In many ways the concept of holistic health care is largely a 20th century notion. This is to say, prior to the twentieth century a thoroughly articulated reductionist or selective philosophy had not fully emerged, and hence neither had the need to articulate a comprehensive and holistic approach in similar terms. What we now label holistic medicine certainly existed, as it was historically speaking the global norm. With the Flexner Report of 1910 however, the medical pluralism of the 19th century came to a dramatic close and a new era of medical hegemony arose not seen since the decadent period of late Galenic medicine. Unlike Galen however, who was beyond question for a millennium and a half, the model Flexner galvanised came under serious re-evaluation in as little as half a century.
Within 60 years of the Flexner report being published two major movements had emerged to address serious flaws in the new approach. From the public sectors of the world emerged the primary health care (PHC) movement; this formalised a radical de-emphasizing of the Flexnian clinical-research model in light of the now understood social determinants of health such as education, community infrastructure and social equality. Culminating in the Alma Ata declaration of 1978, this movement was explicitly political and saw world health as a rallying point for socio-economic change. At exactly the same time a lay-public renaissance in holistic health was emerging entirely outside of state sanctioned healthcare structures. The medical traditions whose schools and associations had been closed in the wake of the Flexner Report were rediscovered by a generation of lay practitioners in an interesting renaissance of the folk tradition previously thought to be extinct in the west.
Both of these movements however, had significant limitations that are now made visible with the clarity of hindsight. The PHC movement clearly articulated the social, political and economic drivers of disease and created a coherent conceptual framework for healthcare policy writers to be guided by. In doing this the medical industry was philosophically forced to relinquish its monopoly of health care, as many of the primary determinants of health, including environmental, economic and cultural factors, were obviously beyond the reach of doctors. Despite upholding the need for a comprehensive and holistic approach to health care planning however, the PHC movement was largely silent on the actual delivery of health care services which thus continued along reductionist lines that contrasted with the otherwise holistic framework.
The holistic health care (HHC) movement on the other hand, brought medicine itself under the spotlight of public scrutiny; no facet of medical practice or philosophy was exempt and ‘complimentary’ and ‘alternative’ options were espoused for everything from acute infections to childbirth. A strong emphasis on personal responsibility was universally upheld in an attempt to address the previous appropriation of lay health care knowledge by the medical industry that Illich termed ‘social iatrogenisis’. By making every health issue one of personal responsibility and empowerment however, the social and political drivers of disease were largely obfuscated, and whilst orthodox medical practice remained the sole source of criticism the existing socio-political status quo went unquestioned by much of the HHC movement.
Viewed from the present, the conclusion to the above situation is painfully apparent. The only point that remains to be made is that whilst the HHC movement has blossomed into a full scale ‘wellness revolution’, the PHC movement was largely scuttled and replaced in all but name by the ‘selective’ PHC model by most national systems. The task of integration therefore appears to have fallen to the HHC movement with a holistic approach to primary health care being the obvious goal.
Dr Jimi Wollumbin
CEO, One Health Organisation