The individualistic short-sightedness of health care

The Global Action Plan for the prevention and control of non-communicable diseases of the WHO aims to reduce by 25% the premature mortality due to these pathologies by the year 2025 (strategy 25 x 25) and, therefore, concentrates on strategies that reduce the following 7 risk factors: a) alcohol consumption, b) insufficient physical activity, c) tobacco consumption, d) high blood pressure, e) excessive salt intake, f) diabetes, and g) obesity. Confronted by this individualistic drift of public health, an international group of researchers has published in the Lancet the results of a meta-analysis with 48 cohort studies and 1.7 million individual records, where they have shown that poverty has more explanatory force by itself over the number of years of life lost that many of the factors 25 x 25, in addition to having an undeniable cross-influence by enhancing the aforementioned risk factors. It’s important to clarify that the cohorts selected by the researchers correspond to first world countries, so the analyzed groups of low socio-economic level  represent poverty pockets that are basically concentrated in deprived neighbourhoods of large cities or in certain collectives such as the destitute or the immigrants.

This finding, on the other hand not surprising, suggests that the WHO strategy is a sample of the individualistic blindness of health systems that believe that blaming people on the way they manage their lives is the only possible way to increase life expectancy of the collectives, but the reality is much more complex, because the lack of quality public schools, unemployment or simply the misery in which millions of people live, lead them to have other headaches more peremptory than those of take care of your health. The 25 x 25 plan assumes that poverty is structural and that, therefore, nothing can be done from the health systems, but Michael Marmot, president of the WHO Commission on Determinants of Health, doesn’t. He seems to see it in the same way when he says: "If the determinants of health are mostly social, the solutions must be social." However, the community vision of public health is far from being influential in effective policies to reduce social inequalities.

Individualistic blindness also in clinical practice

Many physicians, even those with a more humanistic orientation, aware of the adverse social and family circumstances of many of their patients, are unable to incorporate these elements into the equation that will ultimately define their treatments. It seems as if by complying with the dictation of the pertinent clinical practice guide they have already done their work and that if it’s the case that their recommendations are not followed, this it’s not their business. Some have disregarded the true mission of their work, which is none other than improving the quality and quantity of life of the people who trust them.

With the intention of not throwing in the towel in the search for the essential social element of clinical practice, I recently spoke about the model of cumulative complexity and minimally disruptive medicine, a line of work of Victor Montori's research group, which I believe that can help doctors and nurses learn to adjust therapeutic plans to the capacity of each person and their surrounding circumstances.

If public health and medicine don’t know how to go beyond the individualistic gaze, the effectiveness of their work plummets and becomes a useless luxury, like the cobalt bomb that, in a remote African country, some well-intentioned person donated to a hospital without any electricity supply.

Jordi Varela

Editor