- Email: [email protected]
“Hal”—old word, new task
“HAL”-OLD
WORD,
NEW TASK
REFLEC’I’IONS ON THE WORDS “HEALTH” AND “MEDICAL” JOHN D JAGO*
Department of Dentistry, Umverslty of Queensland, Brisbane, Austraha Abstract-Concern with comprehenslve care for the patlent has led to these reflectIons on the meaning of basic words such as “health”, “disease “, “me&me” and “medical” The words “health” and “medlcal” mean quite different thmgs They cannot be used Interchangeably, as they are often are m popular usage The attractiveness of “health” hes m Its shortness and INSsense of comprehensiveness It IS a noun, however, not an adjective A new adJectlve for “health” IS urgently needed to free that noun to retam and develop a richer substantive meaning The author offers the word “hal” and explams why it should come mto common use
symbols The ancient world knew that, among many peoples throughout hlstory there has been clear awareness that to be able to name a thmg was to have power over It Even mdlvldual letters of the alphabet sometimes came to have enormous mfluence, as III the third fourth and fifth centuries of the ChrIstian era when the Chrlstologlcal debate raged at Its height It was said that the future of the ChrIstIan Church hinged on a diphthong’ Whether homo-ouslos (of the same substance with the Father) or hommouslos (hke the Father) truly described the nature of God the Son In our day there has been a profound change over the past 25 years m the language and hterature of pubhc health Words undreamed of at the close of World War II are now m common use, and old words have been used m completely new ways Smce changes m language reflect the cultural changes and soclopohtlcal environment of a society, it 1sworth pausing a moment to brood over what 1shappemng m that area of human endeavor which 1s dedicated to the treatment and cure of sickness and the restoration and promotion of health The good Anglo-Saxon word health has enjoyed an enormous popularity with writers and m general usage durmg the past quarter century It has been used, or over-used, by Itself and m a great number of combmatlons Even the commonest forms constitute a formldable list health attitudes, health behavior, health sciences, health education, health mformatlon, health status, health levels, health position, health Index, health mdlcators, health admmlstratlon, health orgamzatlon. health department, health plannmg, health budgeting, health programming, health momtormg, health manpower, health profesnon, health personnel, health worker, health professional, health aide, health needs. health demands, health problems, health crisis, health practice. health supervision, health Industry, health actlon, health survey, health progress, health counselmg. health promotion, health mamtenance, health scheme, health center, health pohcy, health service health benefits, health expenditure and health msurance Most ubiquitous of all IS health care and its Words are powerful
* Present address Columbia Umverslty, School of Pubhc Health. 630 West 168th Street, New York, New York, 10032
various compound forms, such as health care dehvery, health care system and health care dehvery systems The important thmg to note about all these sets of words 1s that two or more nouns are strung together Health is a noun, not an adjective, yet almost umversally m North America it 1s used m an adJectlva1 way Perhaps It would be more accurate to say that health ISused m the Umted States m particular m a telegrammatlc way, wherein words are telescoped together and a phrase reqmrmg perhaps five words for accurate expresslon IS reduced to two What does this achieve m the way of meanmg’ For example, what does “health expenditure” mean, or “health needs”? Let us first examme the word health and see what meaning it bears THE MEANING
OF HEALTH
The obvious place to go first m our search for the meanmg of health IS to the general dIctIonarIes Only a few definitions can be cited m the time and space available Webster’s Dictionary [l] defines health as physical and mental well-bemg, soundness, freedom from defect, pam or disease, normahty of mental and physical function As an example of its meaning, Webster quotes a sentence from Munger “Health 1s something &fferent from strength, It IS umversal good condltlon” Funk and Wagnalls Dictionary [2] gives three defimtlons of health (1) a condltlon of soundness of any hvmg organism, that state m which all the natural functions are performed freely without pam or disease, freedom from sickness or decay, as, health 1s a better heritage than wealth, (2) the physlcal condltlon, state or degree of bodily soundness as compared with some other state taken as a standard, as, good health, bad health, (3)a healmg power; as, the saving health of the Lord Roget’s Thesaurus [3] further enlightens us with a number of cognate words under the rubric of health, as vitality-healthmess, vigor, hvelmess, goodness -soundness, heal&-rude health, robust health, good health, good constltutlon, health and strength, wellbemg, physical well-being Medical dlctlonarles are another obvious place to search for the meamng of health One American and one Brltlsh should suffice The Brltlsh Medical DIGtlonary [4] defines health as the normal physical state, I e the state of being whole and free from physlcal and
2
JOHN D JAGO
adjective derlvmg from meden, to attend medlcally” It ~111be noted that Partridge does not translate mrderr as to heal or to cure, which IS the translation that Skmner makes m his defimtlon of “medlcme” Latin--medwuz, the art of healing, or the means of healmg, from medzcmus, relating to healing, from medeor or medrcor to heal or cure [S] It will thus be seen that medical has a different and somewhat more restrlcted meaning than health, If we are to accept the definitions of the lexicographers Health refers to the body, to Its vltahty and soundness and freedom from disease, pam and abnormahty The dictlonarles refer to it as a “state” or “condltlon”, and It may occur either m an original or m a restored form If there 1s no departure from health, there 1s no Illness which requtres medlcal attention, for medical refers prlmarily to the treatment and curing of disease and the restoratlon of health In particular. medical refers to a specfied occupation. the medlcal profession or the medical practltloner, who undergoes a lengthy trammg m the art and science of medicine (not health) and receives a medical degree before bemg allowed to practice Over the course of the 20th century the nature of medical practice has altered radically Sclentlfic and technological mnovatlons and public health practices have led to the control or ehmmatlon of the acute mfectlous diseases which had high mortality rates at the THE MEANING OF M/D/CAL beginning of the century, and have brought m their tram a large number of specific groups of workers who Webster’s Dictionary defines medrcal as pertaining were unknownat the turn ofthe century and whose conto “medlcme” and defines the meamngs of this noun trlbutlon ISnow essential for adequate medical care Of as the science and art of dlagnosmg, healmg, curmg at least 30 such occupations, one might single out a few and preventing &ease, rehevmg pain, and rmprovmg examples such as medical laboratory techmclans, and preservmg health The branch of this science and art that makes use of drugs, diet, etc. is dlstmgulshed radiographers, occupational therapists, speech therapists, dental hyglemsts, medical records hbrarlans and especially from surgery and obstetrics Funk and Wagnails Dlctlonary define medrcal as of or pertammg to nursing aides The simple truth IS that the person tramed m medlmedlcme or the practice or profession of medlcme, cal schools today ISnot, and cannot be, tramed m comengaged m practlsmg me&me, or havmg to do with prehensive care, me the full range of medlcal care medzme, as. a medical school, a medical treatise Havwhich would be necessary to restore a patlent to mg curative propertIes, medicinal The Brltlsh Medical Dictionary defines “medlcme” as the science and art wholeness. A dlvlslon of labor, and a coordmatlon of the dlvlded roles IS necessary to achieve that end Even of the treatment of disease and maintenance of health In particular, the branch concerned with the non-surthe word medical has a reduced meamng m everyday gical aspects of treatment of disease Any drug or other usage, because it refers not to comprehenslve care but to the care which can be given by a person with an substance Stedman’s Medical Dlctlonary defines medical as relatmg to medlcme or the practice of M D degree * Further, there IS grave doubt whether a person with an M D degree can give, smgle-handed, medlcme, and defines the noun as (1) the art of preventthe full range of care at an adequate level that IS taught mg or curing disease, the science that treats of disease m all its relations; (2) the study and treatment of m modern medical schools The complex medical general diseases or those affecting the mternal parts of specialty superstructure that has been built on top of the M D degree testifies to that It IS, however, a common the body, dlstmgulshed from surgery, (3) a drug Klein’s etymological dictionary states that the word 1s complamt that the evolution of over 40 speclaltles has derived from the French mtdlcal, from the late Latm led to the fragmentation of medical care and not to the medtcalrs, “of a physician”, from the Latin medlcus, dehvery of comprehensive care to the patlent Compre“physlclan”, which 1s related to meden, “to heal”, from hensive medlcme IS a term which has been used by the Indo-European base med-, “to measure, limit, conauant garde MD’s m recent years, yet there IS little slder, advise ” Klein says that the word “medtcal” was clarity on what the term means One of the very few to attempt a description of comprehensive medlcme Introduced mto English by Br Thomas Browne (1605was Stelger and his associates [9] In their view, the 1682) It IS, therefore, a relatively recent word m our language Partridge’s etymological dlctlonary [7] also most slgmficant feature of comprehensive me&me IS states that “medical” derives from the Latm medlcalls, that It IS patlent-oriented rather than disease-onented, requlrmg a pentratmg understandmg of who IS the “ad@tive of medlcus, a physician, itself orlgmally an patient as well as what 1s the disease Further * I use the term “M D ” for the sake of slmphclty The pnWhat 1sgenerally needed to teach tins comprehensive unmary medlcal quahficatlon has different names m chfferent derstandmg of patients at present ISa team (mtermst, pediamental disease and pam, so that all parts of the body carry on then proper function Stedman’s Medical Dictionary [S] defines health as the state of the orgamsm when it functions optimally wlthout evidence of disease or abnormality Etymological dictlonarles give the derlvatlons or evolutions of words Klein’s etymological dlctlonary [6] states that our word health derives from the Middle English helthe and from the Old Enghsh haelo which means hterally “wholeness”, formed from hal, “whole” Klem says for sense development, compare the Hebrew shalom, “completeness, wholeness, health, peace” In the hterature and m common usage, the words medical and health are frequently used mterchangeably Nearly every one of the 44 terms listed m the previous page could have used the word medical instead of the word health to mean the same thing or something very similar Does medical, then, mean the same as health? For an answer, let us go back to our dlctlonaries The first thing we notlce 1s that whereas health 1s universally noted as a noun, medzcal IS everywhere noted as an adjective Secondly, we observe that medical has some quite different connotatlons from health, although there are some areas of overlap m meamng
parts of the world
truan
or gynecologist. psyctnatrlst, social worker and at
m-11 ..-I.--RC;I,CL,I”IIS
-_
“11
+I.., LUG
. ..-A. W”IU3
times soclologlst. psychologist and cultural anthropologist) wherein each team member has relatively equal prestige Moreover, each team member should be responsible for patient management and should not be allowed the easy dlsengagement that IS characterlstlc of many consultantpatient relatlonshlps Stelger et al concluded by saymg that “The team type of clmlc organlzatlon and the multi-dlsclplmed philosophy, m our experience, allows for a new freedom m clmlcal practice” That was 14 years ago, but m their article they gave none of the important practlcal details that are necessary to assess and to replicate their type of practice They did not say how long they had been practicing m this manner, the number of their patients and clmlcs, who led the team, and how they ensured accountability There has been little m the literature on this subject since, and it would be mterestmg to know whether Ste.lger 1s still practlcmg according to ha 1960 concepts, and whether this type of practice has increased In spite of the sentiments expressed m the above article, we may doubt Just how comprehensive was the medicine which Steiger and those who thought like him really practiced In the article there was no mdlcatlon whatevei of how closely associated the authors were m the care of their patients with other inedlcal (m the comprehensive sense) but non-M D practitioners There was, for example, no mention m their paper of those commonest of all chronic diseases, the dental diseases, and of what role they and the practitioners who deal with them play m the practice of comprehensive medlcme One could make similar comments on other contrlbutlons made by non-M D workers within comprehensive medicine such as physical therapists and podiatrists Recently, Harper has outlined some theoretical models for comprehensive care, but again, has included virtually no practical details [lo] COMPREHENSIVE
AND LIMITED
MEDICINE
If comprehensive medicine 1sto become a reality and not Just a piece ofjargon, it needs to be taken seriously, particularly by M D ‘s, but also by all professional personnel who are dally concerned with the prevention of disease and mamtenance and restoration of the health of human beings Admittedly, it 1s not easy to achieve clarity m what 1s meant by the term Gles [ 1l] took a first step m this direction by making a dlstmcbon between what he called “comprehensive medicine” and “conventional medlcme” Gles associated “conventional medlcme” with the M D degree, the M D practitioner and societies such as the American Medical Assoclatlon By “comprehensive medlcme” he meant the full range of knowledge and skills applied to the care of the patient by all personnel working m this field, mcludmg many without the M D degree Gles’s meaning 1s clear, yet his terms are not widely used Two major barriers appear to me to prevent the use of his terms First, there IS the long historical usage whereby the term medrcal has come to be seen as the monopoly of the Doctors of Medicine In most people’s mmds the two are synonymous Second, 1s the lmgulstlc fact that both “comprehensive” and “conventional” have four syllables, and it becomes tiresome to keep on repeating words of such length simply to express one idea, especially m spoken conversation A similar problem 1s encountered m changing the mean-
“Health”
and
“Medical”
3
mg of “medlcme” back to its ancient and more comprehensive sense of healing, for then we would need to describe the care given by M D personnel as “reduced medicme” or “limited medlcme” or perhaps simply as “M D medlcme” Such descriptions would be accurate but unhelpful, and certainly would be violently opposed by M.D ‘s as unacceptable A second step was needed m an attempt to convey the idea of comprehensive medicine This second step also proceeded from the recogmtlon of the limited scope of the word medical, but instead of prefixing an adJective before the word “medlcme”, as Gles had done, It moved away from the use of “medical” and adopted the word health instead Health became what It had never been before, an adJectlve In the past decade or more its use has exploded the collective consclous, and it has acquired new and ambiguous meanmgs It has become an “in” word, and its meanings as given m the dlctlonarles are m the process of change and at risk to devaluation As stated earlier, the most common use of the word “health” m contemporary American literature 1s m assoclatlon with another fad word-“care” The term “health care” 1s repeated endlessly m the major Journals m the field of public health, often without too much reflection on what the term means By some writers, “health care” 1s used m the sense of truly comprehensive medcme By others, medical care m the sense of M D care 1s equated with health care, this reductlomsm 1susually perpetrated by authors with an M D degree As the representative of the dommant profession wlthm the field of health, the Amerzan Medical Association has had profound influence on the community m general and on governments m particular When It speaks about “health care”, it usually means the part of care delivered by M D’s It has often acted to exclude other than M D care from the field of health, from the time of its successful exclusion of midwifery early m the 18th century, its eventual victory over the homeopaths m the middle of the 18th century, its struggle wltb the osteopaths and chiropractors, its hegemony over the nurses, its attempt to control clmical psychologists earlier m this century, its recent declslon to support withdrawal of Federal funds from schools of public health [12], and its attempts to exclude dental care from some government-financed programs [13] The last case 1s interesting because the dental profession 1s the one group that hlstorlcally has been accorded more or less equivalent status to Itself by the medical profession Whether the result of all this power and prestige pohtlckmg has been of benefit to the health of the people 1s a matter of controversy among historians But there 1s no doubt that the A M.A has succeeded over a long period of time in preserving its preeminence over the other medical care occupations To this day, “health care” and “health msurance” usually refer for all practical purposes to care given by M D s either m or out of hospital, and not to other forms of medical care
A NOTE
ON PARA-
Four terms have been used by doctors of medicine to describe other workers m the medical field These are “paramedical”, “paraprofessional”, “auxlhary” and
4
JOHN D JAGCI
“allied health personnel” The use of the prefix “para-” 1s interesting m Itself It 1s a direct transhteratlon of a Greek word which means “from beslde”, “beyond”, “against” or “contrary to” The word has the sense of up-agamstness, and can mean. according to Klem. “wrong, irregular, abnormal” Webster’s Dictionary gives the usage of “para-” m medicine as “in a secondary or accessory capacity” and “functionally dlsordered, abnormal. as m parafunctlonal” It has no entry describing “paraprofessional”, neither has Stedman’s medical dictionary or the British medical dlctlonary Stedman’s dictionary defines “paramedical” as “relatmg to medicine mdlrectly” while the Brltlsh medical dictionary says “having some assoclatlon with medlcme” From the dictionary defimtlons of the word “paramedical” one does not get the impression of a worker who has an essential part to play m the modern medlcal complex, who may often have had an excellent trammg m a restricted field, who may often do work that the physician finds distasteful, and who 1s often closer m socloeconomlc and cultural status to that of the patient and thereby possibly more effective m commumcatmg care to the patient So narrow have some physicians become m their descriptions of other workers m medical occupations that even dentists have not uncommonly been referred to as paramedical workers [14] The intermittent struggle of the dentists to mamtam their status as an autonomous professlon US-ci-uls the medical profession has been an interesting feature of sociological history over the past century The dlvlslon of labor, arbitrarily and to an extent peJoratlvely, by the physlclans mto “medlcal” and “paramedical” categories has not been without objective merit m the past There was the physicIan and there were some supportmg staff Medical practice was relatively simple, its remedies were not very effective, and a one-to-one therapeutic relationship was deslrable d not actually necessary That day has long since passed Modern medlcal care would break down within a week without the support of the large number of non-M D workers who constitute the large majority of workers known collectively by the fashionable term “health manpower” The dlstmctlon between “medlcal” and “paramedical” is no longer objective or very helpful, since there are so many different types of workers who can be included under the generic term “paramedlcal” But let us suppose for the moment that “paramedical” 1s acceptable as an overall classlficatlon Within the paramedical category would be included some groups that claim to be professional occupations and other groups that nobody would regard as professional occupations To include all workers m the field of health and medicine we would have to use the phrase “medical and paramedIca professions and occupations”, or somethmg similar, to describe them accurately and comprehensively Nobody but an extreme pedant m the Western European-North American action-onented culture would ever dream of using such a phrase It IS much simpler, even tf less accurate, to speak of “health professtonals” This gives everybody workmg tn the field Just a little bit more social prestige, and it also allows us to recogmze that *That delimtton, drawn up m 1946, reads at present “Health IS a state of complete physxal. mental. and social well-bemg, and not merely the absence of disease or mfirmlty”
there are now other tramed workers ddditional to the medlcal professional involved m patient care But leavmg aside the use of the terms “professional” and “profession”, we can clearly see that the use of the word “health” has not solved the lmgulstlc problem PROPOSAL
FOR SOLkING
LINGLISTIC
THE
PROBLEM
Health IS a noun and hen/thy IS its adjective They both refer to the wholeness or soundness or freedom from disease or dysfunction of the human being Medlcme, or medical action, 1s different from health but may contribute to it The problem IS to find a word that has a more comprehensive connotation than medlcal, since that hlstorlcally honorable term IS now too limited to express the full sense of ALL the knowledge, skills and persons who are now needed to bring comprehensive care to the patient Therefore, neither health nor medical adequately express the quantum that IS needed. A new word IS needed Preferably, this new word should have etymological links with both health and medrcal, and it should be short because the word it IS replacing 1s short Strangely, there IS a very old word that possesses both those desirable charactenstlcs, and I would propose It as a second adjectwe for health That word 1s hal. the Old English word meanmg “whole” It has exactly the root meaning that 1s needed and two other advantages as well First, it 1s monosyllabic and similar to health Second. It ends with the letters “-al”, as does meduzaland a host of other adjectives such as “social”. “physical”, “behavioral”, “psychological” and “SOCIOlogical” No doubt the use of the word hal would seem strange at first, but that 1s probably true of every new term that has ever been coined The word itself sounds harmonious when spoken, and goes well m combmatlon with other words where health 1s now commonly employed, as, for example ha1 behavior, ha1 education, ha1 status, ha1 admmlstratlon, ha1 service and ha1 msurance THE NEED TO DEVELOP MEANING
THE
OF HEALTH
The enormous advantage of having an acceptable adJective for health IS that it frees that noun to retam and develop a richer substantive meaning It also allows those who wish to do so to use “health” as a noun m a phrase, without being tyrannized mto reducing that phrase to two key words as at present, usmg instead. for example attitudes toward health (“health attltudes”), problems about health (“health problems”), and expenditure on services to restore health (“health expenditure”) A great deal remains to be done to develop concepts and meanings of health In the modern world, to follow up the pioneering efforts of writers such as Dubos m his “Mirage of Health” [ 151 and Wllhams on his concepts of health science [16] In spite of what dietlonarles now state (and it IS clear that their definitions are always several years behind the most recent understanding of workers mtlmately involved m the field), health IS not a state but a relationshIp, not something static but something dynamic The famous and mfluenteal definition of health widely disseminated by the World Health Orgamzatlon needs alteration at this point * What 1s needed also IS a grapplmg with the
ReflectIons
on the words
amblgultles of medical experience, mcludmg the idea of “nondlsease” put forward by Meador m 1965 [ 173 Meador described nondisease ‘as a definite clmlcal entity, different from both health and disease, and classified it mto at least seven major syndromes on the basis of specific clmlcal or laboratory manifestations Meador also dlstmgulshed between nondisease and “pseudo disease” Some idea of the embarrassment of physicians m having to deal with such concepts can be gauged from the correspondence followmg Meador’s paper [lS] Beyond this, it IS clear that health has not only physical and mental dlmenslons as we have long known, but also a social dimension that 1s still 111defined and a theological dimension from which many people shy away In this connection, Tllhch has said that what IS important 1s not so much concepts about health but the meaning of health For him, health 1s a meaningful term only m confrontation with its opposite-disease, further, health and disease are exlstentlahst concepts, and health 1snot health without the essential posslblhty and the exlstentlal reality of dlsease Man IS a multldlmenslonal unity, uniting wlthm himself all dlmenslons of hfe-mechanical, chemical, blologlcal, psychological, spiritual and hlstorlcal For Tllhch, there IS always a fulfilling and a reducing Idea of health, but complete healing Includes healing under all the dlmenslons of humanness [ 191 In my opmlon, what IS needed now 1s to grind all the diverse conceptual ideas that we have mto concrete reahzable goals for the people of the whole world It ~111require practical operatlonal definitions and contexts of health which can be equated with concepts such as function, stress, adaption and normality, as Dolfman has pointed out recently [20] It will require further work on the definition [21], measurement [22] and quantification of health, mcludmg what are now known awkwardly as “soaomedcal health mdlcatars” * It will require a recogmtlon that health IS not a separate department of life but integral with all other dlmenslons of it, and m particular that much greater stress must be placed on social research m health leadmg to a general science of soclosalustlcs, a science that IS concerned with the relation between health and society t Fundamental to this recogmtlon 1s a hlstorl-
* A sub-committee of the Medical Sociology SectIon of the American Sociological Assoclatlon IS currently engaged on a study of soclomedlcal health mdlcators A report should be available later this year t The term “soclosalustlcs” was coined by Prof Jack Elmson from two Latin words, SOCIUS(companion), and the route of the usage “soc10” and “salus” (health) The area of soclosalustlcs IS thus the Interface between the social sciences and health it IS a more comprehenslve area than Interfaced between the social sciences and medicine Further it 1s the area for any or all of the social sciences relating to health Thus medlcal sociology. medlcal anthropology dental economics nursing psychology and the historq of pharmacy to give but five examples. are all parts of the science of soclosalustlcs The term “sociosalustics” was first used m a paper by Jack Ehnson and Conrad Herr. read at the American Soclologlcal Assoclatlon annual meetmg. San Francisco Sept 1969 entitled A Socromedlcal Response to Ed\\a, d S Roqer s ‘Publrc Health asks of Soclolog) ” (mlmeo) In that paper the authors also suggested that If the scientific commumty preferred a name derived from Greek Instead of Latin the equivalent of ‘soclosalustlcs’ would be “kenonygela”
“Health”
and “MedIcal”
5
cal approach, so elegantly portrayed recently by Rosen ~231
Fmally, It will require a massive mternatlonal collaborative effort, for the meanings, concepts and models of health have to be translated mto political sagaclty and purpose, the will to tackle the ancient enemies of underemployment, poor transport and uncertain food and water, and the tools to deal with the crippling chronic diseases of the affluent countries and the fatal acute illnesses of the developing countries Without enormous investment of material hardware theJob will not be done Iromcally, the world already has enough knowledge and enough hardware to change the profile of health of all Its people What IS mlssmg IS the power to bring this about That power lies not m the world of the material but m the world of the symbolic, and that 1s why words are crucial, especially key symbolic words lrke health Every man lives by symbols, the only question 1swhether they are strong or weak What 1s needed above all today IS for man to forge new and powerful symbols to replace those now m use that have lost then power In the field of health, this 1s the primary task in the final quarter of the 20th century for all ha1 professionals REFERENCES 1 Webster’s New Twentteth Century Duztronary of the Englzsh Language Unabridged 2nd edn New World Publishing, Cleveland, 1968 2 Funk and Wagnalls New Standard Dtctlonary of the Engllsh Language Funk & Wagnalls, New York, 1952 3 Roqet’s Thesaurus of Enghsh Words and Phrases New edttton completely revised and moderntzed by Robert A Dutch St Martin’s Press, New York, 1964 4 The Brltlsh MedIcal Dzcttonary (edited by Sir Arthur Salusbury MacNalty) Caxton. London, 1961, revised 1963 & 5 Stedman’s Medical Dlcttonary, 22nd edn Wdhams Wdkms, Baltimore, 1972 6 Klem E A Comprehensive Etymological Dvztlonary of the Enghsh Language 2 Vols Elsevler, Amsterdam, 1966 I Partridge E Orlglns A Short Etymological Dlctlonary of Modern English, 4th edn Routledge & Kegan Paul, London 1966 8 Skinner H A The Orrgm of Medtcal Terms, 2nd edn Hafner, New York, 1970 medl9 Stelger W A et al A defimtlon of comprehensive cme J Hlth Hum Behau 1,83, 1960 for comprehen10 Harper A C Towards a Job descrlptlon sive health care-a framework for education and management Sot SCI & Med 7,291, 1973 Gles W J Dental Education m the Umted States and Canada Carnegie Foundation for the Advancement of Teaching, New York, 1926 See AMA favors cuts m pubhc health schools fundmg The Nation’s Health 3(6),- 1. 1973, also the Edltorlal by the President of APHA-Dolan M B AMA’s budget stand hazardous to health? The Natton’s Health 3(7): 1 1973 The most recent attempt by organized medicine m the IJ SA to exclude dental services from governmentfunded programs occurred m 1970 For the vlewpomt of orgamzed dentistry on AMA pohcy m this matter, see the editorial Medlcredlt excludes dentistry J Am Dent Ass 81,589,1970 By 1973. the AMA was modlfymg this pohcy The dental benefits package deslgned by the American Dental Assoclatlon for mcluslon m the AMA’s Medlcredlt proposal has been approved by the
6
14
15 16 17 18
JOHN D JACK
AMA Council on Leglslatzon See J Am Dent Ass 86, 265, 1973 For Instance, dentistry was defined as a paramechcal professlon by the (medzcally dommated) World Health Organlzatzon m 1963 On behalf of the dental profession the Federation Dentazre Internatlonale obJected See Int Dent J 21, 101, 1971 Dubos R Mzrage of Health Utopzas, Progress and Bzological Change Harper & Row, New York, 1959 Wzllzams K G Health and society the need for a new sclentlfic attitude Communzty Health 2, 193, 1971 Meador C K The art and Science of nondzsease New Eng J Med 212,92, 1965 New Eng J Med 272, 433, 1965 Letters wrztten by T P Cruthxds, J H Ransom, E C Stone, G M
Bernzer and H N Sampson under the sub-headmg Nonsequztur 19 Tlllzch P The meanmg of health Persp Bzol & Med 5. 92, 1961 20 Dolfman M L Health plannmg-a method for generatmg program ObJectives Am J publ Healrh 63, 238 1973 21 Patnck D L, Bush J W and Chen M M Toward an operational defimtzon of health J Hlrh & sot Behat 14,6, 1973 22 For a recent revzew article on this general area see Hennes J D The measurement of health Med Care Rev 29, 1268, 1972 23 Rosen G Health, hzstory and the soczal sczences Sot Scz & Med 7, 233, 1973
WORD,
NEW TASK
REFLEC’I’IONS ON THE WORDS “HEALTH” AND “MEDICAL” JOHN D JAGO*
Department of Dentistry, Umverslty of Queensland, Brisbane, Austraha Abstract-Concern with comprehenslve care for the patlent has led to these reflectIons on the meaning of basic words such as “health”, “disease “, “me&me” and “medical” The words “health” and “medlcal” mean quite different thmgs They cannot be used Interchangeably, as they are often are m popular usage The attractiveness of “health” hes m Its shortness and INSsense of comprehensiveness It IS a noun, however, not an adjective A new adJectlve for “health” IS urgently needed to free that noun to retam and develop a richer substantive meaning The author offers the word “hal” and explams why it should come mto common use
symbols The ancient world knew that, among many peoples throughout hlstory there has been clear awareness that to be able to name a thmg was to have power over It Even mdlvldual letters of the alphabet sometimes came to have enormous mfluence, as III the third fourth and fifth centuries of the ChrIstian era when the Chrlstologlcal debate raged at Its height It was said that the future of the ChrIstIan Church hinged on a diphthong’ Whether homo-ouslos (of the same substance with the Father) or hommouslos (hke the Father) truly described the nature of God the Son In our day there has been a profound change over the past 25 years m the language and hterature of pubhc health Words undreamed of at the close of World War II are now m common use, and old words have been used m completely new ways Smce changes m language reflect the cultural changes and soclopohtlcal environment of a society, it 1sworth pausing a moment to brood over what 1shappemng m that area of human endeavor which 1s dedicated to the treatment and cure of sickness and the restoration and promotion of health The good Anglo-Saxon word health has enjoyed an enormous popularity with writers and m general usage durmg the past quarter century It has been used, or over-used, by Itself and m a great number of combmatlons Even the commonest forms constitute a formldable list health attitudes, health behavior, health sciences, health education, health mformatlon, health status, health levels, health position, health Index, health mdlcators, health admmlstratlon, health orgamzatlon. health department, health plannmg, health budgeting, health programming, health momtormg, health manpower, health profesnon, health personnel, health worker, health professional, health aide, health needs. health demands, health problems, health crisis, health practice. health supervision, health Industry, health actlon, health survey, health progress, health counselmg. health promotion, health mamtenance, health scheme, health center, health pohcy, health service health benefits, health expenditure and health msurance Most ubiquitous of all IS health care and its Words are powerful
* Present address Columbia Umverslty, School of Pubhc Health. 630 West 168th Street, New York, New York, 10032
various compound forms, such as health care dehvery, health care system and health care dehvery systems The important thmg to note about all these sets of words 1s that two or more nouns are strung together Health is a noun, not an adjective, yet almost umversally m North America it 1s used m an adJectlva1 way Perhaps It would be more accurate to say that health ISused m the Umted States m particular m a telegrammatlc way, wherein words are telescoped together and a phrase reqmrmg perhaps five words for accurate expresslon IS reduced to two What does this achieve m the way of meanmg’ For example, what does “health expenditure” mean, or “health needs”? Let us first examme the word health and see what meaning it bears THE MEANING
OF HEALTH
The obvious place to go first m our search for the meanmg of health IS to the general dIctIonarIes Only a few definitions can be cited m the time and space available Webster’s Dictionary [l] defines health as physical and mental well-bemg, soundness, freedom from defect, pam or disease, normahty of mental and physical function As an example of its meaning, Webster quotes a sentence from Munger “Health 1s something &fferent from strength, It IS umversal good condltlon” Funk and Wagnalls Dictionary [2] gives three defimtlons of health (1) a condltlon of soundness of any hvmg organism, that state m which all the natural functions are performed freely without pam or disease, freedom from sickness or decay, as, health 1s a better heritage than wealth, (2) the physlcal condltlon, state or degree of bodily soundness as compared with some other state taken as a standard, as, good health, bad health, (3)a healmg power; as, the saving health of the Lord Roget’s Thesaurus [3] further enlightens us with a number of cognate words under the rubric of health, as vitality-healthmess, vigor, hvelmess, goodness -soundness, heal&-rude health, robust health, good health, good constltutlon, health and strength, wellbemg, physical well-being Medical dlctlonarles are another obvious place to search for the meamng of health One American and one Brltlsh should suffice The Brltlsh Medical DIGtlonary [4] defines health as the normal physical state, I e the state of being whole and free from physlcal and
2
JOHN D JAGO
adjective derlvmg from meden, to attend medlcally” It ~111be noted that Partridge does not translate mrderr as to heal or to cure, which IS the translation that Skmner makes m his defimtlon of “medlcme” Latin--medwuz, the art of healing, or the means of healmg, from medzcmus, relating to healing, from medeor or medrcor to heal or cure [S] It will thus be seen that medical has a different and somewhat more restrlcted meaning than health, If we are to accept the definitions of the lexicographers Health refers to the body, to Its vltahty and soundness and freedom from disease, pam and abnormahty The dictlonarles refer to it as a “state” or “condltlon”, and It may occur either m an original or m a restored form If there 1s no departure from health, there 1s no Illness which requtres medlcal attention, for medical refers prlmarily to the treatment and curing of disease and the restoratlon of health In particular. medical refers to a specfied occupation. the medlcal profession or the medical practltloner, who undergoes a lengthy trammg m the art and science of medicine (not health) and receives a medical degree before bemg allowed to practice Over the course of the 20th century the nature of medical practice has altered radically Sclentlfic and technological mnovatlons and public health practices have led to the control or ehmmatlon of the acute mfectlous diseases which had high mortality rates at the THE MEANING OF M/D/CAL beginning of the century, and have brought m their tram a large number of specific groups of workers who Webster’s Dictionary defines medrcal as pertaining were unknownat the turn ofthe century and whose conto “medlcme” and defines the meamngs of this noun trlbutlon ISnow essential for adequate medical care Of as the science and art of dlagnosmg, healmg, curmg at least 30 such occupations, one might single out a few and preventing &ease, rehevmg pain, and rmprovmg examples such as medical laboratory techmclans, and preservmg health The branch of this science and art that makes use of drugs, diet, etc. is dlstmgulshed radiographers, occupational therapists, speech therapists, dental hyglemsts, medical records hbrarlans and especially from surgery and obstetrics Funk and Wagnails Dlctlonary define medrcal as of or pertammg to nursing aides The simple truth IS that the person tramed m medlmedlcme or the practice or profession of medlcme, cal schools today ISnot, and cannot be, tramed m comengaged m practlsmg me&me, or havmg to do with prehensive care, me the full range of medlcal care medzme, as. a medical school, a medical treatise Havwhich would be necessary to restore a patlent to mg curative propertIes, medicinal The Brltlsh Medical Dictionary defines “medlcme” as the science and art wholeness. A dlvlslon of labor, and a coordmatlon of the dlvlded roles IS necessary to achieve that end Even of the treatment of disease and maintenance of health In particular, the branch concerned with the non-surthe word medical has a reduced meamng m everyday gical aspects of treatment of disease Any drug or other usage, because it refers not to comprehenslve care but to the care which can be given by a person with an substance Stedman’s Medical Dlctlonary defines medical as relatmg to medlcme or the practice of M D degree * Further, there IS grave doubt whether a person with an M D degree can give, smgle-handed, medlcme, and defines the noun as (1) the art of preventthe full range of care at an adequate level that IS taught mg or curing disease, the science that treats of disease m all its relations; (2) the study and treatment of m modern medical schools The complex medical general diseases or those affecting the mternal parts of specialty superstructure that has been built on top of the M D degree testifies to that It IS, however, a common the body, dlstmgulshed from surgery, (3) a drug Klein’s etymological dictionary states that the word 1s complamt that the evolution of over 40 speclaltles has derived from the French mtdlcal, from the late Latm led to the fragmentation of medical care and not to the medtcalrs, “of a physician”, from the Latin medlcus, dehvery of comprehensive care to the patlent Compre“physlclan”, which 1s related to meden, “to heal”, from hensive medlcme IS a term which has been used by the Indo-European base med-, “to measure, limit, conauant garde MD’s m recent years, yet there IS little slder, advise ” Klein says that the word “medtcal” was clarity on what the term means One of the very few to attempt a description of comprehensive medlcme Introduced mto English by Br Thomas Browne (1605was Stelger and his associates [9] In their view, the 1682) It IS, therefore, a relatively recent word m our language Partridge’s etymological dlctlonary [7] also most slgmficant feature of comprehensive me&me IS states that “medical” derives from the Latm medlcalls, that It IS patlent-oriented rather than disease-onented, requlrmg a pentratmg understandmg of who IS the “ad@tive of medlcus, a physician, itself orlgmally an patient as well as what 1s the disease Further * I use the term “M D ” for the sake of slmphclty The pnWhat 1sgenerally needed to teach tins comprehensive unmary medlcal quahficatlon has different names m chfferent derstandmg of patients at present ISa team (mtermst, pediamental disease and pam, so that all parts of the body carry on then proper function Stedman’s Medical Dictionary [S] defines health as the state of the orgamsm when it functions optimally wlthout evidence of disease or abnormality Etymological dictlonarles give the derlvatlons or evolutions of words Klein’s etymological dlctlonary [6] states that our word health derives from the Middle English helthe and from the Old Enghsh haelo which means hterally “wholeness”, formed from hal, “whole” Klem says for sense development, compare the Hebrew shalom, “completeness, wholeness, health, peace” In the hterature and m common usage, the words medical and health are frequently used mterchangeably Nearly every one of the 44 terms listed m the previous page could have used the word medical instead of the word health to mean the same thing or something very similar Does medical, then, mean the same as health? For an answer, let us go back to our dlctlonaries The first thing we notlce 1s that whereas health 1s universally noted as a noun, medzcal IS everywhere noted as an adjective Secondly, we observe that medical has some quite different connotatlons from health, although there are some areas of overlap m meamng
parts of the world
truan
or gynecologist. psyctnatrlst, social worker and at
m-11 ..-I.--RC;I,CL,I”IIS
-_
“11
+I.., LUG
. ..-A. W”IU3
times soclologlst. psychologist and cultural anthropologist) wherein each team member has relatively equal prestige Moreover, each team member should be responsible for patient management and should not be allowed the easy dlsengagement that IS characterlstlc of many consultantpatient relatlonshlps Stelger et al concluded by saymg that “The team type of clmlc organlzatlon and the multi-dlsclplmed philosophy, m our experience, allows for a new freedom m clmlcal practice” That was 14 years ago, but m their article they gave none of the important practlcal details that are necessary to assess and to replicate their type of practice They did not say how long they had been practicing m this manner, the number of their patients and clmlcs, who led the team, and how they ensured accountability There has been little m the literature on this subject since, and it would be mterestmg to know whether Ste.lger 1s still practlcmg according to ha 1960 concepts, and whether this type of practice has increased In spite of the sentiments expressed m the above article, we may doubt Just how comprehensive was the medicine which Steiger and those who thought like him really practiced In the article there was no mdlcatlon whatevei of how closely associated the authors were m the care of their patients with other inedlcal (m the comprehensive sense) but non-M D practitioners There was, for example, no mention m their paper of those commonest of all chronic diseases, the dental diseases, and of what role they and the practitioners who deal with them play m the practice of comprehensive medlcme One could make similar comments on other contrlbutlons made by non-M D workers within comprehensive medicine such as physical therapists and podiatrists Recently, Harper has outlined some theoretical models for comprehensive care, but again, has included virtually no practical details [lo] COMPREHENSIVE
AND LIMITED
MEDICINE
If comprehensive medicine 1sto become a reality and not Just a piece ofjargon, it needs to be taken seriously, particularly by M D ‘s, but also by all professional personnel who are dally concerned with the prevention of disease and mamtenance and restoration of the health of human beings Admittedly, it 1s not easy to achieve clarity m what 1s meant by the term Gles [ 1l] took a first step m this direction by making a dlstmcbon between what he called “comprehensive medicine” and “conventional medlcme” Gles associated “conventional medlcme” with the M D degree, the M D practitioner and societies such as the American Medical Assoclatlon By “comprehensive medlcme” he meant the full range of knowledge and skills applied to the care of the patient by all personnel working m this field, mcludmg many without the M D degree Gles’s meaning 1s clear, yet his terms are not widely used Two major barriers appear to me to prevent the use of his terms First, there IS the long historical usage whereby the term medrcal has come to be seen as the monopoly of the Doctors of Medicine In most people’s mmds the two are synonymous Second, 1s the lmgulstlc fact that both “comprehensive” and “conventional” have four syllables, and it becomes tiresome to keep on repeating words of such length simply to express one idea, especially m spoken conversation A similar problem 1s encountered m changing the mean-
“Health”
and
“Medical”
3
mg of “medlcme” back to its ancient and more comprehensive sense of healing, for then we would need to describe the care given by M D personnel as “reduced medicme” or “limited medlcme” or perhaps simply as “M D medlcme” Such descriptions would be accurate but unhelpful, and certainly would be violently opposed by M.D ‘s as unacceptable A second step was needed m an attempt to convey the idea of comprehensive medicine This second step also proceeded from the recogmtlon of the limited scope of the word medical, but instead of prefixing an adJective before the word “medlcme”, as Gles had done, It moved away from the use of “medical” and adopted the word health instead Health became what It had never been before, an adJectlve In the past decade or more its use has exploded the collective consclous, and it has acquired new and ambiguous meanmgs It has become an “in” word, and its meanings as given m the dlctlonarles are m the process of change and at risk to devaluation As stated earlier, the most common use of the word “health” m contemporary American literature 1s m assoclatlon with another fad word-“care” The term “health care” 1s repeated endlessly m the major Journals m the field of public health, often without too much reflection on what the term means By some writers, “health care” 1s used m the sense of truly comprehensive medcme By others, medical care m the sense of M D care 1s equated with health care, this reductlomsm 1susually perpetrated by authors with an M D degree As the representative of the dommant profession wlthm the field of health, the Amerzan Medical Association has had profound influence on the community m general and on governments m particular When It speaks about “health care”, it usually means the part of care delivered by M D’s It has often acted to exclude other than M D care from the field of health, from the time of its successful exclusion of midwifery early m the 18th century, its eventual victory over the homeopaths m the middle of the 18th century, its struggle wltb the osteopaths and chiropractors, its hegemony over the nurses, its attempt to control clmical psychologists earlier m this century, its recent declslon to support withdrawal of Federal funds from schools of public health [12], and its attempts to exclude dental care from some government-financed programs [13] The last case 1s interesting because the dental profession 1s the one group that hlstorlcally has been accorded more or less equivalent status to Itself by the medical profession Whether the result of all this power and prestige pohtlckmg has been of benefit to the health of the people 1s a matter of controversy among historians But there 1s no doubt that the A M.A has succeeded over a long period of time in preserving its preeminence over the other medical care occupations To this day, “health care” and “health msurance” usually refer for all practical purposes to care given by M D s either m or out of hospital, and not to other forms of medical care
A NOTE
ON PARA-
Four terms have been used by doctors of medicine to describe other workers m the medical field These are “paramedical”, “paraprofessional”, “auxlhary” and
4
JOHN D JAGCI
“allied health personnel” The use of the prefix “para-” 1s interesting m Itself It 1s a direct transhteratlon of a Greek word which means “from beslde”, “beyond”, “against” or “contrary to” The word has the sense of up-agamstness, and can mean. according to Klem. “wrong, irregular, abnormal” Webster’s Dictionary gives the usage of “para-” m medicine as “in a secondary or accessory capacity” and “functionally dlsordered, abnormal. as m parafunctlonal” It has no entry describing “paraprofessional”, neither has Stedman’s medical dictionary or the British medical dlctlonary Stedman’s dictionary defines “paramedical” as “relatmg to medicine mdlrectly” while the Brltlsh medical dictionary says “having some assoclatlon with medlcme” From the dictionary defimtlons of the word “paramedical” one does not get the impression of a worker who has an essential part to play m the modern medlcal complex, who may often have had an excellent trammg m a restricted field, who may often do work that the physician finds distasteful, and who 1s often closer m socloeconomlc and cultural status to that of the patient and thereby possibly more effective m commumcatmg care to the patient So narrow have some physicians become m their descriptions of other workers m medical occupations that even dentists have not uncommonly been referred to as paramedical workers [14] The intermittent struggle of the dentists to mamtam their status as an autonomous professlon US-ci-uls the medical profession has been an interesting feature of sociological history over the past century The dlvlslon of labor, arbitrarily and to an extent peJoratlvely, by the physlclans mto “medlcal” and “paramedical” categories has not been without objective merit m the past There was the physicIan and there were some supportmg staff Medical practice was relatively simple, its remedies were not very effective, and a one-to-one therapeutic relationship was deslrable d not actually necessary That day has long since passed Modern medlcal care would break down within a week without the support of the large number of non-M D workers who constitute the large majority of workers known collectively by the fashionable term “health manpower” The dlstmctlon between “medlcal” and “paramedical” is no longer objective or very helpful, since there are so many different types of workers who can be included under the generic term “paramedlcal” But let us suppose for the moment that “paramedical” 1s acceptable as an overall classlficatlon Within the paramedical category would be included some groups that claim to be professional occupations and other groups that nobody would regard as professional occupations To include all workers m the field of health and medicine we would have to use the phrase “medical and paramedIca professions and occupations”, or somethmg similar, to describe them accurately and comprehensively Nobody but an extreme pedant m the Western European-North American action-onented culture would ever dream of using such a phrase It IS much simpler, even tf less accurate, to speak of “health professtonals” This gives everybody workmg tn the field Just a little bit more social prestige, and it also allows us to recogmze that *That delimtton, drawn up m 1946, reads at present “Health IS a state of complete physxal. mental. and social well-bemg, and not merely the absence of disease or mfirmlty”
there are now other tramed workers ddditional to the medlcal professional involved m patient care But leavmg aside the use of the terms “professional” and “profession”, we can clearly see that the use of the word “health” has not solved the lmgulstlc problem PROPOSAL
FOR SOLkING
LINGLISTIC
THE
PROBLEM
Health IS a noun and hen/thy IS its adjective They both refer to the wholeness or soundness or freedom from disease or dysfunction of the human being Medlcme, or medical action, 1s different from health but may contribute to it The problem IS to find a word that has a more comprehensive connotation than medlcal, since that hlstorlcally honorable term IS now too limited to express the full sense of ALL the knowledge, skills and persons who are now needed to bring comprehensive care to the patient Therefore, neither health nor medical adequately express the quantum that IS needed. A new word IS needed Preferably, this new word should have etymological links with both health and medrcal, and it should be short because the word it IS replacing 1s short Strangely, there IS a very old word that possesses both those desirable charactenstlcs, and I would propose It as a second adjectwe for health That word 1s hal. the Old English word meanmg “whole” It has exactly the root meaning that 1s needed and two other advantages as well First, it 1s monosyllabic and similar to health Second. It ends with the letters “-al”, as does meduzaland a host of other adjectives such as “social”. “physical”, “behavioral”, “psychological” and “SOCIOlogical” No doubt the use of the word hal would seem strange at first, but that 1s probably true of every new term that has ever been coined The word itself sounds harmonious when spoken, and goes well m combmatlon with other words where health 1s now commonly employed, as, for example ha1 behavior, ha1 education, ha1 status, ha1 admmlstratlon, ha1 service and ha1 msurance THE NEED TO DEVELOP MEANING
THE
OF HEALTH
The enormous advantage of having an acceptable adJective for health IS that it frees that noun to retam and develop a richer substantive meaning It also allows those who wish to do so to use “health” as a noun m a phrase, without being tyrannized mto reducing that phrase to two key words as at present, usmg instead. for example attitudes toward health (“health attltudes”), problems about health (“health problems”), and expenditure on services to restore health (“health expenditure”) A great deal remains to be done to develop concepts and meanings of health In the modern world, to follow up the pioneering efforts of writers such as Dubos m his “Mirage of Health” [ 151 and Wllhams on his concepts of health science [16] In spite of what dietlonarles now state (and it IS clear that their definitions are always several years behind the most recent understanding of workers mtlmately involved m the field), health IS not a state but a relationshIp, not something static but something dynamic The famous and mfluenteal definition of health widely disseminated by the World Health Orgamzatlon needs alteration at this point * What 1s needed also IS a grapplmg with the
ReflectIons
on the words
amblgultles of medical experience, mcludmg the idea of “nondlsease” put forward by Meador m 1965 [ 173 Meador described nondisease ‘as a definite clmlcal entity, different from both health and disease, and classified it mto at least seven major syndromes on the basis of specific clmlcal or laboratory manifestations Meador also dlstmgulshed between nondisease and “pseudo disease” Some idea of the embarrassment of physicians m having to deal with such concepts can be gauged from the correspondence followmg Meador’s paper [lS] Beyond this, it IS clear that health has not only physical and mental dlmenslons as we have long known, but also a social dimension that 1s still 111defined and a theological dimension from which many people shy away In this connection, Tllhch has said that what IS important 1s not so much concepts about health but the meaning of health For him, health 1s a meaningful term only m confrontation with its opposite-disease, further, health and disease are exlstentlahst concepts, and health 1snot health without the essential posslblhty and the exlstentlal reality of dlsease Man IS a multldlmenslonal unity, uniting wlthm himself all dlmenslons of hfe-mechanical, chemical, blologlcal, psychological, spiritual and hlstorlcal For Tllhch, there IS always a fulfilling and a reducing Idea of health, but complete healing Includes healing under all the dlmenslons of humanness [ 191 In my opmlon, what IS needed now 1s to grind all the diverse conceptual ideas that we have mto concrete reahzable goals for the people of the whole world It ~111require practical operatlonal definitions and contexts of health which can be equated with concepts such as function, stress, adaption and normality, as Dolfman has pointed out recently [20] It will require further work on the definition [21], measurement [22] and quantification of health, mcludmg what are now known awkwardly as “soaomedcal health mdlcatars” * It will require a recogmtlon that health IS not a separate department of life but integral with all other dlmenslons of it, and m particular that much greater stress must be placed on social research m health leadmg to a general science of soclosalustlcs, a science that IS concerned with the relation between health and society t Fundamental to this recogmtlon 1s a hlstorl-
* A sub-committee of the Medical Sociology SectIon of the American Sociological Assoclatlon IS currently engaged on a study of soclomedlcal health mdlcators A report should be available later this year t The term “soclosalustlcs” was coined by Prof Jack Elmson from two Latin words, SOCIUS(companion), and the route of the usage “soc10” and “salus” (health) The area of soclosalustlcs IS thus the Interface between the social sciences and health it IS a more comprehenslve area than Interfaced between the social sciences and medicine Further it 1s the area for any or all of the social sciences relating to health Thus medlcal sociology. medlcal anthropology dental economics nursing psychology and the historq of pharmacy to give but five examples. are all parts of the science of soclosalustlcs The term “sociosalustics” was first used m a paper by Jack Ehnson and Conrad Herr. read at the American Soclologlcal Assoclatlon annual meetmg. San Francisco Sept 1969 entitled A Socromedlcal Response to Ed\\a, d S Roqer s ‘Publrc Health asks of Soclolog) ” (mlmeo) In that paper the authors also suggested that If the scientific commumty preferred a name derived from Greek Instead of Latin the equivalent of ‘soclosalustlcs’ would be “kenonygela”
“Health”
and “MedIcal”
5
cal approach, so elegantly portrayed recently by Rosen ~231
Fmally, It will require a massive mternatlonal collaborative effort, for the meanings, concepts and models of health have to be translated mto political sagaclty and purpose, the will to tackle the ancient enemies of underemployment, poor transport and uncertain food and water, and the tools to deal with the crippling chronic diseases of the affluent countries and the fatal acute illnesses of the developing countries Without enormous investment of material hardware theJob will not be done Iromcally, the world already has enough knowledge and enough hardware to change the profile of health of all Its people What IS mlssmg IS the power to bring this about That power lies not m the world of the material but m the world of the symbolic, and that 1s why words are crucial, especially key symbolic words lrke health Every man lives by symbols, the only question 1swhether they are strong or weak What 1s needed above all today IS for man to forge new and powerful symbols to replace those now m use that have lost then power In the field of health, this 1s the primary task in the final quarter of the 20th century for all ha1 professionals REFERENCES 1 Webster’s New Twentteth Century Duztronary of the Englzsh Language Unabridged 2nd edn New World Publishing, Cleveland, 1968 2 Funk and Wagnalls New Standard Dtctlonary of the Engllsh Language Funk & Wagnalls, New York, 1952 3 Roqet’s Thesaurus of Enghsh Words and Phrases New edttton completely revised and moderntzed by Robert A Dutch St Martin’s Press, New York, 1964 4 The Brltlsh MedIcal Dzcttonary (edited by Sir Arthur Salusbury MacNalty) Caxton. London, 1961, revised 1963 & 5 Stedman’s Medical Dlcttonary, 22nd edn Wdhams Wdkms, Baltimore, 1972 6 Klem E A Comprehensive Etymological Dvztlonary of the Enghsh Language 2 Vols Elsevler, Amsterdam, 1966 I Partridge E Orlglns A Short Etymological Dlctlonary of Modern English, 4th edn Routledge & Kegan Paul, London 1966 8 Skinner H A The Orrgm of Medtcal Terms, 2nd edn Hafner, New York, 1970 medl9 Stelger W A et al A defimtlon of comprehensive cme J Hlth Hum Behau 1,83, 1960 for comprehen10 Harper A C Towards a Job descrlptlon sive health care-a framework for education and management Sot SCI & Med 7,291, 1973 Gles W J Dental Education m the Umted States and Canada Carnegie Foundation for the Advancement of Teaching, New York, 1926 See AMA favors cuts m pubhc health schools fundmg The Nation’s Health 3(6),- 1. 1973, also the Edltorlal by the President of APHA-Dolan M B AMA’s budget stand hazardous to health? The Natton’s Health 3(7): 1 1973 The most recent attempt by organized medicine m the IJ SA to exclude dental services from governmentfunded programs occurred m 1970 For the vlewpomt of orgamzed dentistry on AMA pohcy m this matter, see the editorial Medlcredlt excludes dentistry J Am Dent Ass 81,589,1970 By 1973. the AMA was modlfymg this pohcy The dental benefits package deslgned by the American Dental Assoclatlon for mcluslon m the AMA’s Medlcredlt proposal has been approved by the
6
14
15 16 17 18
JOHN D JACK
AMA Council on Leglslatzon See J Am Dent Ass 86, 265, 1973 For Instance, dentistry was defined as a paramechcal professlon by the (medzcally dommated) World Health Organlzatzon m 1963 On behalf of the dental profession the Federation Dentazre Internatlonale obJected See Int Dent J 21, 101, 1971 Dubos R Mzrage of Health Utopzas, Progress and Bzological Change Harper & Row, New York, 1959 Wzllzams K G Health and society the need for a new sclentlfic attitude Communzty Health 2, 193, 1971 Meador C K The art and Science of nondzsease New Eng J Med 212,92, 1965 New Eng J Med 272, 433, 1965 Letters wrztten by T P Cruthxds, J H Ransom, E C Stone, G M
Bernzer and H N Sampson under the sub-headmg Nonsequztur 19 Tlllzch P The meanmg of health Persp Bzol & Med 5. 92, 1961 20 Dolfman M L Health plannmg-a method for generatmg program ObJectives Am J publ Healrh 63, 238 1973 21 Patnck D L, Bush J W and Chen M M Toward an operational defimtzon of health J Hlrh & sot Behat 14,6, 1973 22 For a recent revzew article on this general area see Hennes J D The measurement of health Med Care Rev 29, 1268, 1972 23 Rosen G Health, hzstory and the soczal sczences Sot Scz & Med 7, 233, 1973