During intense moments of conflict, the partners must be able to share moments of laughter and positive emotion together for the automatic nervous system to cool down, he added.

While knowing how to navigate arguments is important for strong relationships, Brown said long-term partners who want to keep the romantic spark alive must continue activating the brain’s reward system intentionally. This could be scheduling date nights or cuddling in bed.

For some, romantic love seems more like a spiritual experience, and it cannot be explained by neuroscience. But Brown said understanding how romantic love works wouldn’t take away the pleasure.

“We were all born to experience magic, awe, and wonder—and this is all part of it,” Brown said. “Knowing about these systems doesn’t reduce your feelings of magic.”

What This Means for You

Hormones and neurotransmitters are part of romantic love, but long-term couples have to put in some effort to keep their spark alive. Safe communication, date nights, and shared laughter can help keep relationships strong.

Fisher H, Aron A, Brown LL. Romantic love: an fMRI study of a neural mechanism for mate choice .  J Comparative Neurology . 2005;493(1):58-62. doi:10.1002/cne.20772

Seshadri KG. The neuroendocrinology of love . Indian J Endocrinol Metab . 2016;20(4):558-563. doi:10.4103/2230-8210.183479

Carter CS. The oxytocin–vasopressin pathway in the context of love and fear .  Front Endocrinol . 2017;8:322440. doi:10.3389/fendo.2017.00356

Bode A, Kavanagh PS. Romantic love and behavioral activation system sensitivity to a loved one .  Behavioral Sciences . 2023;13(11):921. doi:10.3390/bs13110921

By Stephanie Brown Stephanie Brown is a nutrition writer, educator, and culinary instructor.

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Woman eating takeaway food while working on her laptop

Working from home can bring big health benefits, study finds

A review of 1,930 papers into home working found major pluses, but also downsides such as antisocial hours and being overlooked for promotion

Working from home allows people to eat more healthily, feel less stressed and have lower blood pressure, according to a large-scale review of academic literature on post-pandemic workplaces.

Yet remote workers are also more likely to eat snacks, drink more, smoke more and put on weight, the study by researchers at the UK Health Security Agency (UKHSA) and King’s College London found. And employers who believe that people working from home are lazy should think again – they are less likely to take time off sick, tend to work longer hours and to work evenings and weekends.

The review, led by Charlotte Hall from the UKHSA, considered 1,930 academic papers on home working, teleworking and other types of hybrid and home working in an effort to distil the often contradictory research.

Prof Neil Greenberg, a psychiatrist at King’s College London and one of the study’s authors, said the study showed that workers and employers needed to start considering home working with the same seriousness as they did office working.

“In the old days of office working, people realised that if you put everyone in the same room with no sound-proofing, it was all unpleasant and you didn’t have a very productive workforce,” he said.

“Now that we’ve shifted to a home working culture, it makes sense for organisations and the government to make sure that people who are home working are doing it in as effective a way as possible.”

The review, published in the Journal of Occupational Health , identified three themes – the working environment at home, the effect on workers’ lives and careers, and the effect on their health. Greenberg said the research showed that there were winners and losers in many areas of home working. The working environment depended on how much space there was at home, the available equipment and on how much control workers had over their day.

People on higher incomes often enjoyed home working more, but those with more responsibilities at home such as childcare or housework – often women and those living alone – tended to be more stressed.

“Overall, people felt more productive at home,” Greenberg said. “It was particularly good for creative things, but much more difficult dealing with tedious matters. A lot of people worried about career prospects – this feeling that if you’re not present in the office, you’re going to get overlooked.”

Effects on health were clearer. The transition to home working during Covid was linked “with an increase in intake of vegetables, fruit, dairy, snacks, and self-made meals; younger workers and females benefited the most in terms of healthier eating,” the paper said.

One of the studies reviewed found that 46.9% of employees working from home had gained weight, and another put the figure at 41%. Most of the papers reviewed showed that homeworkers were more sedentary.

Greenberg said: “Managers needed to think about finding ways to support their homeworkers and help create their working environment.

“There’s a great adage in science that at some point, we need to stop admiring the problem and actually think about solutions,” he said. “We know quite a lot now. So we need to ask ‘what is the best training for an individual who’s going to become a partial homeworker?’ What we don’t need to do is to ask ‘would it be helpful to train someone to homework?’ The answer is clearly yes.”

Since the end of Covid restrictions in 2022, some companies have insisted that employees return to the office full-time, with firms such as JP Morgan requiring managers to be in five days a week.

“If companies like JP Morgan are afraid that people at home will be slacking, or won’t be doing a good job, and they can’t keep an eye on them, then I think that is an outdated concept,” Greenberg said.

Refusing WFH options will mean that talented employees may find other jobs, and makes companies less flexible in the event of future crises, such as another health emergency or strikes or severe weather conditions that prevent people from reaching their offices, he added.

“If they are doing it merely out of fear, then they risk being left behind,” he said. “We looked at a huge amount of evidence of the years and what our review shows is that there are ways to make the home working approach actually work well for the organisation and also for the employee.”

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Reproductive rights in America

Abortion pills that patients got via telehealth and the mail are safe, study finds.

Selena Simmons-Duffin

Selena Simmons-Duffin

what is health essay

Access to the abortion drug mifepristone could soon be limited by the Supreme Court for the whole country. Here, a nurse practitioner works at an Illinois clinic that offers telehealth abortion. Jeff Roberson/AP hide caption

Access to the abortion drug mifepristone could soon be limited by the Supreme Court for the whole country. Here, a nurse practitioner works at an Illinois clinic that offers telehealth abortion.

In March, the Supreme Court will hear a case about mifepristone, one of two drugs used in medication abortions. A key question in that case is: Was the Food and Drug Administration correct when it deemed the drug safe to prescribe to patients in a virtual appointment?

A study published Thursday in Nature Medicine looks at abortion pills prescribed via telehealth and provides more support for the FDA's assessment that medication abortion is safe and effective.

Researchers examined the electronic medical records for more than 6,000 patients from three providers of abortion via telehealth. They also conducted an opt-in survey of 1,600 patients.

Some abortion patients talked to a provider over video, others used a secure chat platform, similar to texting. If patients were less than 10 weeks pregnant and otherwise found to be eligible, the providers prescribed two medications: mifepristone, which blocks a pregnancy hormone called progesterone, and misoprostol, which causes uterine contractions. Patients got both medicines via mail-order pharmacy.

Research at the heart of a federal case against the abortion pill has been retracted

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Research at the heart of a federal case against the abortion pill has been retracted.

"Then 3 to 7 days later, there was a clinical follow up," explains the study's lead author, Ushma Upadhyay of the University of California – San Francisco. "The provider checked in with the patient. 'Did you receive the medications? Did you take the medications?' They asked about symptoms. And then there was a clinical follow-up four weeks after the original intake."

The researchers found that the medication was effective – it ended the pregnancy without any additional follow-up care for 97.7% of patients. It was also found to be safe – 99.7% of abortions were not followed by any serious adverse events. The safety and efficacy was similar whether the patients talked to a provider over video or through secure chat.

"These results shouldn't be surprising," Upadhyay says. "It's consistent with the over 100 studies on mifepristone that have affirmed the safety and effectiveness of this medication."

The results also echo international research on telehealth abortion and studies of medication abortion dispensed in a clinic with an in-person appointment, she notes.

Rishi Desai of Harvard Medical School is a medication safety expert who was not involved in the study. He says it was "well-conducted," especially considering it can be difficult to track patients who only connect with providers remotely.

"I would say that this study provides reassuring data regarding safety of the medications, and this is very much in line with what we have seen in many previous studies," he says. "So it's good to see that safety findings hold up in this setting as well."

Still, whether mifepristone is safe and whether FDA has appropriately regulated how it is prescribed is a live legal question right now.

An anti-abortion rights group sued FDA in 2022, arguing that mifepristone is not safe and was improperly approved in 2000. Judge Matthew Kacsmaryk, a district court judge appointed to the federal bench by President Trump, ruled that mifepristone should be pulled from the market nationwide. Although his decision didn't take effect pending appeals, the appeals court ruled against the FDA in part, specifically rolling back telehealth abortion access. That is also on hold for now.

The Supreme Court hears arguments in the case on March 26. The decision could affect access to medication abortion nationwide and set a new precedent on challenges to the FDA's authority.

Recently, there's been a flurry of mifepristone research news. Last week, a paper that raised safety concerns about mifepristone was retracted . This study, released Thursday, affirms the FDA's position that the medicine can be safely prescribed remotely.

Upadhyay says she's been working on this research for years and that the timing of its publication weeks before the Supreme Court arguments is coincidental.

"I don't know if they can enter new evidence into the case at this point," she says. "But I do hope it impacts the perception of how safe this medication is."

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Guest Essay

King Charles Has Done What Monarchs Before Him Would Not Dare

An illustration showing King Charles looking forward; the shadow he casts appears to be wearing a crown.

By Miranda Carter

Ms. Carter is the author of “George, Nicholas and Wilhelm: Three Royal Cousins and the Road to World War I.”

The most surprising thing about the disclosure that King Charles III has been diagnosed with cancer after less than two years on the throne is the fact that it’s been disclosed at all.

Cancer is common; candor about the British royal family’s heath, not so much. Over the centuries, like many royal families, it has gone to great lengths to hide the condition of the sovereign’s body. Charles’s honesty, as far as it goes, seems to be a sign of his desire to be a different kind of monarch.

A ruling monarch has always been the embodiment of the state, a living metaphor of its health. Just look at Hans Holbein’s 1537 portrait of the six-foot-plus Henry VIII, a robust giant bestriding the world at the peak of his powers. Healthy king, healthy country. It works in reverse, too. Shakespeare — never above a little Tudor propagandizing — turned Richard III, the king from whom Henry’s father grabbed the throne in 1485, into someone with a hunchback, a man so ugly that dogs barked when he passed. Examination of Richard’s body, discovered in ruins under a car park in the English city of Leicester in 2012, showed he simply had scoliosis.

When your body is the state, how do you speak of its inevitable weaknesses and frailties? Historically, you didn’t. Four hundred years after the Tudors, in 1859, Kaiser Wilhelm II, the last German emperor, was born with a withered arm (and probably some brain damage) as a result of a complicated delivery. The idea of a physically disabled heir was unthinkable, especially in a country where the aristocracy defined itself by its military prowess. Wilhelm’s grandfather asked if it was even appropriate to offer congratulations on the birth.

Desperate and frankly weird attempts were made to make the limb work. Wilhelm’s functioning arm was bound to his body when he was learning to walk, in an attempt to force him to use the other one: predictably he fell over a lot. Electric shocks were passed through it. The arm was placed inside the warm carcass of a freshly killed hare, the idea being that the heat of the dead animal would transmute itself into the child’s arm. At the age of 4, as his mother wept, he was regularly strapped into a machine to try to stretch the muscles. Nothing worked. Wilhelm grew up to be difficult, anxious and resentful, though ironically he adapted very well to having only one functioning arm.

Wilhelm’s cousin, Nicholas II, the last czar of Russia, went to extreme lengths to hide the hemophilia of his son and heir, Alexei, and refused to explain the presence of the notorious faith healer Rasputin, whose exploits became a metaphor for the Russian state’s corruption.

Such suppressions almost always came at personal, emotional and political costs. The source of Alexei’s hemophilia gene is believed to be none other than King Charles’s great-great-great-grandmother Queen Victoria. Victoria passed the gene on to her son Leopold, who died at 30 in 1884, after suffering a brain hemorrhage after a fall, and to two of her daughters. As a result of Victoria’s energetic royal matchmaking, the gene passed into the royal family of Russia, through her granddaughter Czarina Alexandra, and some of the royal families of Germany, through her daughter Alice. After the queen’s death it passed into the Spanish royal family, through her granddaughter Victoria Eugenie, known as Ena, who married King Alfonso XIII in 1906. Her husband’s discovery that she was a carrier helped to destroy their marriage, and her oldest and youngest sons would both die young of bleeding after minor car accidents.

Victoria may also have been a carrier of porphyria, the illness to which some historians have attributed George III’s madness and which produces physical symptoms including agonizing abdominal pain, skin rashes and purple urine. The queen’s eldest daughter (also named Victoria, the mother of Kaiser Wilhelm II) may have had porphyria, too; DNA testing on the exhumed body of her daughter, Charlotte, found a gene mutation related to the disease.

That both illnesses may well have run in the British royal family were closely guarded secrets at the time, and the question has still never been publicly acknowledged by the monarchy.

One might have expected that as the British royal family became a ceremonial institution without power, it would become more open. In fact, the opposite was true. If appearance is the only power you have, appearance matters very much. Just before midnight on Jan. 20, 1936, the royal doctor Bertrand Dawson injected George V’s “distended jugular vein” with a cocktail containing enough morphine and cocaine to kill him at least twice. Lord Dawson gave the ailing king a comfortable exit, but just as important, guaranteed his death would be reported in the reputable morning papers, rather than in the “less appropriate evening journals.” The story finally came out 50 years later in 1986, not via the royal family but through Lord Dawson’s biographer.

George VI, the current monarch’s grandfather, smoked two packs of cigarettes a day and had already undergone the removal of his whole left lung by the time he died. Nonetheless, the cause of his death was reported as coronary thrombosis, a disease with less social stigma than the cancer that actually claimed him . According to a recent biographer of Queen Elizabeth II (Gyles Brandreth, a close friend of her husband’s), even her stated cause of death — “old age” — was a euphemism for multiple myeloma , a kind of bone-marrow cancer.

So there’s been widespread sympathy and praise for King Charles’s honesty. “His Majesty has chosen to share his diagnosis,” the official statement explained, “to prevent speculation and in the hope it may assist public understanding for all those around the world who are affected by cancer.”

It was, however, arguably the minimum amount of disclosure that the king could get away with, given that any withdrawal from public duties would immediately be noticed. Moreover, it did not specify which cancer he has — there are many kinds — nor how advanced it is. As Richard Smith, former editor of the British Medical Journal, wrote, whether the king might “be either right as rain or dead in a few weeks.”

That said, it’s probably asking too much to expect full candor from any head of state about his or her health. American presidents are just as prone to keep their medical information to themselves: Franklin Roosevelt hid the effects of his polio; John Kennedy’s perma-tan distracted the world from his Addison’s disease and probable celiac disease. A president’s physical and mental condition has a tangible effect on both American politics and those of the rest of the world. There will continue to be intense speculation about this question for the septuagenarian and octogenarian candidates in the coming U.S. presidential election, but no one expects either of them to tell the full truth.

The King’s illness is surprising and unwelcome news. But at least British citizens can take comfort in the fact that the monarchy is a ceremonial institution with a clear and uncontroversial line of succession.

Miranda Carter is the author of “ George, Nicholas and Wilhelm : Three Royal Cousins and the Road to World War I.”

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

Follow the New York Times Opinion section on Facebook , Instagram , TikTok , X and Threads .

Health and Fitness Essay for Students and Children

500+ words essay on health and fitness.

We have always heard the word ‘health’ and ‘fitness’. We use it ourselves when we say phrases like ‘health is wealth’ and ‘fitness is the key’. What does the word health really mean? It implies the idea of ‘being well’. We call a person healthy and fit when he/she function well physically as well as mentally.

Health And Fitness Essay

Factors Affecting our Health and Fitness

Good health and fitness is not something which one can achieve entirely on our own. It depends on their physical environment and the quality of food intake. We live in villages, towns, and cities.

In such places, even our physical environment affects our health. Therefore, our social responsibility of pollution-free environment directly affects our health. Our day-to-day habits also determine our fitness level. The quality of food, air, water all helps in building our fitness level.

Role of Nutritious Diet on our Health and Fitness

The first thing about where fitness starts is food. We should take nutritious food. Food rich in protein, vitamins, minerals, and carbohydrates is very essential. Protein is necessary for body growth. Carbohydrates provide the required energy in performing various tasks. Vitamin and minerals help in building bones and boosting our immune system.

However, taking food in uneven quantity is not good for the body. Taking essential nutrients in adequate amount is called a balanced diet. Taking a balanced diet keep body and mind strong and healthy. Good food helps in better sleep, proper brain functioning and healthy body weight.

Include vegetables, fruits, and pulses in daily diet. One must have a three-course meal. Having roughage helps in cleaning inner body organs. Healthy food habit prevents various diseases. Reducing the amount of fat in the diet prevents cholesterol and heart diseases.

Get the huge list of more than 500 Essay Topics and Ideas

Impact of Exercise on our Health

Routine exercise helps improve our muscle power. Exercise helps in good oxygen supply and blood flow throughout the body. Heart and lungs work efficiently. Our bones get strong and joints have the pain free movement.

We should daily spend at least twenty minutes in our exercise. Daily morning walk improves our fitness level. We should avoid strenuous Gym activities. Exercise burns our fat and controls the cholesterol level in the body. Various outdoor games like cricket, football, volleyball, etc keeps our body fit. Regular exercise maintains our body shape.

Meditation, Yoga, and Health

Meditation and yoga are part of our life from ancient time. They not only make us physically fit but mentally strong as well. Meditation improves our concentration level. Our mind gets relaxed and thinking becomes positive.

A healthy mind is key for a healthy body. Yoga makes us stressfree and improves the endurance power of the mind. Yoga controls our blood pressure. With yoga, a strong bond with nature is established. Meditation is considered the best way to fight depression.

A person stays happier when he/she is fit and healthy. A fit and healthy person is less prone to chronic diseases. The healthy mind reacts better in a pressure situation. The self-confidence of a person is increased. Risk of heart failure is reduced drastically. With the increased immunity power body could fight cancerous cells. The intensity of the fracture is decreased with regular exercise.

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Reflections on Black History Month 2024

This oil painting depicts a bouquet of off-white roses and greenery in a brown bowl. The round bowl, done in deep brown tones, stands to the right side of the picture. In the bowl are five blooms and several sprays of greenery. Several other blossoms, a sprig of greenery and a long stem lie scattered around the bowl. Peeking from behind the bowl are a pile of darker green leaves and a cluster of bright red berries. Hanging on the left hand background wall is a textile with a yellow, red, and white plaid pattern.

In 1926, historian Carter G. Woodson established “Negro History Week,” and fifty years later, President Gerald Ford designated the month of February “Black History Month” in 1976. This year’s theme recognizes the Arts, a recognition of the significant impact of Black arts on US culture.

While the arts are essential to our wellbeing, not a frivolous addition, this year’s theme—no doubt selected way in advance—feels out of step with the current challenges. US history is full of advances of Black rights followed by subsequent pushback.

In 2020, amidst a historic pandemic and stark racial disparities, the world witnessed the brutal murder of George Floyd, prompting a willingness to recognize the persistence of US racism.

In 2024, teachers, scholars, artists, and activists—particularly those advocating for a comprehensive examination of America’s complex past—find themselves navigating tumultuous waters. Articulation of unwelcome facts may even lead to the curtailment of free speech. I read with interest and concern a commentary by Khalil Gibran Muhammad , who reflects on how scholarship that focuses on racism can enter the crosshairs.

Many Black artists lent their skills to the movement for Black rights. Here are a few examples:

  • 14 Black Artists Who Changed Art History
  • The Black Arts Movement and the Power of Resistance
  • Black Women Artists: Shattering Stereotypes and Reclaiming Narratives
  • National Gallery of Art: Black History Month
  • Kara Walker
  • Romare Bearden

In 2024, let Black History Month be a time for reflection, education, creativity, and advocacy. At FXB, our efforts are dedicated to supporting marginalized and excluded groups. By understanding the interconnectedness of historical struggles, recent challenges, and the path forward, we can contribute to an inclusive and equitable future for all.

— Mary T. Bassett, MD, MPH Director of the François-Xavier Bagnoud Center for Health and Human Rights

Featured image: Creative Commons Still Life with Roses by Charles Ethan Porter, Collection of the Smithsonian National Museum of African American History and Culture, is licensed under CC0 .

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