Health is one of those nebulous concepts that seems straightforward and obvious, but then on closer investigation is very difficult to pin down. Of course, some health judgements are easy, but many aren’t possible to make without aesthetic judgements that are person- or culture-specific. How important is physical capability? How important is longevity? Are athletes (people who are at higher risk for heart disease) healthier or less healthy than non-athletes? Are people who use wheel chairs inherently less healthy than people who can walk? How important is beauty? Is horrible acne a health problem? Is bad body odor (in the absence of other symptoms) a health problem? What about happiness? Is happiness a part of health? If so, how do we define emotional well-being? Is someone who experiences a lot of joy, often in inappropriate situations healthier than someone who experiences much less joy?
I’m not interested in answering any of these questions right now. I’m just trying to demonstrate that health is subjective: Health depends on cultural values and aesthetics—we can’t have a discussion of health without also having a discussion of what aspects of the human experience are valuable. So, where do these values and aesthetics come from? Well, um. A lot of them come from powerful people who want to make money in the health industry.
To some extent, advertising is about sharing information, so that people who would want a product—if only they knew about it—will know that it exists, will want it, and will buy it. But people don’t have immutable desires, so advertising is also about shaping what people want. If you can shape the public’s utility functions, then you can make people want to buy whatever you have to sell. In the health industry, shaping utility functions means manipulating the public conception of what it means to be well.
A couple of examples:
Herpes is extremely common. Up to 90% of the adult population has some form of herpes. It’s also extremely stigmatized. One 2007 poll placed it in second to HIV for the most stigmatized STI. Herpes is also mostly harmless, in most people causing only a mild itchiness at times when our immune system is down, like when we have the common cold (hence the term “cold sores”). In rare cases, the virus is inconclusively linked to much more serious illnesses.
Where does the herpes stigma come from? Herpes stigma arose in association with disease awareness campaigns conducted by Burroughs Wellcome, a pharmaceutical company that had developed an anti-viral herpes treatment. Within a decade, herpes went from itchiness to disease.
This shift in public perception is based neither on facts nor on misinformation, but instead on aesthetic preferences. Is communicable itchiness a health problem, or an aspect of the human condition? I don’t think there is a correct answer to that question. It’s not a question of essential health, but instead a cultural question about how we interact with our bodies.
Prozac was the first SSRI to hit the market, and made a huge difference for a lot of people who were suffering from depression. For Prozac’s pharmaceutical company, Eli Lilly, the mission wasn’t as straightforward as connecting patients with a preexisting depression diagnosis with a new medication. They also wanted new diagnoses. They wanted to create a depression drug market.
Prozac was released with unprecedented “revolutionary” levels of dedicated marketing. Eli Lilly needed to communicate that depression was something that normal people could experience—decreasing the stigma of psychiatric treatment and therefore expanding their market. And they needed to spread the idea that chronic sadness was something that could and should be treated as a biochemical problem. By adjusting the levels of neurotransmitters in our brains, we can become healthier and happier—and investors in Eli Lilly can become wealthier.
Arguably, the narrative that the Prozac marketing team pushed was a very healthy narrative for society to receive. Here‘s a New York Times opinion piece that argues exactly that.
Not only was it suddenly O.K. to be taking an antidepressant, for many it became a badge of honor. Its marketing let everyone know, “hey, depression isn’t a personal failing or due to poor morals or bad parenting. It’s a biochemical thing that a medication can help with.”
More recently, I’ve seen a lot of push back against the depression-as-illness narrative. Mood issues definitely can be caused by biochemical imbalances, but when we treat chronic sadness as necessarily medical, we sublimate community issues like oppression or loneliness or economic strife into a collection of maladies that afflict separate individuals. And we treat these community issues with individual drug prescriptions, instead of with social change.
As with herpes, I don’t think there’s a fundamentally correct answer to the question “Is chronic sadness a health problem?” Some people really benefit from thinking about depression under the health-problem umbrella. Others view chronic sadness as a healthy response to a bad situation. Of course the answer will be largely dependent on the specifics of the sufferer and the sufferer’s situation. But it’s also necessarily a question of a culturally determined ideal. How much sadness does a healthy person experience? What is health? These are exactly the types of nebulous questions that marketing is good at targeting. Prozac shifted the public conception of a healthy person toward a more joyful person.
Marketing shapes how we conceive of own bodies. I don’t really have a coherent argument about this being a bad thing, but it makes me uncomfortable. A conception of health that is shaped around enriching pharmaceutical companies probably isn’t a good conception of health. Right? I don’t know..