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	Healthcare What's in a word?
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Contents

Preface

The stated purpose of this Website is to explore the nature of information and its pivotal role in healthcare relationships and activities. The first step, then, should have been to model the many dimensions of healthcare, but when I began looking for words with which to spell out some preliminary thoughts, I was surprised to discover that the words themselves define a conceptual model as elegant as any I had been considering. The purpose of What's in a word?, therefore, is to unpack and assemble this framework for thinking about healthcare as found in the dictionary and grammar books.

It may seem strange that the dictionary should become an analysis and design tool in this way, but language is more than a passive conduit for ideas. Human speech is an active repository of thought and emotion. Because language inherits from the experiences of the past, the words we use in everyday discourse help mold our present experience and shape our current understanding. In the case at hand, the term healthcare is of recent origin, but its constituent words stem from the very origin of humankind, and their meanings reveal much about the human condition, affording a conceptual model within which to better understand healthcare. It is a perspective that accounts for the abstract, detached nature of information management, but one that also avows human dignity, confronts human suffering unashamedly, and embraces human aspirations.

In a nutshell, complementary definitions of health lead to complementary problem-oriented and goal-oriented views of healthcare, both of which overlay a more abstract information-oriented perspective. Care, within this framework, is a cognitive relationship having two fundamental aspects: close attention and watchful oversight. Both facets have important implications for how health-related information is managed, but underlying this cerebral perspective is a visceral awareness of human aspirations and human suffering.

Defining healthcare

We seek not words with which to define
our own preconceived ideas about healthcare;
rather we seek to discern the presuppositions of words
that define the very notion of healthcare.

Healthcare is a loaded word. Few expressions in modern discourse evoke a wider range of sentiment, from comfort and hope to despair and cynicism. Few other topics are as politically divisive or as economically intimidating and none more intensely private, yet at the same time, more public. From AIDS to genetic engineering, from birth control to living wills, healthcare is at the center of far-reaching debate. For provider and consumer alike, and for policy makers at all levels, the questions and issues wrapped up with healthcare are difficult, pervasive and often volatile. No part of society is outside the bounds of the discussion and no individual immune to its outcomes. Healthcare is indeed a loaded word.

But the word healthcare is also semantically rich, loaded with meaning accumulated through millennia of language evolution, with roots perhaps as old as humankind itself. Although the personal, social, economic and political overtones of this word are of recent origin, a century in the making at most, its ancient linguistic heritage faithfully reflects the essential human condition. The purpose of this essay, therefore, is not to enter into the current healthcare dialogue, but to reassemble a framework within which to better understand this dialogue. We are not so much looking for words to define our own preconceived ideas about health and its care, as we are seeking to discern the presuppositions inherent in language defining the most basic notions of healthcare.

The framework afforded by our analysis is one in which disease, distress and fear are acknowledged, but one that also accounts for hopes, dreams and desires. It admits that life is hard, perhaps even cruel and unfair, but insists that life should also be good. Behind these assertions are the basic notions of gain and loss, order and disorder, collection and dissipation. Healthcare, it will be seen, is an epistemic relationship between subject and object, which leads to the view of healthcare as a set of cognitive activities. These are characterized by the flow of information and knowledge, in which close attention and watchful oversight overcome (or reduce) loss and help one to gain well-being. Such relationships and activities have important ramifications for the allocation and distribution of resources, for the sharing of obligations and privileges, and for the management of information. All of which is taken, of course, strictly from the dictionary and grammar books. :) And how is it, you ask, that the dictionary can provide such a perspective?

Language: a repository of human experience

Human language is a vast ecosystem, where species of utterances (words and idioms) thrive in an environment of speakers and listeners, and where each grammatical form represents an established dependency between various types of expression. Through reproduction, mutation and natural selection, the environment (the culture) molds and is molded by its vocabulary of words and their interrelationships. Reproducible, hence recognizable, speech sounds survive and continue to be reproduced because they propagate certain stabilizing functions (meanings). Yet natural variation allows both the phonetic structures and their associated semantic functions to evolve over many generations. Language evolution is therefore a balance between stability and change.

It is not the inherited meaning of individual words, however, but the semantic interaction among words that gives human speech its astonishing communicative power. Much like competing or cooperating organisms in an ecosystem, words modify their behavior in response to words around them, and assume different meanings depending on the context in which they appear or the roles they play in a given expression. In this way, language enables a culture to formulate novel representations from commonplace parts in a manner unparalleled in the biosphere. Unpacking the notion of healthcare wrapped in the word healthcare therefore requires careful dissection of the word itself and close observation of the semantic niches in which its constituents have evolved and now flourish.

Healthcare is a compound word composed of two nouns, one of which, health, has become an adjective modifying the other, care. Because care is the head of the noun phrase health care, this word sets the tone for the entire conceptual model, and thus it is with care that we begin our investigation.