Holistic Health: Concept
and Scope - Issue Papers
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Holistic Health: Concept and Scope.
Mathura P. Shrestha
and Indira Shrestha
- People's Health Assembly - Issue Paper
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1. What is holistic health and why?
In Ayurveda health is
termed as Swasthya which means self-sustenance in
life and living. It also means self-reliance or self-establishment in the context of the
interdependence of a life or self with Jeevatwa or the elements of life in the universe
(the Earth, light, wind, space, and heat). Thus health is a state of equilibrium between a
human’s external and internal environment. The concept of environment extends from
that within a nucleus of a cell to the universe. World Health Organization defined health
as a state of physical, mental and social wellbeing and not merely the absence of disease
or infirmity. This concept tries to maintain that health is an expression of total
conditions of human life - physical, genetic, chemical, environmental, cultural, economic,
psychosocial, mental, intellectual, and spiritual. Health
relates to every thing that becomes of the part of human life systems or that determines
the living. What on earth is not related to life or living? Therefore, the concept
of health has to transcend from the present techno-centric boundaries to holistic health
encompassing the development of, or relating all or total aspects of human life.
2. Basics of Holistic Health Care.
A. Informed Decision and
Responsible Choices - Civic responsibility:
Health care too has to change from the present prescriptive pattern to participatory
health development with informed and responsible decision and choices. Here, a person
decides or makes choices with a comprehensive knowledge of outcome - benefits and/or risks
- of the decision or choice in a responsible manner. A person who seeks health services
has a right to know what is his or her health status or problem, determinants of that, and
options with the information about the best as well as alternative approaches available.
The person may need help from a provider or providers. The help is to be in the form of
appropriate counseling, guidance and advice followed by appropriate intervention, if
necessary. Provider and recipient relationship is based on a social contract. This is to
make the provider transparent, responsive and accountable, and the recipient informed,
responsible and confident. This relationship is to be developed and founded on reason and
trust encompassing the ecological, psychosocial, cultural, economic and personal
considerations. Provider too has to have informed decision and appropriate strategy and
action based upon evidence based information to have the productive relationship. The
other aspect of the recipient responsibility is to participate in the management of
one’s and community’s health actively with innovative initiatives.
B. Providers’ role:
As early as 1842-48, Rudolf Virchow advocated that the ‘Social determinant of health
and disease as “political” matters beyond the physician’s preview’,
and ‘Medicine is a social science, and politics is nothing more than medicine on a
large scale’[1]. He was a tireless exponent of health education of general public. He
wrote, ‘As long as [education] does not aim to maintain and increase, …. by
power of independent thought, a sound, genuine and unadultrated human understanding….
the layman will lack the basis to form his own judgment on his physician. … Not only
the uneducated, but also the educated layman will remain survilely subordinate to medical
authority; … a resounding title … will constitute a most lucrative shingle for
the medical quack …’.[2]
In my idea, a provider or health professional has to play four basic roles to fulfill his
social responsibility, one has:
-
First, to update the self and others for the human
resource development, and contribute to the advancement of science, technology and
services related to one’s profession,
- Second, to use science, technology and services for the wellbeing of the people and for
the benefit of the society.
- Third, the intended benefit and wellbeing must be experienced and accepted as positive
gain or difference by the people, and
- Fourth, the gains could be measured statistically as the evidence of the progress or
change.
Providers are to be responsible and interactive in
making informed judgment and prescription, respecting human rights of the users.
C. Basic Minimum Needs
and Quality of Life:
For holistic health both health and non-health parameters must be considered. Quality of
life is intimately related to health and development. The concept of basic minimum needs
should include adequate access or entitlement to the following twelve components of
living:
Food; shelter;
clothing; education; health; security including social security, and clean and sustainable
environment; productive employment with income; progressive development (physical, mental,
intellectual and social); participation in social and political affairs outsides
one’s home; information and communication for social relations and for one’s
social identity; recreation and entertainment; and human rights[3].
The basic minimum need is the primary to the
enhancement of quality of life. The quality if life is, however, progressively dynamic as
is the human needs. Opportunity and distribution of needs are to be based on equity and
social justice in the spirit of collective social responsibility of humans.
D. Health and Non-health
Sector:
The so called health and non-health sector is artificial and can not remain independent of
each other as far as health and development is concerned. However for those who wish to be
identified within the health sector, it may be said that health relates to non-health
sector rather than health sector like education, income and access to opportunity and
services, environmental conditions, food and nutrition, sanitation, participation in
cultural and sociopolitical activities, etc. Health professionals, however, have to take
leadership role in involving people and those in other sectors to optimize health
development. They have to breakaway from aspect blindness and paradigm paralysis in order
to move forward.
There are some extreme quotations and anecdotes related to medicine and medical practice.
As I have already qualified them as extreme, I do not advise any to borrow the idea as
they are. But they deserve serious thinking and one needs to analyze open-mindedly why
these are said. These are after all based on serious observations or analysis. To quote
Oliver Wendell Holmes, ‘If all the medicines in the world were dumped into the sea,
it would be much better for humans, but so much worse for the fish’[4]. And old
saying is equally tantalizing - ‘A few is cured by doctors, a few more without
doctors and many more in spite of the doctors’[5]. Evan Illich has said ‘the
investment in medicine including public health is tremendous waste of public and private
fund’. These observations become valid if health and medicine continue to be
fragmented, sectoralized, and isolated from the societal health. Advancement in medical
technology and services in reality is not to glamorize these but to enhance societal
health and wellbeing.
It is thus the prime responsibility of the health professional to advocate that health is
public agenda and therefore the common concern of all[6].
E. Health as Human
right:
Health is an integral part of a human’s living
shared among and with other humans and biotic community (Shrestha I, Shrestha MP,
1997). Health is thus a basic human right and is
everybody’s responsibility. French Declaration of the Rights of Man and of the
Citizen of 1778 was the first document of its kind to have referred to what we now call
social, economical and cultural rights: rights to education, work, property, and social
protection. In 1941 Atlantic Charter was drawn which evolved the process of the
development of Bill of Rights during 1942-45. Universal declaration of Human Rights was
adopted and proclaimed by UN General Assembly in December 10, 1948. The article 25.1 of it
states: -
Everyone has the
right to a standard of living adequate for health and wellbeing of himself and of his
family, including food, clothing, housing and medical care and necessary social services,
and the right to security in the event of unemployment, sickness, disability, widowhood,
old age, or other lack of livelihood in circumstances beyond his control[7].
The WHO Constitution obligates the signatory
governments to provide ‘adequate health and social measures’ for ‘the
highest attainable standard of health’ and ‘informed opinion’ to all of
their people.
F. Eco-health / Health
and Environment:
Today, global eco-system and environment are challenged by increase in irresponsible
consumerism aggressively promoted by multinational companies and forces of present
day’s globalization. In addition, the nature and environment is severely exploited.
Every day, hundred of precious species are forced to extinction. Human survival itself is
challenged now. The cult of violence in the world and among human population and
increasing poverty have further deteriorated the quality of environment, living and
safety. Planetary eco-system is now in real danger.
G. Human Governance:
Human Governance is a part of health and quality of life. In many countries Democracy is
being insulted, that too, in the name of democracy. Democracy relates to every thing that
is developed or done with and by the people and not for or to the people. Whereas misuse
of democracy has played havoc in the lives of people, there are several studies showing
that democracy itself is the most important predictor of health and quality of life. It is
also found that where democracy is working there is minimum loss of life in the event of
catastrophe compared to countries where democracy is not working or misdirected. Democracy
is also a prerequisite of good and humane governance. Good governance again is another
important predictor of human health. We presume that good and humane governance has
following dimensions:
At political level: Following elements must be
effective:
-
Political commitment.
-
Primacy of people = Democracy.
-
Transparency and accountability.
-
Compliance to protect people and health.
-
Responsible bureaucracy (independent of partisan politics but committed to the service
of people and reigned by the politics of people).
At socioeconomic level:
-
Priority to public health goods - tackling determinants, managing conditions, and
achieving results to make a difference.
-
Macroeconomic balance in allocation.
-
Equity and social justice.
-
Holistic approach
-
As of Alma-Ata Declaration - Accessible, Adequacy, appropriate, affordable, and
acceptable.
At civic level:
-
Right and responsibility of the governed. They must empower themselves to assert and
execute these.
-
People’s participation in sociopolitics, policy development, and management.
-
Demand (Real), solidarity (Organized voice), and assertion.
-
Local-self Governance.
3. Traditional and
ethnomedicne/health:
Our region has a rich tradition and heritage of traditional and
ethnomedicine developed and based on the thousand years of empirical experience and test
of time. Western countries are engaged in biopirecy to extract, investigate and market new
product out of these medicines. We, however, manage to ignore the richness and
potentiality of these medicines and health practices. It is the time we give these a due
priority. We need to bring these in scientific footing. Any malpractice or misdirected
practice in the name of these should be discouraged.
4. Conclusion:
Holistic health depends upon our attitude and commitment. If we
are to solve human health problems with a good result then holistic health and holistic
management of health care is the answer. Holistic health is cost-effective and
sustainable. It is non-discriminatory. It addresses issues of equity and social justice.
It keeps all the viable options open.
Colombo: October 5, 2000
References
[1] Eisenberg L. Rodolf
Virchow: The physician as politician. In
Bonhoeffer K. Gerecke D (Ed). Maintain life on earth. Document of Sixth World Congress of
the International physicians for the Prevention of Nuclear War in Cologney, May 29 - June
1, 1986. Munich: Jungjohann Verlagsgesellschaft Nekarsulum und Munchen; 1987 : 79-84.
[2] LJ Rather. Virchow R: Collected essays on public health and epidemiolgy. Vol. 1.
Canton, MA: Watson Publishing International; 1985: 53-54.
[3] Shrestha MP. Challenges and new paradigm in human rights. A paper presented to the
Consultative meeting of Alliance for Human Rights and Social Justice, June 1999;
Kathmandu.
[4] Quotation extracted from Steinberg L. Myvision of futuristic medicine. Presentation at
the World Congress of Medicine Alternica 2000, January 1-3, 2000, Colombo and published in
Sunday Observer, January 2, 2000: 10.
[5] Quoted from - Shrestha MP, Shrestha I. Our social responsibility. Paper presented to
the Second Convention of the Physicians for Social Responsibility, April 10-11, 1998,
Chitawan, Nepal.
[6] Shrestha I, Shrestha MP. Making health a public agenda: Beyond advocacy to the common
concern of all. Khojbin - J Nepal Health Research Council,
Kathmandu, 1997; 1(1):15-22.
[7] UN. Universal Declaration of Human Rights
Biodata summary
Mathura P. Shrestha
Chairperson Resource Center for Primary Health Care, PO Box 117, Bagbazar,
Kathmandu,
Nepal. Email: mathura@healthnet.org.np
Indira Shrestha
Pediatrician and Honorary Member Secretary and Coordinator, ENHR Nepal Network, PO Box
117, Bagbazar, Kathmandu, Nepal.
