Perspectives
It took decades to develop an effective Influenza vaccine, 13 years for the first Typhoid Fever vaccine, and four years for the MMR vaccine. The Covid-19 vaccine was created in fewer than 12 months. Whilst these comparisons lack nuance, they are illustrative of the exponential growth rate of scientific development for disease prevention.
However, this is just one facet of health. There have also been significant shifts in how we approach the diagnosis and treatment of health conditions, and how we think about health itself. An example of this change is homosexuality being included as a mental illness in the International Classification of Diseases (used by health care professionals to assign codes to patients based on their medical condition) until the 1970s, reflecting shamefully normalised homophobia.
It is easy to look back with incredulity at the way societies of the past considered health and disease, but we would also be naive to imagine generations in the future will not think in the same way about how we are addressing our most pressing health challenges today.
How can we think differently about our current challenges?
It’s important to remind ourselves that health doesn't just exist within a biomedical paradigm. Take the concept of disease for example - how would you define it?
In the most general sense, a subjective definition is when a person indicates a health need: they self-assess and conclude they are not well. Of course, this varies hugely – a stoic’s mild ailment may be another person’s incapacitating sickness.
Many would default to a seemingly objective explanation: that a disease diagnosis requires the outcome of a diagnostic test or the presence of specific symptoms that can be clinically examined. This definition works in an abstract sense, but in the real world there is still an element of subjectivity here: diagnosis rests on a physician’s judgement. If they miss a diagnosis, does that mean is there no disease present?
Why is disease so difficult to pin down?
Like many concepts, it depends on who you’re asking, when you’re asking it, and where you are in the world. Taking this into account, one accepted definition is that disease is a condition, which, judged by prevailing culture, is painful or disabling and deviated from either the statistical norm or norm from some idealised status.
The key word here is culture: what we consider disease, and health more generally, is dependent on the values, beliefs and norms that shape our understanding.
This definition helps highlight how disease is not just a concept in the world of biomedicine, but is socially constructed. As a society, we draw on many factors to understand disease, and these factors change over time and place.
For example, the term whiplash was misused in medical literature in the 1940s to describe injury from collision, when its initial use was to simply describe a motion. It was then increasingly used as a diagnosis of what can be subjective symptoms, arguably promoted by financially-motivated patients, lawyers and medical professionals.
A disease diagnosis allows a person to access what is described as the sick role, which may include: permission to be ill, the possibility of treatment, benefits such as sick pay, and drawbacks such as stigma. If society enables access to these, they then in turn affect what we diagnose as disease.
How is this useful to us?
Changes in disease recognition and categorisation reflect changes in more than just medical and scientific knowledge. We need to appreciate that context and culture not only shape our understanding of disease but also impact how and why diagnostics and treatments are developed, how health care is delivered and paid for, and how patients experience and perceive it.
As researchers, we need to be cautious in our confidence about present-day knowledge, and our ability to predict the future. It is vital for us to question how we know what we know, and what we might be missing.
These questions will help us recognise cultural paradigm shifts early, be open to the multiplicity of futures they may incite and deliver truly uncommon insights for our clients.
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