Health and wellbeing?

To the familiar assertion, endorsed in the well-known founding statement of the World Health Organization, that ‘health is more than the absence of disease’, sociologist Stephen Bowler responds: ‘the question is, though, how much more?’¹

‘At what point’, he continues, ‘does health lose all meaning and become, instead, a register of everything as it impacts, or not, upon an individual? At what point does the individual become a product of all those forces, as opposed to a self-determining agent in his own right?’.

These questions came immediately to mind when I read the terms of the NHS Health Check,² now being ‘rolled out’ in our surgeries to every patient between the ages of 40 and 74. This programme incorporates a ‘mid-life’ health check and a ‘behaviour change tool’. This Orwellian-sounding device is designed to deliver ‘individually-tailored lifestyle advice for everyone having a check, regardless of their risk’. The idea is that it helps to ‘motivate’ patients and ‘support the necessary lifestyle changes to manage risk’. The tool incorporates detailed checklists regarding smoking, physical activity, weight management, and alcohol consumption, requiring the examiner to inquire into the patient's habits, record these carefully and advise accordingly.

According to the promotional literature, the NHS Health Check ‘analyses the information people provide and then presents them with detailed feedback’. It ‘helps people plan for lifestyle change, giving ideas, information, and support’. Furthermore, ‘users will be able to set personal goals and request helpful information’. It seems remiss that the Department of Health has not produced something along the lines of a Blue Peter badge — perhaps a baseball cap? — so that ‘users’ could display the fact that they have completed the Health Check.

The ‘ultimate aim’ of the NHS Health Check is to help individuals to ‘manage their risk and stay well for longer’. It is thus not merely concerned with maintaining physical health, but also with preserving ‘wellbeing’, a term increasingly coupled with health in official policy documents.

Another sociologist, Paul Hoggett, is in favour of what he describes as ‘a holistic vision’ for welfare policy in general ‘which aims at meeting the emotional as well as physical needs of human beings’³. For him ‘the concept of wellbeing provides a core principle around which a new vision of positive welfare could be organised.’ He is critical of the record of the NHS and other welfare services for paying only ‘lipservice to wellbeing and prevention’ while concentrating resources on treating acute problems. No doubt he would welcome the NHS Health Check as signalling the adoption of ‘a holistic approach to integrated subjects rather than one adapted to specialised, professional interventions aimed at objects.’

Yet the process of objectifying the body has been the key to the triumphs of medical science over the past three centuries. It has enabled the human subject to transcend some of the limitations imposed by nature — his own included. Hoggett's notion of an ‘integrated subject’ reflects the breakdown of the historic division of labour between doctor and patient, medicine and society, ‘in which medical science attends to the body of man to the extent that the body of man is thought to compromise his will’.¹ But in a society in which the creative tension between the dynamic subjectivity of robust individualism and the vigorous objectification of progressive science has become attenuated, the integrated subject emerges in the form of the ‘worried well’, the feeble and vulnerable ‘service user’ who is the object of the ‘behaviour change tool’ of the NHS Health Check.