Health Care or Medical Care?

For quite some time, breastfeeding advocates have been working to change the language of infant feeding to reflect that breastfeeding is the biological norm (and formula feeding is the replacement/substitute). This includes sharing about the "risks of formula feeding" rather than the "benefits of breastfeeding" as well as encouraging research that no longer uses formula-fed babies as the control group or considers formula to be a benign variable (i.e. the babies in the breastfed group of many research projects also received some formula, but since our culture views formula as the "norm," this was not seen as a conflict). I love Diane Wiessinger's example--would we ever see a research project titled "Clear air and the incidence of lung cancer." No! Problem behavior is linked to problem outcomes in other areas of research, so it would be "Smoking and the incidence of lung cancer." However, we routinely see research titles like "Breastfeeding and the rate of diabetes" rather than linking problem to outcome--"Infant formula and the rate of diabetes."

Similarly, "intactivists" (people who oppose circumcision) have pointed out that there should be no need to refer to some boys as "uncircumcised"--being uncircumcised is the biological norm, it is "circumcised" boys that should received the special word/label. (On a related side note, I have written about "pleonasms"--words that contain unnecessary repetition--and birth and breastfeeding on another blog before.)

So, this brings me to another need for a change in the common language--correctly identifying whether we are really talking about "Health Care" or "Medical Care." This was brought to my attention recently by Jody McLaughlin the publisher of Compleat Mother magazine. We have a tendency to refer to "health care" and to "health care reform" and "health insurance" and and "health care providers" and "health care centers," when it reality what we are truly referring to is "medical care"--medical care reform, medical insurance, medical care providers, and medical care centers. As she says (paraphrasing), "we do not have a HEALTH care system in this country, we have a MEDICAL care system." She also makes an interesting point about a trend to re-name medical care systems with names that use the word "health" instead:

This is what I have observed: Our local facility was called Trinity HOSPITAL, later re-named Trinity MEDICAL CENTER, and now it is Trinity HEALTH.

In the late 70’s and early 80’s the discussions centered around the MEDICAL crisis, MEDICAL reform, MEDICAL insurance and MEDICAL care cost containment.

MEDICAL insurance morphed into HEALTH CARE insurance. MEDICAL reform morphed into HEALTHCARE reform.

This is a difference with a distinction.

Health care includes clean air and safe water, enough good food to eat, exercise, rest, shelter and a safe environment as well as healing arts and the availability of and appropriate utilization of medical care services.

Medical care is surgery, pharmaceuticals, invasive tests and procedures. Malpractice tort reform is on the agenda too but no one is talking about reducing the incidence of malpractice, or alleviating the malpractice crisis by improving outcomes.

Why does this discussion belong on a midwifery blog? First, I wanted to address it because we have sent out several Grassroots Network messages regarding "health care reform" (and including access to CPMs in this legislation). Secondly, because I think it is clear that midwifery care can truly be described as health care, whereas standard maternity care in the U.S. can much more aptly be described as medical care.

--
Molly
CfM Blogger