Is Man Free to Make Choices for Health?
Douglass, Joseph H., American Journal of Health Education
This paper is reformatted and reprinted as part of the 40th Anniversary of the American Journal of Health Education. (originally School Health Review), Health Education--Our Heritage series. The original article appeared in the inaugural issue of School Health Review (Volume 1, September 1969, pp. 4-8). At the time, Joseph H. Douglass, Ph.D., was Chief, Interagency Liaison Branch, National Institute of Mental Health, Washington, D.C. and was serving as staff director for the 1970 White House Conference on Children and Youth. A commentary on the 2010 relevance to health education of Dr. Douglass' paper immediately follows this reprinted version.
When considering the problem of man's freedom, Eric Fromm has asked, "Is man free to choose the good at any given moment or has he no such freedom of choice because he is determined by forces inside and outside himself?"
My own answers to this must be couched in somewhat qualified and obscure terms, for in reaching conclusions it is necessary to consider the category of youth to whom reference is made. For the "average" middle-class or middle-income youth in our nation, the range of choices regarding health matters, as in many other areas, is wide indeed. He and his family have continuous access to perhaps the best medical care system which the world has produced. His value system has been carefully nurtured throughout his lifetime, beginning with good prenatal and obstetrical care of his mother. He has grown up in fresh air, sunshine and pleasing sanitary surroundings, accompanied by adequate nutrition, proper rest, excellent recreation facilities and culturally enriching experiences. (In school he sat on the side of the classroom which used "Crest.") To a significant extent, therefore, his values and choices in health are quite personal ones, guided by the most advanced knowledge and consultation available and with a tremendous range of discretion and freedom as to his personal pursuits and health habit patterns.
The extent to which this model extends to the majority of our population, however, is unknown. There appears to be overwhelming evidence that this pattern, in gross terms, is far more atypical than we would suspect. I should propose that we examine three or four major aspects of the situation. These have to do with the overall delivery of the health care system, continuing poverty of a sizeable portion of our population, what we may term the "network" of health and health-related pathologies, and the large problem of communication of values.
I pursue this approach because, to paraphrase William Menninger, a human being must be seen as a totality, and sooner or later his family, community, work, upbringing, physiology, biochemistry, pathology and residuals of early disease and experience must be taken into account. Obviously, in dealing with the health of the human being in his family or community context, it is necessary that numerous disciplines work together in coordinated fashion because the man himself must be seen as a whole man.
THE HEALTH CARE DELIVERY SYSTEM
In looking at the health care system in our nation for the population at large, there are problems of fragmentation: medical services must be shopped for and can be found only in little pieces and segments. This has resulted in medical care services which are not comprehensive but are narrow and limited; even in concept they are not designed to cope or to be concerned with looking at the total problems of the total person. We have also created problems where health care services are not continuous, because of the multiple organizational structures which have evolved. In addition, health care services have been developed which are all too often of poor quality. Dr. John Philp has said that, "there follows an obvious need to completely restructure and repackage our system of providing health care. Our new package and structure must be a system which will eliminate the fragmentation, which will provide comprehensive care for the total problems of the total person, which is continuous, which is of high quality, and which is family centered. …