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 technorational 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; “Scienceand-technology is the most powerful force under human control; hence, scientific fundamentalism is the most dangerous.” (p. 836). Of course Roy isn’t 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

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