redefining / redesigning health

May 11, 2018

Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.

- World Health Organization, 1946

More than half a century ago, the world came to the conclusion that health was not just "not being sick" but all-encompassing of multiple facets of wellness; that definition, today, feels distant, especially with the prevalence of chronic illness, the opioid crisis, epidemic of obesity, rampant addictions -- there's even a New Yorker article about how the Juul craze has become so mainstream and is diffusing into the population of high schoolers.

How can this be? Has our healthcare system improved much from more than seven centuries ago? And this is not to say that medicine or technology has not developed since - in fact, it's the opposite. There's a lot of money that has been funneled into the healthcare world: about 18% of America's GDP. There's now a developing tail end of highly specialized projects, /new/, ~sexy~, *tech* that captures covers of TIME magazines and whose researchers win Nobel Prizes - these are the projects that scientists gravitate towards for deep and theoretical breakthroughs, whose research grants actually receive funding.

But funding, like all other forms of money, is still governed by the same principles of economics: it is scarce. The more funding that is piled onto these breakthroughs, the less there is for other endeavors that deal with population health, public health metrics - the ones that have immediate practical applications. Those kinds of problems are "old", things that have already been entrenched in our society, so people learn to accept it and eventually adapt to it.

This same culture of nonchalance seeping into the people who are in charge of healthcare decisions, i.e. pharmaceutical companies who decide: "how much do we allocate our capital, and in which drugs?" Investment pours into the new sexy and groundbreaking. Little is left to be spent on drugs for chronic illnesses that sell for a comparatively minuscule amount. Truth is, the R&D spent on developing a drug for chronic illness can't be financially justified. Capitalism is the dominant culture, even in the world where altruism should be the main mode of thinking.

So this progression has given way to a divergence. As people that live in a capitalistic world, we are faced with an ironic paradox: we have so much choice as buyers of food, of drugs, of options, yet so little access (read: cost-efficient, time-effective, stress-free access) to healthcare. And what's hypocritical is that the surplus of choices is has a very deep causal relation to these epidemics; it's just to easy to become addicted to things that you have constant access to.

And the solution? The healthcare system isn't going to change itself, especially as it's continued to be scrutinized and subjected to the for-profit mechanisms of this nation. Instead, we must work bottom up to make the default option healthy. As Hippocrates once stated that inhabitants inevitably develop both physical and mental characteristics of their own unique environment, the correct environment is the key to civilization.

In city planning, perhaps ideas for bike lanes or open public areas could be suggested. Or in terms of building construction, perhaps there could be more immediate access to stairs vs. elevators. In making "primary care" a default (or at least more competitive) option means making the environment better for people to make better choices - the power of choice architecture. Instead of barraging the overwhelmed consumer with all possible options, we may kindly and delicately suggest a select few. Of course, this opens up another avenue of conversation of ethics - "isn't this mass brainwashing?" "who can decide what the best option is for me?", but that's for a later date.

But this concept extends to a multitude of fields: we can apply design thinking to not only urban infrastructure, but to all other facets of life - how we structure time, design habits, but most importantly, communities. Communities have been psychologically proven to be one of the most powerful determinants of behavior change, so if we help push each other to educate ourselves on making conscious daily decisions that eventually shape our lives, this would be a step forward to a healthier world. Though there is still much change to be had in the corporate world, communities and education can provide strong launchpads to enact and inspire greater change. After all, what is the government but an entity that is "of the people, by the people, for the people"?