EDITORIAL

Volume 4, Number 4
October-December 1999

Scott C. Ratzan, Editor

At the cusp of a new millennium, the digital revolution is changing society much like the printing press did centuries ago. Like the Guttenberg invention, information technology and the world wide web will redefine the world with the potential to advance knowledge beyond our wildest imagination.

However, we know that transmission of information or mere data does not equal effective communication.  Nor does the ability of global transmission inherently carry with it ethical responsibility of the source’s message being transmitted.  We must beware of the existing barrier to developing knowledge.

At the same time, we also have a great amount of data on measuring morbidity and mortality, descriptions of chemicals and risk factors, and a vast nomenclature for disease, syndromes, signs and symptoms.  Nonetheless, “health” remains difficult to quantify and attain equally throughout the world.

While this new communication age can reconfigure our understanding of who we are, as well as aspirations for our communities and the world, it also has the potential to drive a health revolution.  A revolution that does not focus on the economic “system” of payments, reimbursements and professionalism, but rather a revolution that provides each of us the tools and knowledge for ideal health decisions.

The challenge for such a revolution to focus on health was perhaps presaged by Thomas Jefferson in his day.  Jefferson challenged 18th Century leaders: “With your talents and industry, with science, and that steadfast honesty which eternally pursues right, regardless of consequences, you may promise yourself every thing—but health, without which there is no happiness. An attention to health then should take place of every other object.”  Clearly, while much has happened since Jefferson’s day, health is still not at the top of everyone’s agenda.

What might this 21st century revolution look like?

First, our call to arms should be the development of an individual ethic in using technology to promote quality health worldwide.  While a minority of the world’s population has direct access today, in the 21st Century the Internet will be ubiquitous—accessed from television, land-linked and cellular phones, satellites, radio, kiosks, watches and other new venues.  The wearable web or “e-device” will be a multi-way device with the potential to monitor physiologic components and to communicate with providers for instant feedback/advice and recommendations.  Eventually, it also will overcome the reliance on English and the 20th Century forms of written language.

Of course, there is a great role for scientific discovery in advancing health.  But science will not have all of the answers.  The translation of the incremental nature of scientific progress to the public is limited. In the 21st Century, we must not only strive for new medical discovery, but also to translate such knowledge into usable data for a healthier society.  Communicating health accurately will require communication of the context—what this will “mean” for the health of the individual.

Our current  window to the world is the computer or television set – the media.

The paradox is that a concentration of leadership in media conglomerates has emerged which could benefit the transmission of valid and valuable information.  Instead, the erosion of traditional journalistic norms that have contributed to serving the public good have been threatened with corporate stakeholders’ financial interests.

Such for-profit motives  threaten to dictate news decisions and choices of entertainment programming.
Simply put, where do the six billion individuals who share the earth as their home now turn for a valid assessment of the world   - as well as a legitimate call to action on research, health and quality of life issues?  The result of such corporate re-structuring is a crisis in - if not absence of  - ethical leadership committed to serving the overall global public good.

Furthermore, the escalation of medical knowledge and technology is taxing the ability of governments and news media to monitor new developments or to assess their implications, so we have an information glut with media clutter and confusion.   The challenges are for the health consumer to navigate a “system.”  But it is difficult for many to answer the following questions.

1. Who is to be believed?
2. Who decides and using what criteria, if an advancement actually promotes the general health?
3. Which so called advancements undermine social/cultural ethics and should be controlled?

The answers do not reside solely with individual or global governments and organizations.  Today’s economic windfall has only widened the gulf between rich and poor countries. The unbridled prosperity has not trickled down to many parts of the world.  Harvard professor Jeffrey Sachs suggests that the 42 so-called Highly Indebted Poor Countries face “a combination of extreme poverty and financial insolvency that mark them for a special kind of despair and economic isolation.”   According to Sachs, such countries “escape our notice—almost entirely—unless war or exotic disease breaks out.”   One selfish motive for including such coverage is clear - the sensational appeal and expected increase in market share in the “infotainment” format that now permeates much of the commercial media programming.

Clearly, as we embark upon a new millennium with 6 billion people, the global health and resources are strained.  Yet, we have the ability unlike other generations to progress and increase our ability to navigate amongst an environment and global marketplace unparalleled in history.  The answer to the question: “Can the world be healthy?” on the current course is unknown.  If we marshaled all of our resources to overcome poverty, we would still have infectious and non-communicable disease, albeit at a lower level.  All health requires a commitment and investment to apply our scientific know how to the idea of creating “ideal health.”  If we commit to integrating health into all sectors of society and generate the same level of enthusiasm as we have for economic growth, we will be revolutionizing health.

The future will challenge us to use our wisdom to prevent disease, build a society with healthy economic and environmental development, and offer scientific progress to support our behavioral commitment to quality of life and health.  With such wisdom the emphasis will shift when ethical decision-making and leadership can advance us into an age we can all be proud of—the health age.

A major caveat:  We must beware of  best health.  It is the enemy of good health.

What is the difference between good health and best health? If we strive toward a world with attainment of basic needs—adequate food, shelter and clothing—we will be making great strides in health. The world does not need a proliferation of modern day technologies. Health is not measured by the number of MRI’s, the human genome, or the availability of a super medical facility.

We should focus on ideal health—ideal to the community, ideal given economic conditions, ideal as based on the individual that we often discuss as a statistic.  Ideal health to most deals with quality issues of individual salience, rather than absence of disease.  Health for all should guarantee a basic set of values and services; it should not be confused with “free” health for all or “longest life” for all.

Much of the success of the last century is largely due to the early work and discoveries of Louis Pasteur, Robert Koch and others who identified germs as well as Joseph Lister introduction of antiseptic practices. Average life expectancy grew from between 45 to 50 years in Europe at the turn of the century to now over 80 years in some countries.   The next great leaps will be with new ideas. We can heed the advice of history and work to alleviate such inequalities through the modern-day knowledge to diffuse personal health, hygienic practice, and enact policies to enhance public health to strive for ideal health and to meet the goal of good health. The western world can continue to set the scientific agenda for ideal health, but at the same time powerful agencies (pharmaceutical companies, governmental funded studies, universities etc.) have an ethical responsibility also to insure basic needs are met during this health revolution.

Earlier this year, my son Alexander was born.  It is my hope the health progress  can offer him the opportunity to witness the entire health revolution first hand as it develops in the 21st Century.  I also hope we extend the economic prosperity to translate into health status so that other children born in Africa, Asia, Latin America and throughout the world who share the discoveries of vaccines, antibiotics, medical interventions and nutrition and who avoid the lifestyle diseases of tobacco, sedentary lifestyle and other such vulnerabilities.

Of course, I am urging each of us, as readers of the Journal of Health Communication, to take an active role—as credible, trustworthy sources in communicating health issues to particular targeted audiences.  We can all be healthy: it begins at home, at work, at school, in government and in our environment. But most importantly, health begins in our mindset.
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