Health is a fact that has preoccupied people and communities of all times and places. In the near past, after the Second World War, on 7 April 1948, the World Health Organization was created with the aim of building a better and healthier future for people all over the world. It began by defining health as a state of complete physical, psychological and social wellbeing, not just the absence of disease. This was obviously an advance over other more limited conceptions, but as we will see in this presentation, it is a vision and an application that needs to be revisited, and that is what we intend to do in this presentation. At present, the health care of communities is the responsibility of the Health Systems that have developed in the world, but with a reduced and fragmented vision of what is understood by health.
By Jorge Pompei -9th International Symposium of the WCHS-.
Reduced because it focuses its attention on the biological aspect and secondarily on the psychological, neglecting the spiritual, social and environmental aspects.
Fragmented because over the last century and since the so-called Flexner Report of 1910, health care has been divided into specialities and sub-specialities which, although they have achieved a deeper knowledge of the damage suffered by people, do not manage to take into account the totality of the factors that determine health.
On the other hand, they propose an almost exclusively pharmacological or surgical therapy, not taking into account the universe of “non-conventional” care strategies that have accompanied and served communities and civilisations throughout history, both distant and near. Finally, it is considered as a market good determined by financial interests rather than a social good and a Universal Human Right.
This means that health care is focused on the damage already installed in people, limiting its attention according to their economic capacity. This makes it difficult to think about health in a holistic way and with a comprehensive and effective approach to the problems. But for it to make an effort to think of new solutions that go beyond the current ones, we must make an effort to go beyond the limits of thinking, which, like invisible barriers, make us look for solutions where there are none.
If we want to change the situation that determines the state of health of populations, we will have to question the current look that leads us to think that we will improve life and health indefinitely, analytically separating people into smaller and smaller portions for their treatment. This generates the emergence of more specialties that will define more pathologies and that will only deepen our knowledge of the damage, but will lead us to give increasingly partial and therefore insufficient responses.
It will be possible to go beyond the limits of thinking about health if we try an exercise that leads us to a structural thinking that goes beyond the analytical vision and shows us how all the parts are connected, forming a coherent whole that, through the vital process, will always seek to perpetuate itself and grow, overcoming the instances that limit it. Seen in this way, the history of human health is then the history of overcoming the conditioning factors that limit life span and wellbeing.
We will then analyse the elements that make up the structure and dynamics of the health process, describing its current limitations and will be proposing the steps to be taken to overcome them.
For this, the first thing we need to do is to define what we mean when we talk about health. Silo said in his book The Internal Landscape”. It has to be in the essence of what you believe in that is the key to what you do”. Then it will be important to understand what we believe about life and health. If we start by considering that people are bio-psycho-spiritual beings who are born and develop in a social world and in a natural environment, then we will define health as a situation of dynamic balance in the biological, psychological, spiritual, social and environmental spheres and as a process that seeks increasing adaptation that leads to living longer in adequate health conditions. And if healthy life is a dynamic equilibrium, when the limits of equilibrium are transgressed, risk, illness and death appear. Therefore, to maintain health, it is necessary to move within these limits, strengthening the mechanisms that allow us to return to equilibrium when it is lost.
This leads us to define five areas and three moments of the health process. The areas to work on in an integral vision of health will be:
Biologically, by attending to adequate nutrition, hydration, breathing, movement and rest.
Psychologically, by establishing harmonious relationships with oneself and with the community.
Spiritually, by developing the capacity for inner silence and finding meaning in existence.
Socially, by understanding that one’s own wellbeing is not unrelated to that of those around us, and by promoting supportive behaviour that allows us to rebuild, without violence, the social fabric.
Environmentally, by promoting the careful treatment of the environment, generating favourable conditions for the life of all and recovering the environment from the deterioration caused by indiscriminate plundering. This environment begins in the home, which protects us from immediate adverse environmental conditions.
This is a static vision that allows us to enumerate the ambits in which we must work. The process vision shows us the different stages through which we pass and situates us with respect to the situation in which we find ourselves and, depending on it, what must be done. The first stage is one of health, characterised as a way of passing in balance, without registers of pain, suffering or meaninglessness and with a feeling of full vitality and force to move forward in life.
Another stage, separated from the previous one by unclear limits, is the stage of risk, where some manifestations appear that sometimes go unnoticed but which are key to developing preventive actions, which will be more effective the earlier they are taken. The third stage is the disease. This gives more definite signs that show us a situation that clearly affects life. But in order to reach the moment when the disease manifests itself, other moments have been passed through which, if attended to, could have prevented the damage. This means that an integral look at the human being and his health leads us to state that there is no possibility of integral health if the fundamental aspects are not resolved:
The lifestyle and living conditions of people and populations.
The personal and social violence that is generated in society when the human being is not the central value and is mistreated in his or her dignity.
When the prevailing purpose is material accumulation which leads to a few people having much more than they need and more and more people not having even the bare necessities.
If we do not take care of our common home, which is the planet, avoiding its degradation and global warming, and starting with housing and the immediate environment, if we do not take care of them, they will make it an uninhabitable place.
This is why we need a consciousness of the global situation and a rapid change in the way people and communities live their lives.
In synthesis, it is why we understand that in the area of health it will be necessary to develop:
A structural and process look rather than the preponderantly biological view and orientation.
A holistic approach rather than the prevalence of fragmentation of the person according to specialities.
Good treatment as an indicator of care with human quality rather than identifying technology as a synonym for quality of care.
The maintenance and improvement of health and prevention according to risks rather than the treatment of the installed disease.
A warm and humanised approach to childbirth as the beginning of human life and incorporation into the community.
The accompaniment of people at the end of their vital process as a fundamental part of the preoccupation with the art and science of caring.
The incorporation of non-conventional knowledge of proven efficacy in the formation of health personnel.
The strengthening of the Primary Care Strategy and Health Education for all communities.
Promoting the formation of general practitioners and family doctors accessible to the whole community.
In other words, a holistic and process-based approach shows us the need to treat all these elements simultaneously, not making the disease the focus of our attention and giving priority in personal and community action to the development of a healthy Style of Life.
REHUNO – Red Humanista de Noticias en Salud
