The difficulty of identifying gradual changes in health status

By David Hunter

It wasn’t until I was eight that I first got glasses. This wasn’t because I wasn’t short sighted before then, rather the contrary I was very short sighted I just hadn’t noticed. I thought trees were just blurry green blobs at a distance, I sat at the front of the classroom so I could read the board, I thought the other students just didn’t want to be able to read the black board… In other words I had just adjusted to my condition, such that I didn’t notice it. Getting glasses was a revelation suddenly the world was clear.

When I was 18 I had the laser eye operation to correct my eyesight in New Zealand. I did it in part because we had fairly comprehensive health care insurance and the operation was about to be redefined as “cosmetic” rather than “curative” and thus to fall outside the coverage. I got relatively lucky and was transformed from needing coke bottle thick glasses to nearly twenty twenty vision.

As part of moving to Keele University my wife and I decided to purchase a car something we hadn’t had for the last three years. And this slowly brought something to my attention. I noticed, particularly at night that reading street signs often only happened as they whizzed by!

It was pretty clear that my eyesight had worsened and I needed to see an optician. Once again the world is clear, once again I was probably short sighted without even realising it.

To me this raised two interesting points

1. It can be difficult to tell whether or not you have a health condition.

2. Whether or not a condition is bad for you in terms of your well being is strongly dependent on your environment and how you might adapt to it.

These two points make considering distributive justice in health care difficult because depending on your account of illness, illness may well be subjective and certainly the impact of ill health on well being will be highly subjective.

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