An Old Woman of Arles

A Vexing Question: What Is Healthy?

Appearance has come to dominate our concept of what is healthy. And in turn, our culture links both appearance and health to virtue. Thus, when Cosmopolitan invites 11 women with wildly different appearances to describe their personal journeys to good health, Twitter has a fit. The cardinal sin seems to be declaring This Is Healthy! in regard to a woman in a body that doesn’t conform to cultural standards for size, shape, and appearance.

The retort from critics was sharp: This is irresponsible! From there, the discussion deteriorates into a pointless argument about the health implications of obesity. Yuck.

At the heart of this discussion is a fact that people have a hard time accepting. The definition of good health is very personal. It is different for every person. So unsolicited judgment or advice about a person’s health is unwelcome, ignorant, and rude.

A Culture of Health? Or Healthy Appearances?

The idea of fostering a culture of health is quite popular. It sounds like a great aspiration. But in practice, our image-driven culture often corrupts that aspiration. Annemarie Jutel and Stephen Buetow explain:

“This dominance of the visual in our image-driven culture has assumed a disproportionately prominent position. Media, businesses, and health care commonly misrepresent appearance as the reality of health. Industry mongers beauty-promoting wares and services as health-protecting products, and physical appearance contributes to clinicians’ imperfect heuristics.”

For a condition like high blood pressure, this doesn’t get in the way of clinical care. That’s because the measure for this disease is purely objective. Providers measure it. If it’s high, they treat it.

But when a condition affects a person’s appearance, objectivity is at risk. A visual cue is an invitation to stigmatize a health condition. Professor Rachel Smith calls it the mark for health stigma.

Lazy, Crazy, and Disgusting

Health stigma makes living with any health condition much more difficult. Unfortunately, some public health advocates make the mistake of using stigma as a tool to promote health. But it can go terribly wrong. It can have the effect of labeling people who deserve care as lazy, crazy, and disgusting. In a compelling book, Alexandra Brewis and Amber Wutich describe the great harm that ensues.

Certainly, we have seen this in obesity. And the result has been four decades of blame, shame, and policies that only made things worse for the people living with this condition.

Good Health Is an Aspiration

At the end of the day, we need to admit that good health is an aspiration that is different for every one of us. We all have health problems. Some are visible, some are not. Appearances are deceptive. And in the end, life is short. When we presume to make judgments about someone else’s health, we are devaluing their life. That is a mistake to avoid.

Click here for more on the book – Lazy, Crazy, and Disgusting. For more on the role of appearance in health from Jutel and Buetow, click here.

An Old Woman of Arles, painting by Vincent van Gogh / WikiArt

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January 17, 2021