Knowing Well, Being Well: well-being born of understanding

Abstract

C OVID-19, inevitably, has co-opted this-the first spread by True Health Initiative under the ''Knowing Well, Being Well'' banner-as it has nearly all else related to living in this moment. When we and the journal editors first conceived of this repurposed patch of literary real estate, we had other intentions. In particular, I had hoped to speak first of knowing, at bedrock: diverse sources of evidence, and how they converge into the human capacity to know and understand what is true. We will come back to that intention when opportune. For now, what we know, and what we do not know, about COVID-19 is the signature influence on our collective capacity to be and feel well, and so we direct our efforts there. This brief collection highlights something of the spectrum of our knowledge on this fast-changing topic. Per the contribution of Frates and Rifai in Making the Case for ''COVID-19 Prophylaxis'' with Lifestyle Medicine, we know that the generally poor, prior state of health in America contributes considerably to the risk of severe COVID infection. 1 SARS-CoV-2 has proven to be very different diseases in the generally young and vital, and in the elderly individual and those with a heavy burden of chronic disease. In a sense, COVID has taken the long-neglected, chronic deficiencies in American health and made them an acute liability and acute concern. 2 Perhaps that concentrated attention creates an opportunity to address the immediate in a manner that confers lasting benefit. We also have known since the start 3 that the pandemic could harm people in more ways than one. Direct infection by SARS-CoV-2 is the more obvious threat to health and life, but the indirect effects of our interdiction efforts are no less important at the population scale. Mass unemployment reverberates through the social determinants of health in ways that also imperil both health and lives, and this topic is addressed here by Rollston and Galea in Covid-19 and The Social Determinants of Health. Finally, in Herd Immunity: Knowns, Unknowns, Challenges, and Strategies, McNaughton takes on the topic of herd immunity, a critical element in getting to an ''all clear'' that gets all of us-including those most vulnerable to severe COVID infection-our lives back. She and I are looking at the same glass, but we do have different impressions of it. As I write this (May 6, 2020), I see the glass as half full, and potentially rising. Seroprevalence surveys in populations as diverse as the Diamond Princess cruise ship, Navy vessels, New York City, 4 and Guilan Province, Iran, 5 all seem to suggest that a sizable portion of the general population may be natively resistant to SARS-CoV-2. If that is true, and another sizable portion of the remainder of us have been exposed and made antibodies, we may already be much of the way out of the woods. That is my more sanguine view, but Dr McNaughton, whose expertise I respect greatly, offers a differing and more sobering perspective. A diversity of perspectives is salient among the elements that foster understan...

Knowing Well, Being Well: well-being born of understanding: The Homo Sapiens Superpower

“…The impact of the social determinants of health in exacerbating health care disparities have been reviewed extensively elsewhere, and these include factors affecting diet such as differences in access to healthcare, lack of availability of fruits and vegetables, and higher concentrations of fast food restaurants in communities with lower socioeconomic status. 6-7 Factors related to the clinician-patient relationship may contribute to patient stress, disengagement, and reduced willingness to consider or embrace dietary change. These include implicit bias, mismatched agendas, not recognizing or attending to people’s social and emotional realities, and using language that is potentially shaming or blaming.…”

Empathy and Language in the Clinician Patient Relationship: Improving the Translation of Evidence to Practice

“…The impact of the social determinants of health in exacerbating health care disparities have been reviewed extensively elsewhere, and these include factors affecting diet such as differences in access to healthcare, lack of availability of fruits and vegetables, and higher concentrations of fast food restaurants in communities with lower socioeconomic status. 6-7 Factors related to the clinician-patient relationship may contribute to patient stress, disengagement, and reduced willingness to consider or embrace dietary change. These include implicit bias, mismatched agendas, not recognizing or attending to people’s social and emotional realities, and using language that is potentially shaming or blaming.…”