MEDICINE
John Rowan Wilson
When the United Nations set up the World Health Organisation in 1948 it found itself confronted with a minor but teasing problem. What exactly was health, when you came down to it? After a good deal of solemn debate, it finally came out with a definition. "Health," it said, " is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity."
Complete physical, mental, and social well-being. Well, you certainly can't aim higher than that. Though who occupies this extraordinary state of nirvana I have never been able to discover. Certainly nobody I have ever encountered in twenty years' practice of medicine.
It is always slightly unnerving to come across the odd eccentric who takes the WHO definition seriously. However, a recent publication in the Lancet actually proposes going further than this by making health a basis for a mathematical calculation. The authors describe a device known as a 'health index,' designed to assess the degree of health of a particular 'individual by the use of a standard questionnaire. There are ten questions, mostly of a general nature, and obviously designed to cover a wide functional area. They ask, for instance, whether there is any impairment in such essential items as work capacity, sleep, communication, enjoyment of food and drink, and sexual performance. Also whether the subject suffers at all from pain or worry, and if so, how much. He is given marks in each section by the doctor, and these marks are divided by ten to give his health index. This can range from 1.0, for a person who is perfectly fit, to 0.0, which is presumably a prelude to admission to the post-mortem room.
The only snag is that health, when you come down to it, is rather like the weather: it is a matter of opinion. What is a fine day for a golfer may be a disaster for a farmer. Similarly, as an American public health expert recently pointed out, 'the definition of health largely depends on where you are and what you do. On an island of oyster fishermen, an individual who can stay under water for several minutes would be considered healthy even if he had goitre and intestinal parasites. In a large city an individual who can fulfil his office work and resist three •hours on the subway is considered healthy even if he cannot swim."
It 'is very important that both doctors and patients should get away from the concept of absolute health. The body is not a perfectly operating machine. Phrases like " below par" and "one degree under" are more suitable for patent medicine adver tisements than the consulting room. Few of our physical and mental functions work perfectly all the time, and their deficiencies increase in a perfectly natural way as we grow older. We all suffer from anxiety, for example; any man who says he is free from it is either a liar or suffering from serious mental illness.
It is the same with our performance in bed, both active and passive. Some are better sleepers than others, some are more energetic practitioners of sexual intercourte. But there is no par for either of these activities. Nobody knows how many hours a given individual needs to sleep. As for sex, if it isn't fun, it isn't worth doing anyway.
If health is regarded as a normal state, it is certainly not a state of complete physical, mental, and social well-being, scoring an index of 1.0 on the Lancet scale. The normal is a man who finds that on some days he can work and on others he suffers from unaccountable attacks of lassitude and lapses of concentration. He sleeps fitfully, occasionally waking up to worry about bankruptcy or World War III. He enjoys his weekend game of golf about one Saturday in three, when he feels he is playing reasonably well. He is losing interest in his wife physically, but hasn't the inclination or the energy to find a mistress. His powers of communication if his relationship with his children is any index) are minimal. He eats and drinks more than is good for him and has been trying to stop smoking for the last ten years. He has an ache in his shoulder and a nasty dragging pain in the lower part of the abdomen which he •is quite sure On spite of all his doctor's reassurance) is an early sign of cancer.
That's par on the Wilson Scale. Go below it and perhaps you ought to see a doctor. Get much above it you're in danger of being psychologically muscle-bound, which is dangerous in itself. It's the aggressively stable people who quite suddenly come apart at the seams. Men are like boats in that way. As an old sailor used to say to me, "You're always safer in a squeaky ship."
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