Should health be seen as the central goal and means?

WHO’s Commission on the Social Determinants of Health makes the case that ‘(t)he development of a society, rich or poor, can be judged by the quality of its population’s health, how fairly health is distributed across the social spectrum, and the degree of protection provided from disadvantaged due to ill-health’. The argument is that the health of a given population is a measure of how well the society is functioning. Furthermore, it writes that ‘(g)ood health enables people to participate in society, with potentially positive consequences for economic performance’. The argument is that better health is a means to obtain to better economic growth and thus welfare and maybe also more democracy through increased participation. The quotes are from the preliminary report: Achieving health equity: from root causes to fair outcomes. In the final report, the first quote can be found on the first page while the last quote did not appear but similar statements did: ‘better health enables more people to participate in the economy’ (p. 39) and ‘enabling more children to grow into healthy adults who can make a positive contribution to society, socially and economically’ (p. 51). The first quote raises the question whether health should be seen as a goal that outdoes all others? Is it the decisive measure for the quality of a society and is therefore improved health status of the population as the outmost important goal of a society? Not everyone will consider the countries with the best health to be the best to live in. Cuba is an example, it performs excellently on health but very low on freedom of speech and democracy. Another question is if health always is the most important factor in people’s lives. Most people value health highly. It is, however, obvious that a lot of people value other goods higher or as high, like freedom, religious and political goals, or just recognition, pleasure, excitement and leisure, and are prepared to risk their health and sometimes their lives to achieve these goals. This is not to say that good health is incompatible with other goals, often it is a precondition for achieving them, but sometimes the goals are not compatible. Should people’s health then always have the highest political priority? Another question is if the task of improving health of populations is gained by being seen as a decisive means for achieving a better or richer society. Does better health always imply better economic performance, and if it does not, should better health then not be pursued? There are examples, such as Kerala in South India, where the health is excellent but the economy is not. Sweden during the 19th century is another example. It had lower infant mortality and thus longer mean life expectancy than Denmark, still it was much poorer. It did not catch up with Denmark until after World War I. Should health not be valued and strived for even if it does not necessarily lead to improvements in other areas of society? In my view, health should be valued as both more and less important than the commission does. It is more important because it is worthy to be a goal in its own right irrespective of possible effects on prosperity, participation, etc. It is less important because there are other as valuable achievements a society should strive for and be measured against such as freedom and democracy. And people should be entitled to pursue other goals, religious or political, as well as pleasure and adventure even if they are not always compatible with an improved health status.