What Queen Charlotte teaches us about health

Towering over his head like a Queen Charlotte hairpiece, it’s the first thing I notice about Kyle (not his real name).  The stuffed full black garbage bag is somehow perched on his neck and oddly stable, considering its size. He seems not to notice it as he walks, the bag not budging from its place. 

He takes pieces of paper out of his pockets. These had a few key sentences on them, which he points to as he shows them. The first one says, “I have a speech impairment and cannot talk.” He uses these to ask a few questions about the dinner we were offering. We answer these. He refolds his worn-thin papers. He bows his head slightly in thanks (the bag doesn’t move) and goes on his way. 

Now ask yourself, what is the best thing that could happen to improve his health? 

Obviously, it is to get a stable place to live. This would give him several crucial health-giving things, like a place to rest and bathe. Just as important, it would free up mental bandwidth for thinking beyond the next place to sit, sleep, or eat. 

No sane person would look at him and say, “Gee, let’s get his blood pressure tested and see if he needs treatment.” Or “He really should get screened for colon cancer.” 

Intuitively, we know that health is not medical care, but we only seem to know this when the person’s life circumstances are blatantly hazardous. In truth, even for Queen Charlotte, life circumstances do more to shape our health than medical care. Social and economic factors affect almost half of our health status; medical care affects less than 20 percent. 

This means that addressing social and economic conditions impacts a person’s health more than making medical care easily available. In fact, medical care won’t do much if the social conditions are untouched. That would be like getting Kyle a colonoscopy and leaving him unhoused. On the other hand, good life circumstances soften the impact of bad health habits. Queen Charlotte’s snuff habit doesn’t shorten her lifespan as much as it would for her subjects. Surrounded by luxury, she has a lower risk of lung cancer. 

Like Mae West, are we just saying, “I’ve been rich and I’ve been poor, and rich is better.”? (Note: West also said love conquers all things except poverty and toothache.) While that may be true, it doesn’t help us to help people. To truly help people live longer, healthier lives, we need to focus first on the environment of their health. Medical care might come later.