Friday, January 21, 2011

Analysis #2 - How can "health" be measured?

Numbers can provide an efficient way to organize and classify people in various situations. We walk into a restaurant and we see above the doors “Capacity 168”. We open up the morning’s newspaper and read the headings titled “52 Residents Saved in Local Fire”. We watch on television the latest breaking news that claim scientists have “successfully treated 174 out of 250 lung cancer patients in a research study”. These are but a few nonfictional and fictional examples of how people are organized and addressed as numbers. Organizing people into numbers is not in itself harmful, as long as the numbers are not being used to place numerical values on people. Under such circumstances, people become recognized only by the numbers they represent and the relative value behind these numbers. Although this appears to happen rather frequently in today’s society (i.e. a businessman’s “worth” to a company as being measured by how much sales he can rake in monthly, the number of winning cases a lawyer carries as a measurement of his/her level of competence and value to prospective clients, etc.), it is disturbingly frightening to imagine a world in which health becomes a target of such numerical categorization.

The above image, found on a business coach’s personal blog (, shows three individuals with numbered white tags on their foreheads. Above this image are the words: “I’m More Than Just a Number”. The blog uses this image to help its readers understand that a successful business mindset is to look not just at the numbers, but “the person behind those numbers…who they are, what their interests are, and what they enjoy/dislike about your product or service” ( I believe this same mindset should be applied when providing health care to people on a local, national, international, and global scale. In Vincanne Adams’ chapter titled “Against Global Health? Arbitrating Science, Non-science, and Nonsense through Health”, she describes the shift in the role of science in defining the meaning of health. She states that “the foundational grounds for its inquires was always health as seen in real patients with real diseases, [which] could be contrasted with later efforts to pursue “science” as an end in and of itself through colonial or postcolonial medicine” (Adams, 43). These later efforts, which emphasized the need to focus on empirical evidence, led to a “shift from health to “science”” (Adams, 43). This shift would eventually lead to the representation of patients as merely people with numbers attached to them, much like the image provided above. Each patient would be labeled as either a success or a failure in a research study. The socio-cultural, political, or economic backgrounds of patients are ignored unless their “relevance can be justified by [their] ability to advance real, scientifically based interventions” aimed at improving health (Adams, 46). Such a statement demonstrates that people are increasingly becoming evaluated by their scientific worth – that is, whether or not they can provide empirical numbers to strengthen a scientific claim. Adams discusses the emphasis pharmaceutical sciences place on statistical evidence and suggests that “it is the prioritizing of pharmaceutical consumption and its research agenda over the prioritizing of health that leads to” problems of racial and social inequalities on study populations that have no other way to obtain health except to enroll in clinical trials (Adams, 48).

The rise of global health sciences, as explained by Adams, has changed the way we measure health. A patient may die, yet a treatment is deemed “successful” if it fulfills its original objective – that is, if the treatment reduces the malady (i.e. tumor size), it is considered a success even if it comes at the expense of the patient’s life. Such way of thinking “requires embracing the notion that health itself could be located in a specific organ rather than in a whole person. In this logic, death itself was absorbed within the notion of health” (Adams, 49). Health becomes subject to technological and statistical calculations of “profit and loss” (Adams, 50), which may be dangerous as it justifies the action of sacrificing the few “for the sake of obtaining more robust numbers that could tell us that more…could be saved in the future if we furthered our knowledge of the scientific “evidence base”” (Adams, 50).

Changing notions of health have forced health to do “more than just eliminating disease. It is made to do the work of generating scientific studies and producing evidence-based outcomes that don’t always mesh well with the goals of patient care” (Adams, 55). This brings into mind Good and Good’s chapter on “Learning Medicine: The Constructing of Medical Knowledge at Harvard Medical School”, in which they describe how an emphasis on “competence” has led medical students to focus more on medicine as a science rather than the patient as a person. When asked to “reflect on the meaning of being a good physician, two juxtaposed themes quickly emerged – “competence” and “caring”” (Good & Good, 91). Being competent meant understanding the “language of the basic sciences, with “value-free facts and knowledge, skills, techniques, and “doing” or action” (Good & Good, 91). Being caring meant understanding the “language of values, of relationships, attitudes, compassion, and empathy” (Good & Good, 91). This juxtaposition between “competence” and “caring” seems very similar to the dichotomy between “science” and “non-science” as described in Adam’s chapter on global health sciences. It is the challenge between being able to see people as numbers (representing science) and being able to see the people behind the numbers (representing non-science/social science). This challenge is “built into American medicine as a cultural institution and the struggle between technology and humanism, between science and culture” (Good & Good, 93). The real question is then, is it possible for us to find a healthy balance between the two worlds? Can we see beyond the numbers stamped onto the bodies of each and every individual?


Adams, Vincanne. 2010. “Against Global Health? Arbitrating Science, Non-Science, and Nonsense through Health”. In Against Health: How Health Became the New Morality”. Edited byJonathan M. Metzl and Anna Kirkland. Pp. 40-58. New York: New York. University Press,

Good, Byron J. and Good, Mary-Jo DelVecchio. 1993. “Learning Medicine: The Constructing of Medical Knowledge at Harvard Medical School”. Pp. 81-107. In Knowledge, Power, and Practice: The Anthropology of Medicine and Everyday Life. Edited by Shirley Lindenbaum and Margaret Lock. Berkeley: University of California Press.

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