WHO defines health as “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity”.
We must look at health as a positive attribute and we must differentiate it from medical care. While it is true that better medical infrastructure is available in the cities, it is also true that this does not necessarily translate into better health.
Better health comes from a healthy lifestyle – wholesome food, physical activities, fresh air, low stress living etc.. With today’s technology, it is easy to adopt preventive healthcare measures and manage chronic illnesses no matter where one is. Management of chronic illnesses like diabetes, hypertension, coronary heart disease, thyroid disease, chronic mental illnesses like depression etc. are not an issue, because they are patient-compliance based and they can get guidance online. In fact, they are better managed in a low stress setting.
The key phrase is “well being”. One should feel well. Unfortunately, there is a lot of anxiety and fear among the people today as we become rather obsessed with various medical conditions. Our focus today is on disease rather than health and this itself is a state of disease!
When people think of moving to an “underserved” area, just as they are worried about the lack of infrastructure that they are used to, they are particularly worried about availability of medical help. This is especially true for the relatively older people.
Diseases can be physical, mental or even deeper which some would describe as “spiritual disquiet”. In life, nothing is permanent and eventually, despite the best of precautions and care, we all fall prey to some form of disease or the other. Some are minor in nature while others are major or life threatening.
Most illnesses begin slowly and give us time to respond while some are emergencies which require immediate attention and time is of essence. It is the emergencies that we are worried about when we live in an underserved area. The commonest emergency situations are:
- Heart attacks
- Strokes including heat strokes
- Bites and stings
Adequate knowledge of first aid would be essential and could be life saving in an under-served area. Having a well maintained emergency kit which includes life saving medicines and other material can help mitigate many emergency situations and buy time till the patient is able to reach an adequate facility.
Today, many people, particularly in the cities, live in fear and are constantly worrying about falling sick. There is also the fear of huge medical expenses which have become the order of the day. Such fear and anxiety itself is detrimental to well being and health.
Also never ending expectations are setting newer and newer standards of what medical care should be like. Paradoxically, this does not always translate into good care. Corporate entities are increasingly taking charge of medical care in the cities and by design their intentions are commercial rather than altruistic. There is always an incentive for acquiring more and more equipment and adding infrastructure that generate more returns. When doctors are facing litigation and even physical assault in their line of work, they are increasingly under pressure to practice defensive medicine- this means they will tend to utilise every available technology to make “sure” of what they are dealing with. Oftentimes patients in their anxiety even demand tests and treatment that have dubious merit just because of the way they are advertised. Because there is always uncertainty in the outcome no matter how competent the treatment is, doctors are always placed in the dilemma of having to use every available technology in order to prevent “mishaps”. So, every possible scan or other tests tend to be used. ICU care is resorted to when care in the general setting is adequate and so on. This often predisposes to unnecessary medical interventions. Medical expenses are burgeoning. When insurance companies step in to address this opportunity, they add another dynamic to the system by dictating treatment protocols which are often suboptimal.
It is also a reality of urban living that because of heavy traffic and snarls, it is not unusual for undue delay in reaching hospitals which may physically not be that far away.
In times of pandemics, we have seen that people of the cities with its crowds and activity are much more vulnerable than the people of the rural areas who live in more open spaces.
A healthy state comes from relaxed, stress free living, close to nature and not constantly fretting over one’s physical condition. No matter where you are, there occur situations that you can’t anyway do much about. So really, it is a matter of accepting what level of resources you have access to.
Urban vs. rural, which is better with respect to healthy living? Both have their own advantages and disadvantages. If you look at longevity alone, there probably is no clear winner between urban and rural, but in terms of wholesomeness, my choice is rural. Farm living makes for a better holistic health experience, but emergency services, if one should suddenly fall ill, are probably better accessible in urban areas. Ultimately, it is a matter of attitude and acceptance.
Dr. Sunil K. S.
Gudalur, The Nilgiris