Essay
10 min read
I am a doctor and while my job is to protect human health, I often struggle to take care of my own.
Not because I don't know how. I know exactly how. I know what my sleep should look like, what my nutrition should look like, what my stress load should look like, what my labs should look like. I know the protocols as well as any preventive medicine physician does.
But before I can take care of my own health, I have to secure a job that pays the bills, an income that gives me security, a life I can actually enjoy, the same things every other person in this system has to secure first, and the road to securing them is exactly the road that erodes the health I am supposed to be protecting in others.
This is the paradox at its sharpest point. A doctor whose entire professional purpose is health cannot put her own health first, because the system forces her to put job and income first, like everyone else. The knowledge does not exempt you from the structure.
Most of us learned about Maslow's pyramid in school. Physiological needs at the base, then safety, belonging, esteem, self-actualisation at the top, with the theory that you can't address the upper needs before securing the lower. Health is the body that climbs the pyramid. Without it, none of the other tiers exist. And yet, in the way most of us live today, health is the first thing we trade away.
To secure the base of the pyramid you need a job, the job gives you money, the money gives you food, shelter, safety, the means to raise a family, the connections, the belonging, and eventually the enjoyment of life, because yes, you also need money for that. Everything above survival is mediated by income. You can't secure anything, not even survival, without a job and money.
But the path to that money, chronic stress, no sleep, sedentary work, postponed doctor visits, fast food because there is no time, destroys the very prerequisite the pyramid stands on. The mechanism that lets you afford health is the same one that takes it away.
This is not a personal failure of discipline. This is the architecture of the system.
The data say it everywhere. The higher the socioeconomic status, the better the health status, and the better the survival outcome if disease presents, in nearly every country studied.¹ ² ³ But the route to higher status, especially for the people climbing in the middle, is paved with exactly the conditions that produce cardiovascular disease, metabolic dysfunction, inflammatory dysregulation, burnout.⁴ ⁵ We climb by burning the floor we stand on. So you trade health for health. And while you are trading, you lose it.
A sceptic would say the most important health behaviours cost nothing, that sleep, walking, social connection, breathing properly are all free, and therefore the paradox is overstated.
But that is exactly the point. We trade them. We trade sleep, walking, social connection, breathing, all of which we could have for free, for the hours we work harder for more money so we can afford to take care of our health, and by the time we have the money the body that needed those free things is no longer the same body. The free things are not free because the system has already taken the resource they cost, which is the time we already gave away.
The same logic explains, at the level of whole societies, why countries that have not secured the base of their collective pyramid cannot prioritise health. When survival is uncertain, prevention is a luxury, and public health campaigns about sleep, nutrition, stress management sound absurd to a population that cannot reliably eat or pay rent. Health becomes something you deal with after you have secured everything else, which for most people means never.
The people who most need health protection are the ones least able to prioritise it. And the act of trying to climb out of that position is what damages them.
Maslow placed self-actualisation at the summit, morality, creativity, fulfillment, the realisation of your individual potential, but late in his life he proposed a sixth tier, self-transcendence, serving something beyond yourself, because every other tier is atomic oriented. My survival, my safety, my belonging, my esteem, my self-actualisation. A complete picture of a human life has to include the return to society, the contribution back.
Of course we need to prioritise our own life first, like in the airplane, first you put the oxygen mask on yourself and then you help the person next to you, as you cannot help anyone if you are unconscious. You cannot return to society if you have not first completed your own needs.
But usually we forget this last need. We don't acknowledge its importance, because we believe one can truly enjoy life inside a society that is suffering, and we are wrong about that, because your own longevity is tightly linked to your social relations. The Harvard Study of Adult Development, directed by Robert Waldinger and ongoing since 1938, has tracked the lives of its participants across more than eight decades and found that close relationships predict long-term health and life satisfaction more reliably than wealth, social class, or even genetics.⁶ Feelings translate to chemistry and ultimately body function. Loneliness, measured in the body, looks like inflammation, and social isolation increases the risk of mortality by roughly 29 percent.⁷
You can lock yourself behind a high wall, you can buy the best food, the best healthcare, the best education for your children, and still the suffering outside the wall reaches you, through the air, through the news, through your own conscience, through the next generation that inherits the broken system. There is no private exit from a collective problem.
So the order is right. Self first, then others. But others must come.
Naming this paradox is the first step. The way out is not individual.
Treating health as a tier on the pyramid you reach when you can afford it, and starting to treat it as the prerequisite for everything else, is the one condition society itself has to protect.
That is the reason these thoughts are turned to text. And I am still inside the paradox while writing them.