A plea for the progress of serious thinking about health!

Clinton E. Betts
Assistant Professor
School of Nursing,
Faculty of Health Sciences,
McMaster University

I most certainly agree with the reviewer comments cited by the authors in the text
of their paper; The paper is timely and can be potentially useful for health policy
makers (p. 1032). However, timely in this case is a bit of an oddity. In response
to a recent critique of progress that I had written (Betts, 2005) a rather noted
philosopher, who is kind enough to review scholarly work for me from time to time,
asked me; I would think that this language [of Progress] is pretty hollow now. Do
your colleagues really believe it? The point is, that serious thinkers have not
believed in Progress since well perhaps since Nietzsche (1990) suggested that;
Mankind surely does not represent an evolution toward a better or stronger or
higher level, as progress is now understood. This progress is merely a modern idea,
which is to say, a false idea. (p. 4), over a century ago. Though, certainly since Ivan
Illich gave the term iatrogenesis a whole new meaning. And yet virtually all of our
social and political institutions, particularly those of health and welfare, are founded,
perhaps even premised on the idea of Progress.
One wonders then, why it has taken so long for many of us, who generally consider
ourselves to be health practitioners of one kind or another, to catch on to this serious
problem of Progress? Could it be that we have subscribed so heavily to a techno-
rational science model, again particularly in the health and welfare industry, that all
of our, so highly advertised, critical faculties have become stuck in a paradigm of
delusion? Indeed, in a recent article by Roy (2005), a chemist by the way, aptly
titled in my view; Scientism and Technology As Religions he claims that; Science-
and-technology is the most powerful force under human control; hence, scientific
fundamentalism is the most dangerous. (p. 836). Of course Roy isnt the first to
suggest that techno- rationalism (or scientism) may well constitute a religion of
sorts, in fact, once again a century ago, Nietzsche claimed something similar, as
have many others. In fact, more recently, Schaler (2002) has proposed that health
itself had indeed become a religion, with the medical profession as a priestly caste.
(p. 67).
Those of us who do the work of healthcare (be it diagnosis, intervention, education,
promotion and what not) must now begin some serious thinking, or at any rate begin
to pay attention to some of the serious (anti-modern if you will) thinking that has
characterized the 20th century. Perhaps we might begin with a question of the
profoundest sort that has already, and again recently, been proposed by Joseph
Heath (2004); Is it possible to emulate many of the attractive features of western
societies, while avoiding the social pathologies? (p. 665-6). While I do agree with
the authors claim that; Public health needs to be more passionate about health
issues associated with human progress and adopt a health promotion stance. (p.
1033), we must also be careful for at least two reasons. The first concerns what both
Fitzgerald (1994) and Fitzpatrick (2001) refer to as The Tyranny of Health, while the
second is perhaps best summed up by Ulrich Beck regarding his theory of reflexive
modernity (or second modernity); Due to the close link between institutions that
depend on one another to exist, it can be assumed that processes of change and
transformation in particular parts of the structure will trigger problems in other parts
(the side-effects of side-effects) (Beck & Lau, 2005, p. 533). Indeed, side effects
are the order of the day, and nothing happens without them happening. The problem
then, for those who claim to be engaged in the fixing of problems, is which side
effects are good and which are bad. Or put differently, which are acceptable and
which are not. Moreover, these are socio-political and socio-cultural issues of value,
and they are anything but scientific. Finally, in the spirit of the authors well put
claim that; public health has to become more assertive and politically aware (p.
1033), with, perhaps, a continuing attention to Foucault, let us begin a plea for the
progress of serious thinking about health, rather than maintaining the modern course
of unhealthy Progress.
References
Beck, U. & Lau, C. (2005). Second modernity as a research agenda: Theoretical and
empirical explorations in the meta-change of modern society. British Journal of
Sociology, 56(4), 525-557.
Betts, C. E. (2005). Progress, epistemology and human health and welfare: What
nurses need to know and why. Nursing Philosophy, 6, 174188
Fitzgerald F. T. (1994). The tyranny of health. N Engl J Med, 331, 196-198.
Fitzpatrick M. (2001). The tyranny of health: Doctors and the regulation of life style.
Routledge: New York.
Heath, J. (2004). Liberalization, modernization, westernization. Philosophy and Social
Criticism, 30(5-6), 665-690.
Nietzsche F. (1990) The Anti-Christ (tr. R.J. Hollingdale). Penguin, New York.
Roy, R. (2005). Scientism and technology as religions. Zygon, 40(4), 835-844.
Schaler, J. A. (2002). Moral Hygiene. Society, May/June, 63-69
Published December, 13 2005 as a Rapid Response to Chio, B. C. K., Hunter, D. J.,
Tsou, W. & Sainsbury, P. (2005). Diseases of comfort: Primary cause of death in the
22nd century. Journal of Epidemiology and Community Health, 59, 1030-1034.
Available at: http://jech.bmjjournals.com/cgi/eletters/59/12/1030#427