With the predictable ostentation of tradition, and the particular scrutiny born of untraditional concerns, the health of President Trump was announced to us this week as “excellent.” We might all be forgiven for thinking that means something formal, standardized, and reliable. As a medical insider, however, I regret to report we are not nearly so precise as that. Characterizations of health are subjective, rather in the eyes of the beholder, and like all else–relative.
We are invited accordingly to ask: excellent, compared to what? Even that tends to vary, but the customary answer would be: the prevailing norms of a given population or culture.
The typical American, with a typical American diet and lifestyle, is at massively elevated risk for debilitating chronic disease relative to, say, the typical Blue Zone resident, or the atypical Americans who manage to take good care of themselves here in spite of it all. America overall is famous for spending more on disease care than peer nations around the world, while having far less health to show for it by the measures that matter most: years in life, life in years, and the bounty of both. Americans lag behind much of the developed world in longevity , and lag even further behind in vitality.
None of this means, however, that Americans can’t have “excellent” health. It’s just that our version of excellent health is relative to one another. Among the
Tsimane , or in Ikaria, Greece, excellent health at age 71 is likely to mean no trace of coronary atherosclerosis, and the likelihood of remaining vigorous for years to come. Here, “excellent” health at 71 almost certainly means you have plaque in your coronaries like everyone else living where junk is a food group; the food supply is
willfully engineered to be addictive and no one seems to mind ; and sitting is the national contact sport (the contact being, of course, between cheek and chair). What’s required for “excellent” is simply that in spite of all of that, you haven’t had your first coronary bypass operation…yet.
The typical American among us, in other words, would likely register as having “excellent” health the day before their first preventable heart attack, stroke, or hyperglycemic emergency.
This all makes perfect sense amidst the radically distorted view of health our culture has promulgated. While referring routinely to a “health care” system, we in fact have a disease care system instead, doing stunningly little as a society to cultivate health at its origins in lifestyle and social circumstance, and instead reacting preferentially to disease we could have readily prevented only after it arrives. We go further, propagating chronic disease to the profit of certain large industries, and then treating the unnecessary misery that ensues to the profit of others.
Excellent American health, alas, is defined in this context. The bar is set rather low.
If anything, the bar for excellent presidential health may be set lower still. As noted aptly at Vox, public disclosure of the president’s health status is more political theatre than a peak behind the curtain at
HIPAA headquarters. Rest assured privacy is being protected; there is some public relations legerdemain at play. We are being shown only what we are supposed to see.
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