Centering dignity as the ultimate goal of health

Reframing our engagement with a universal human value.

In 2021, I wrote a Viewpoint for JAMA Health Forum arguing that elevating dignity should be a central goal for our pursuit of health in the COVID-19 era and beyond. Most of those who work in the health space would likely say that we value dignity, but it struck me that few have articulated the importance of dignity as an organizing principle for all we do, one which can help guide our efforts in the complexity of this moment. Since writing that piece, I have continued to think about the role of dignity as a core value for our work. In many ways, dignity, despite its importance, remains under-discussed in the health conversation. There have been only a handful of academic articles which have discussed dignity in health, and these tend to focus on patient dignity in healthcare rather than dignity in the broader context of health—as in, for example, Francis Peabody’s classic 1927 article, “The Care of the Patient.” While this article does not actually use the word “dignity,” it in many ways started the conversation about dignity in healthcare by advising clinicians to keep always in view the individual identity of patients, rather than see them as faceless, interchangeable problems to be solved.

I have written previously quite a bit about why we aspire to be healthy. I have argued that we want to create health so we can create opportunities for people to live, rather than the other way around. But this definition elides something important; I think our role is not simply to use health to help people to live, but to help people to live dignified lives. This is consistent with centering health as a human right, an idea that has emerged as a strong thread in the health literature over the past few decades. But, separate and apart from that, I argue that we should be advocating for dignity as the ultimate role of health very much for its own sake. Toward this aspiration, I will here reflect a bit on dignity—what it is and why it should be the central goal of our pursuit of health.

Let me start by asking: what do we mean by dignity? The Cambridge Dictionary defines dignity as “the importance and value that a person has, that makes other people respect them or makes them respect themselves.” This seems a good working definition of dignity, emphasizing as it does the fundamental, intrinsic value of all people, of which dignity is a reflection and an acknowledgement. This concept, so central to our modern framing of human rights, is, it is important to remember, fairly new in human history. For much of our species’ past, life was seen as cheap, and the course of human events was one of conquest, with the strong dominating the weak. This reflects the slow process by which a recognition emerged that dignity is an inherent human quality that must be respected. This evolution in thinking intersected with a range of religious and philosophical traditions, from the Christian concept of dignity rooted in the fundamental sacredness of human life created in the image of God to the Confucian concept of dignity based on the moral potential of every human to be a good person. Such traditions have informed our contemporary notions of dignity, rooting them in a vision of the world in which the fundamental worth of every human being is celebrated and protected. Because dignity is a human universal, it has the power to help us transcend the forces that can divide us, so that we engage on equal terms in the work of creating a better present and future.

These concepts of dignity reflect why we should want to pursue dignity as a general good. But why, specifically, should we center supporting human dignity as the ultimate goal of health? Fundamentally, a dignified life means that persons can live how they wish to live, even as we may need to tolerate disagreement with how some wish to live. But living how people wish to live is best served by them not being encumbered by poor health. Hence, our work on health is indeed creating the right pathway for people to live in line with their own desires, with the dignity that allows them to do so. Ensuring that all can be as healthy as possible for as long as possible is an ineluctable pathway to that.

Building a world where a dignified life is possible for all also calls for us to ask, always: what are we trying to achieve in health, and what is the world like for those who cannot achieve all that others can achieve because of non-improvable health challenges? This means that health takes a front and center role in creating pathways for the self-actualization of all, regardless of capacity, physical or otherwise. This implies creating a different form of society than one, say, where we advocate only for pathways to achievement for those who can already do more or less all they want to do. Rather, it is on us to make a world where there are multiple pathways that recognize multiple capacities.

Creating these pathways starts with seeing where they are lacking, and this means doing a better job of truly seeing other people. We live in an increasingly atomized world where it is perhaps easier than ever to see only what we want to see, to neglect the dignity of others, to seal ourselves off from people from very different walks of life. Forces like technology, partisanship, and even geography can all support this willful shutting of our eyes to the wider world. But we can make a choice, in this moment, to use the tools at our disposal to connect with others, to really see them, and, in doing so, to create a world that centers dignity. Rather than let the distractions of the world blind us to the lives of those who are different from us, we should see them, see how they are not well served by the status quo, and commit to creating a world where difference does not mean indignity. I have written previously about this in the context of people who live with disability. Centering dignity means creating structures that uplift and ennoble, rather than merely accommodate, those who live differently than we do, who face different, sometimes difficult realities. Creating these structures is the central task of creating health, which is why dignity is, and should remain, core to our efforts.

What, then, are the practical implications of centering dignity in our pursuit of health? What does a concern for dignity urge us to do in our work? First, centering dignity calls on us to judge our efforts not just by how well they prevent disease, but by whether they remain focused on the unique needs and perspectives of the communities with which we engage. Our efforts should reflect an ongoing dialogue with these communities, so we never do anything that does not take into account the full humanity of the people we are trying to help. Second, a concern for dignity means centering dignity in all we do, recognizing that just as dignity is a universal human characteristic, it should be universally applicable in our work. This means asking ourselves at every turn if what we are doing does indeed support the dignity of all, and being honest with ourselves when our efforts fall short. Third, centering dignity means, unavoidably, pursuing health as a human right, with all this entails for how we think about health and how we work to build a healthier world. It means maintaining a radical vision of a healthier future, even as we pursue this vision pragmatically, incrementally. Such a vision recognizes that we are not healthy until we are all healthy and that our efforts are incomplete if anyone is denied the dignity that health enables.

Ultimately, pushing dignity to the center of our thinking means remembering our role as centering persons as individuals, with their own sorrows and pains, joys and pleasures. This reminds us that our role is to celebrate and ennoble the human spirit, not to negate it, and insofar as the work of health sometimes, of necessity, places limits on what people can do, it does so only to support the health that allows us to do everything else that makes life worth living. Even so, when we impose limits, we should always do so with the utmost concern for dignity, never going farther than we must in advocating for the restrictions that can, under certain circumstances, support health. At the same time, we should always be aware of how the world, as it is currently constituted, places restrictions every day on individuals and communities that are excluded from the resources that create health. It is our job to address these circumstances, and the state of indignity they can create, to build a world that generates health for all by supporting the dignity of all. Such a vision has the potential to be a unifying force in our pursuit of health, helping to shape a movement that is positive, inclusive, and engaged in the issues that matter most for the health of populations. 

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Also this month

Thoughts in Observing Science with Michael Stein on What To Do When Science Gets It Wrong, Generating Science That Informs Decision-Making, The Pump Handle, Speaking Out, and The Real Reward.

New in PLoS One with Dan Evan, Greg Cohen, and Ruochen Wang, The cumulative contribution of direct and indirect traumas to the production of PTSD.

A new study in the American Journal of Epidemiology with Catherine Ettman, Salma Abdalla, Ruochen Wang, and Samuel Rosenberg on generalized anxiety disorder in low-resourced adults across the COVID-19 pandemic.

Thoughts in JAMA Health Forum on learning from nonadherent patients about populations Thoughts. 

A study of PTSD among adults in communities that have suffered from incidents of mass violence via JAMA Network Open, with Angie Moreland, Caitlin Rancher, Faraday Davies, Jamison Bottomley, Mohammed Abba-Aji, Salma Abdalla, Michael Schmidt, John Vena, and Dean Kilpatrick.

A study on Epigenome-wide association studies identify novel DNA methylation sites associated with PTSD: A meta-analysis of 23 military and civilian cohorts. 

Thoughts in JAMA with Yvette Cozier and Lisa Mellman on the evolution of Diversity, Equity, and Inclusion programs in academic health.

Thoughts with Itai Bavli in PLOS Digital Health on key considerations for public health’s engagement with artificial intelligence.

Our study, Perceptions of the determinants of health across income and urbanicity levels in eight countries, in Communications Medicine, with Salma Abdalla, Ethan Assefa, Samuel Rosenberg, Mark Hernandez, and Shaffi Fazaludeen Koya.

Thoughts with Dan Even and Nason Maani in The Lancet Global Health on news media as a commercial determinant of health.