The Politics of Health

Is it permissible to speak of politics in matters of health, or of health in matters of politics? Has health in Lebanon any politics — or has politics in Lebanon any health, one wonders?

Between politics and health in our country there is a marked aversion, plain to see on both sides. The political circle, on the one hand, considers the rank of health work to be among the lowest ranks on the ladder of ranks; and the health circle, on the other hand, considers the rank of political work to be alien to it, and beneath its worth — in essence, and in its claim upon a man's attention. Hence the politicians, when they distribute the various posts responsible for rendering the various services to the various parts of the people, do not race for the posts responsible for health as they race for certain others; nor do they carve out for health its due share of the general budget, but assign to it whatever the leavings of the budget allow, after the shares of most of the other important public services have been cut from it. And likewise the men of health: if it fell to them, say, to shoulder the responsibility of politics in general, they would distribute the various posts and divide the chapters of the budget according to their own conception (not the politicians' conception) of the relative importance of the various public services, and would give the educational, health, and agricultural services the importance that befits them.

Yes, one observes clearly that there is a plain difference between politics' view of health and health's view of politics. Politics, in its essence, is a reconciling and balancing of duties with rights, and of responsibilities with powers, in the arena of the continuous interplay between the individual and the community. Health, in its essence, is the application of politics to one single service among the services of the public interest — namely, the service of the body and all that it involves: the relief of pain, the treatment of sickness, the warding off of ailments, and the improvement of man's capacity to enjoy material and moral well-being together. Hence politics is a psychological and social movement in the full sense of the word, while health is at once a biological and a psychological-social movement.

Politics, then, concerns itself with what is more important than the body, inasmuch as it concerns itself with the purpose for which man was placed upon this earth within the frame of the body; and therefore it is more important than health, because it contains it — while health is the less important, not only because it is a part of politics, but because it concerns itself with the body and what pertains to it; and the body is nothing but an instrument for those values for whose sake arose the need to order men's affairs with one another — that is, for politics itself. In other words, the concerns of politics include the concerns of health as an instrument, and not the reverse. We gather from this definition of each — of politics and of health — that the aversion actually apparent between them is no aversion inherent in their nature; on the contrary, the essence of politics comprises the essence of the work of health, and the work of health is, after all, among the works from whose sum the work of politics is composed.

Therefore, to speak of politics and health, or of the politics of health, is entirely permissible; and we have the right to weigh, in speaking of it, the basic considerations upon which the health of the politics of health rests. It is no secret that to speak of politics in general means, inevitably, to speak of the responsibilities and duties of the government and of those in authority, more than of the responsibilities and duties of the people; that talking politics has become almost the specialty of the general public in our country, ahead of the professionals and those engaged in it; and that the physician — who, in matters of general politics, is one of the general public — is accordingly entitled to give his opinion on the politics of health at least. It should be understood, moreover, that if it were destined for the physician actually to take over the reins of politics, or of public administration, it might perhaps

be vouchsafed to him — thanks to his fidelity to his professional heritage, and thanks to his knowledge of the principles of diagnosis, treatment, and prevention — to organize it well and to shoulder it, were he to follow in treating it the same principles he follows in the practice of his profession, or to consider that society, like the individual, is a unity of different parts, which falls ill whenever the inclinations of its parts conflict, and recovers whenever those inclinations harmonize...

And as for people in all their variety — if the men of politics mastered their several tasks, people would find no way and no occasion to talk politics; rather they would turn from it to attend to their own private affairs, upon the level of the ultimate spiritual values for whose realization man was created, and for the securing of whose possibility of realization politics existed at all. What, then, are these basic considerations, these principal foundations, of the politics of health in Lebanon?

First — the science of health is necessary for the conduct of the affairs of health. Health programs — rural and urban; curative, preventive, and ameliorative; centralized and decentralized; official and private — must proceed according to the science of the specialists, in the light of trustworthy statistics, and through a respectable budget of not less than ten percent of the general budget; and they must be directed to the people at large, who have the right to bask in a flood of the light of health education. Yes, health is a science, not opinion; and it is a science concerned with producing specialists — physicians, nurses, midwives, health visitors, social workers, dentists, pharmacists, sanitary inspectors, laboratory experts, and others — to render the health services to the whole people. Hence the politics of health must be drawn from the science of health, and not from the politics of sectarianism, feudalism, and favoritism — even if the present situation in human Lebanon is still stamped with this latter politics, and not with the science of politics itself. For the present situation in microbial Lebanon is affected by these considerations only to the degree that people's mentality is affected by them in their readiness to take counsel of the specialists in the matter of their health. All this is a part of what the specialists themselves must attend to — they know it better than anyone, and know better than others that the health of human beings, unlike the health of animals, is affected not by biological considerations alone but by human psychological and social considerations as well. Indeed, the health of human beings is rooted in the biology of microbes and bodies, and branches out into an atmosphere heavy with human psychologies and socialities. Therefore, if the health scientist takes account of people's mentality and their psychology in respect of sectarianism, favoritism, and feudalism,

he takes account of all that only when rendering the health services to the human flock; and he takes account of nothing but moral and scientific competence when appointing or employing those to whom the task of carrying out these health programs is entrusted. The politics of human health is rooted in the soil of biology, and rises with its trunks and branches to the sky of psyche and society; while the politics of animal health is sunk in the soil of veterinary science, and never aspires above the dust.

Second — administrative organization is necessary for the conduct of the affairs of health. All the health services, classified in the light of the science of health into general programs by the health specialists, and directed to the various parts of the people according to age, sex, and educational, economic, and health level, must be centralized in the Ministry of Health, so that this Ministry becomes their final advisory and administrative authority — while these various tasks are distributed, within the frame of the Ministry itself, in a decentralized arrangement, according to the logic of science and to local capacities.

Hence it is expected of the Ministry of Health alone to unify and coordinate the various international and local efforts, governmental and independent, with which the country teems — without guidance, and without any overseeing, clear-sighted direction.

Third — executive firmness is necessary for the conduct of the affairs of health. The Ministry of Health, once it has planned its programs and organized its administration in the light of the science of health, must consider itself, in fact, a ministry of defense. For just as the military ministry of defense against the human enemy is compelled to conduct its affairs with rigor and firmness, so the health ministry of defense against the microbial enemy must see itself compelled to conduct its affairs with the same rigor and the same firmness. The operations of execution according to the plan laid down must be neither obstructed nor deflected by any outside considerations foreign to the logic of health. Thus, for example, in the distribution of fellowships for specialization abroad or at home, nothing but competence may be weighed; and in the distribution of the health services among the districts and provinces, nothing may be considered but local need, curative and preventive, as the science of health and statistics have shown it.

It is clear from the foregoing that the aversion between politics and health is only an apparent aversion; that reality attests to a bond between them so close that it makes the politics of health in Lebanon healthy if it rests upon three pillars — science, administrative organization, and executive firmness — and makes it sick if it rests, on the contrary, upon ignorant, haphazard floundering, upon administrative chaos, and upon executive flabbiness.

Yes — thus can the politics of health in Lebanon be set right; and thus too, little by little, can the health of politics in Lebanon be set right as well.

Dr. Zaki Shakhashiri
Member of the Department of Hygiene of the American Medical Institute
and President of the Lebanese Public Health Association