Who needs health care?

Editor—I agree with Heath that the waning of professional power among healthcare professionals has been wrongly perceived to be in the interest of patients' autonomy, whereas increasing corporate power has done more harm, albeit indirectly, to patients' autonomy.¹

I also agree about the relation between longevity and self reported illness. Heath seems to attribute this to the supposition that when society achieves good health, it has greater expectations of health and consequently more fear and anxiety when health seems threatened by real or perceived risks.

This observation is, however, not surprising if the response of society to improving health is conceptualised in similar ways to Maslow's description of the hierarchy of human needs.² Society can be considered an individual entity for the purpose of this concept. Accordingly, a society that is still grappling with ill health will not move on to expectations of higher needs, whereas a society whose basic ill health issues seem resolved will naturally expect something higher—longer and quality life as well as abolition of uncertainties in health.

According to Maslow, any gaps in the need level at which an individual operates may result in reversion to earlier need levels to “remove” the gap. To suggest the devolution of resources away from preventive medicine in a society that is already health primed such as ours will only lead to an unhealthy reversion to a lower needs status with its attendant challenges. Preventive medicine deserves more respect than has been accorded in the article.