key: cord-0739603-n02tdrak authors: Monajemi, Alireza; Namazi, Hamidreza title: Health lag: medical philosophy reflects on COVID-19 pandemic date: 2020-12-23 journal: J Med Ethics Hist Med DOI: 10.18502/jmehm.v13i28.5045 sha: 0c277f7058b48f56efdf725b4f148155b56863b1 doc_id: 739603 cord_uid: n02tdrak In this paper, we reflect on the COVID-19 pandemic based on medical philosophy. A critical examination of the Corona crisis uncovers that in order to understand and explain the unpreparedness of the health systems, we need a new conceptual framework. This helps us to look at this phenomenon in a new way, address new problems, and come up with creative solutions. Our proposal is that “health lag” is a concept that could help frame and explain this unpreparedness and unreadiness. The term “health lag” refers to the failure of health systems to keep up with clinical medicine. In other words, health issues in most situations fall behind clinical medicine, leading to social, cultural, and economic problems. In the first step to define health lag, we have to explain the distinction between clinical medicine and health and address the role of individual health, public health, and epidemic in this dichotomy. Thereafter, the reasons behind health lag will be analyzed in three levels: theoretical, practical, and institutional. In the third step, we will point out the most important consequences of health lag: the medicalization of health, the inconsistency of biopolitics, inadequate ethical frameworks, and public sphere vulnerabilities. Finally, we try to come up with a set of recommendations based on this philosophical-conceptual analysis. Bill Gates, in a Ted Talk in 2015, compared the cold war situation with the present time. He told a story about when he was a kid, the American people were worried about nuclear war. All families had filled their cellars with cans of food and water. All people were taught what was needed to be done in a crisis: go downstairs, hunker down, and eat out of the barrel. However, nowadays, rather than a nuclear war, the greatest risk is pandemic. But it seems that we are not actually well prepared for such an epidemic (1) . Furthermore, the comparison between the COVID-19 pandemic and the Spanish flu that happened a hundred years ago reveals that the preventive technology (e.g., mask) has not changed significantly, and we use roughly the same measures against COVID-19. In this period of time, however, the diagnostic and therapeutic technologies have evolved so drastically that previous technologies look as old as the hills. Why is that? Why prevention has remained unchanged in the past hundred years, while the diagnosis and treatment have improved drastically? Why we are never ready for epidemics? In addition to the existing healthcare crises, the latest coronavirus pandemic has exposed several challenges in the healthcare systems around the world, such as system inability to rapidly detect and monitor the dissemination The health lag is basically due to the Ill-structured health institutions are the main reasons behind this gap (11) . Health lag has several consequences, the (14). Health lag indicates that health is not simply limited to clinical medicine and has cultural, social, and political aspects. Although Biopolitics links health with clinical issues (15) . This does not mean biopolitics that aims at eugenesis, nor does it seek social control, but it is a concept close to care-politics. Since health is described as a governmental duty and a right for the citizens, care policy does not mean governmental stewardship but requires everyone to take care of their own health as well as that of others. Commonly The three mistakes in moral reasoning in the COVID-19 pandemic highlight the other aspects of health ethics inadequacy: "illusion that we can avoid trade-offs," "leave it to the experts", and "precautionary paradox" (17) . As health is not based on an independent theory and knowledge, popularization of health leads to medical language usage. Using medical vocabulary and literature to encourage people to preserve health will lead to health anxiety. This is because we have to health, the conception of public health will be based on a strong commitment to collective endeavor (18) . The most recent use of the term 'new public health' has emerged from the recognition of the fact that major health problems cannot be solved by current medical care (18) . For epidemiology to become reintegrated with public health practices, changes will be required in both the education and training of epidemiologists as well as in the practice of public health. It will not be easy for epidemiology to regain its population purposes and have a closer connection with healthy public policies. In this regard, a social policy approach to healthy lifestyles' rather than the current 'lifestyle approach to social policy' is required (18) . In order to overcome health lag, medical humanities should play a crucial role both in reflecting on the health lag and criticizing the contemporary approach to health. In this regard, a paradigm shift towards critical medical humanities should take place (15) . Interdisciplinary disciplines such as health policy, bioethics, and medical education that originally belong to the field of medical humanities 1 have forgotten their roots and become highly technicalized and bureaucratized. Will discovering the corona vaccine solve all the problems? 1 . Medical Humanities is a field of research, education, and practice that examines health and medical issues from the perspective of medical philosophy, medical ethics, medical hermeneutics, medical sociology, medical history, literature and medicine, and so on. Medical humanities, while trying to neutralize and overcome the reductive and dehumanizing approach of biomedicine, has attempted to improve and enrich clinical practice, patient care, and medical education (5). Do we no longer need to deal with health lag? Would science reclaim its superiority with the discovery of the vaccine? Is it true to say that the main reason behind the priority of clinical medicine over health is greater efficiency and less complexity? Would these questions still be relevant in the presence of the vaccine? Should the vaccine be given to everyone? If not, who is in priority? Obviously, these are not the main clinical concerns. So, it could be concluded that there is no escape from prioritization, which is a philosophical, political, social, and cultural issue and belongs to the health realm. December 2020 The next outbreak? We 're not ready COVID-19 implications for the health care system Communicating in a public health crisis. The Lancet Digital Health COVID-19 pandemic and comparative health policy learning in Iran Medical humanities meets corona virus pandemic: a report of the webinar on the dialogue between medicine and humanities The Enigma of Health: The Art of Healing in a Scientific Age The Hermeneutics of Medicine and the Phenomenology of Health: Steps Towards a Philosophy of Medical Practice The Birth of the Clinic. UK: Routledge Normality as convention and as scientific fact From old to new public health: role tensions and contradictions Concepts of Epidemiology: Integrating the Ideas, Theories, Principles, and Methods of Epidemiology The Medicalization of health and shared responsibility Medicalization of global health 1: has the global health agenda become too medicalized? Glob Health Action Clinical practice in the techno-science age: living in crisis The Medical' and 'Health' in a critical medical humanity Preparedness: medical ethics versus public health ethics Three mistakes in the moral reasoning about the COVID-19 pandemic Public Health at the Crossroads (Achievements and Prospects)