This month, the world saw the first-ever image of a black hole. The picture was captured by the Event Horizon Telescope, a network of radio telescopes operated by a global team of scientists. The black hole is 53.49 million light-years away, at the center of the Messier 87 galaxy. Taking a picture of such a distant object was an immense feat of science and engineering. The roots of this achievement stretch from Einstein’s first theorizing about the existence of black holes, all the way to the creation of cutting-edge technology that allowed us to finally see one.
Such stories are reminders of why it sometimes feels like science can do anything, from exploring the cosmos, to peering into the distant past, to blurring the boundary between life and death. And that feeling often extends to the science that informs our health. On that front, the 20th century brought a host of major discoveries, from penicillin to the double helix. As the Digital Age ushers in new advances, it is as easy as it has ever been to imagine that science really can solve all our health problems one day.
Our behavior suggests we may even hope that, through the power of science, we can one day innovate our way out of the human condition—the inevitability of age and death. Consider: the United States spends far more on health care than any other country in the world. The vast majority of this spending goes to the drugs and treatments that are the fruits of scientific discovery. With this sky-high spending have come sky-high expectations.
We eagerly await the drugs that will cure dreaded diseases like cancer and AIDS. We are fascinated by the evolution of precision medicine, with its possibility of tailoring treatment to an individual’s specific lifestyle and genetic code. And we thrill at the notion that technology might extend life indefinitely, that we can someday “hack” mortality, if we can only get the science right.
These hopes inform a spirit of exploration, one that we should nurture. Yet unbounded confidence in science can also distract us from the core forces that underlie our lives and health—forces far larger than any theorem, technology or cure.
Each day, we are deeply influenced by the social, economic and environmental conditions that surround us. These conditions are at the heart of how our lives unfold, deciding whether we are sick or well. We must have the humility to acknowledge the influence of these forces. When we do not, we open the door to hubris, and risk undermining the very goals we accumulate knowledge to pursue.
There are ample examples of how we have neglected the foundational forces that shape health, even as we have poured resources into developing new treatments. Take asthma. If a child has asthma, science can indeed provide her with medicine for her illness. But why does she have asthma to begin with? Could it be because she is a child of color, a demographic with a higher asthma risk? Or because she grew up in an economically disadvantaged neighborhood, located near a pollution center like a major roadway, as such neighborhoods often are?
Or could it even be because of political decisions to build the neighborhood in such an inopportune location? We are less likely to ask these questions when we think that the only action we need take to address an illness like asthma is to design ever-better treatments for it. While we often do not think of health in this way, we are effectively letting six million children live with a preventable disease like asthma because we are distracted by the flashy potential of high-tech science, at the expense of solutions that are at hand.
What about the continued existence of HIV, a disease for which we have excellent treatments, but which nevertheless persists in some countries due to the forces of poverty, stigma and political negligence? In such cases, our medical advances are simply not enough. We need the humility to recognize that we cannot end these diseases without tackling forces that exist outside the realm of scientific innovation, whose influence can only be checked by collective effort and the application of political will.
There is nothing wrong with making better medicines. A cure for asthma or HIV would indeed be welcome. But would it not be better to live in a world where these diseases no longer exist? To get this world, we must have the humility to see that there is more to health than our capacity to cure disease and extend life. Health emerges from our shared context—from the air we breathe, the water we drink, our economy, politics, schools, workplace safety laws, corporate practices and other large-scale influences.
I discuss these influences in my new book, Well: What We Need to Talk About When We Talk About Health. Engaging with them, to improve health, means first recognizing their scope, how they are bigger than any one person, and that they can only be properly addressed when we work together, with humility.
Take another look at the black hole image. It is a ring of light against vast darkness. This sliver of light, framed by the dark of space, is a useful metaphor for the relative smallness of what we know compared to the tremendous scope of what we do not. Our health, like our universe, is shaped by forces that dwarf even our most brilliant advances and discoveries. It is only by having the humility to recognize this that we can begin to move, collectively, towards a healthier future.