By MIKE MAGEE
In my course this Fall at the University of Hartford, titled “The Right to Health Care and the U.S. Constitution”, we have concentrated on the power of words, of precedents, and the range of interests with which health has been encumbered over several hundred years.
The topic has been an eye-opener on many levels. On the most basic level, it is already clear that the value of this “right” depends heavily on your definition of “health.”
We’ve highlighted three definitions worth sharing here.
The first is attributed to Eleanor Roosevelt. In 1948, as lead for the United Nations Declaration of Human Rights, she defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” She also made clear at the time that each of us, as responsible citizens, bore a level of personal responsibility for our own health. By virtue of the choices we make, and the behaviors we exhibit, we raise or lower the chances of being “healthy.”
The second voice highlighted was also a woman. She is a physician from Norway, born on April 20, 1939, in Oslo, the daughter of a physician and politician. She received her Medical Degree from the University of Oslo and went on to earn a Master’s in Public Health at Harvard. She served three separate terms as Norway’s Prime Minister, never having fewer than 8 women in her 18-member cabinet. Her name is Gro Brundtland. In 1998, she was confirmed as director-general of the World Health Organization (WHO).
In one of her first WHO directives in 1998, she took on the definition of health which she described as “Part Goodness and Part Fairness.” She went on to explain, “Goodness in the sense that our professionals are well trained and qualified; our institutions well outfitted and safe; our processes engineered to perfection; our teamwork a reflection of training and excellent communication.”
“Fairness in the sense that these skills and capabilities are fairly and equitably distributed to the broadest population possible.”
The third featured definer of health was a Catholic Cardinal from Chicago during those early Brundtland years. His name was Joseph Bernardin. He had terminal cancer in 1996 and was ultra-focused on health delivery when he addressed the Annual Meeting of the American Medical Association. He said, “There are four words in the English language that have common English roots. They are heal, health, whole, and holy. To heal in the modern world, you must provide health. But to provide health, you must keep the individual, the family, the community, and society whole. And if you can do all that, that is a holy thing.”
As the Earth and its inhabitants entered the new millennium, it was clear that the delivery of health care – whether local, national, or global – was a complex human endeavor. Even if you declared it a “universal right” as the UN and the WHO did, you would still need responsive programs, trained professionals, equal access, continuity of care, funding, compassion, understanding, and partnership. And even these would not be enough without forward-planning, anticipation, scientific discovery, and reliable funding.
When the Covid-19 pandemic hit, it rapidly revealed the cost of lack of U.S. planning, investment, and capacity. Specifically, the complex supply chain, including materials, human capital, and science failed. More alarming than these however was the damage and confusion that flowed directly from flawed leadership at the top. What Trump revealed was that trust, truth, and integrity were critical elements when it came to health delivery.
Weaknesses in this regard have been with us since the birth of this nation. But they have never quite been called out with such penetrating clarity as they were by Rev. Martin Luther King Jr., when he addressed the crowd at the Poor People’s Campaign on March 25, 1966, and said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
As I said to my students, we could learn a great deal by pondering whether Dr. King was right, and if so, why? At the time, President Lyndon Baines Johnson was struggling to make real his “Great Society.” The three-prong “Martyr’s Cause (as he labeled his efforts to honor JFK’s death), included the implementation of The Civil Rights Act, The War on Poverty, and Medicare. All three, integrated and interdependent, were necessary if justice was to prevail as suggested by the U.S. Constitution.
Mike Magee, MD is a Medical Historian and Health Economist, and author of “CodeBlue: Inside the Medical Industrial Complex.“