After a few years, working in traumatology felt for me like gliding into a carefully rehearsed performance. As soon as a patient arrived, I would know precisely what to do, where to look, and how to respond. Better still, when we had the chance to be a dedicated team, it felt like a well-choreographed dance or a magic trick. It was so smooth most of the time that we felt like one, as though we had all the answers. I’ve often joked that traumatology was easy: they come, you fix, they go.
But that illusion of healing, that magic trick, usually existed only because our patients’ journey had begun long before they reached us.
I’ve come to realize that people’s experience with health starts well before an illness or injury. We often associate health with doctors, nurses, hospitals, and clinics, but medicine rarely produces health; it mostly attempts to repair it. Health unfolds everywhere before. To understand its mechanisms and ultimately to improve it, we must wonder: Where is health born?
Person
In my circles, conversations about “being healthy” often revolve around personal habits. We get bombarded with information about exercise, protein intake, supplements, and tracking habits. God forbid we put bananas in our organic smoothies.1
There is, of course, nothing wrong with any of those things. Some of them can meaningfully improve our well-being. But this indicates something more pervasive: We tend to see health as a lifelong self-improvement project, rather than something we have limited control over. By extension, many people begin to view others they consider “unhealthy” as individuals who simply failed to make the right choices. People struggling with obesity, chronic conditions, sexually transmitted diseases, or addictions become easy to judge. Worse still, those people struggling may come to internalize shame. Health status is then perceived as a reflection of character or, alternatively, a personal failure, instead of the outcome of a complex system.
“If only they had tried harder.”
Right?
Paradoxically, we only have the luxury of thinking this way because countless collective achievements have faded into the background. Things such as water treatment plants, vaccination programs, safety regulations, sanitation systems, public health institutions, and legal frameworks protect us daily. They have become so reliable that we no longer perceive them as health interventions.
The system works so well that we are mistaking health status for personal achievement. But when people understand health primarily as a matter of individual choices, they overlook the fact that people must first have the knowledge, resources, and conditions that make those decisions possible. After all, what kind of choices can we make without information and means?
Knowledge
From my experience with patients and students, I have come to believe that very little about health is truly intuitive. Nobody “just knows”. Knowledge about one’s health is decisive, and the question is rarely whether health education exists, but what it teaches.
Health literacy determines not only what people know, but also what possibilities they can imagine for themselves. It is a vector of agency.
In many countries, it becomes particularly evident when discussing health issues affecting vulnerable populations. In Kenya, only 55% of children between 12 and 23 months are fully vaccinated,2 and merely 40% of married women believe they can refuse sexual intercourse with their husband.3 Those numbers are not just data on a public health report. They attest to the intimate intertwining between beliefs, knowledge and health. Someone who has never learned how their body functions, who cannot recognize reliable information, or who has never been taught the inviolability of their body, cannot exercise their freedoms and rights to their full extent. They are navigating life with an incomplete map.
But agency does not operate in a vacuum, and individual knowledge isn’t everything. For example, practices such as female genital mutilation (FGM) demonstrate that health cannot be separated from cultural or social expectations. Still in Kenya, some counties, such as Mandera, reported that 96% of women had undergone FGM.4 Girls growing up in these communities do not face a purely medical decision when cutting is considered a condition for belonging. Knowing that most are cut as children, the human need for belonging and acceptance becomes part of an impossible conflict between bodily autonomy and social identity. Sometimes, knowledge simply cannot offset the social cost.
Understanding health, and by extension, making meaningful choices, requires much more than receiving medical information. It requires integrating the mechanisms that determine which kinds of knowledge are taken seriously and incorporated into the social fabric.
I want to insist that these dynamics are not unique to any part of the world. Every society transmits ideas about health and is vulnerable to misinformation and competing narratives. Recently, debates surrounding immunization and the concerning resurgence of measles in North America5 illustrate that health literacy remains fragile, even in highly educated populations, especially when politically charged discourse is present.
Intentionally or not, all communities interpret what health is and how it is articulated. The question is whether what is communicated genuinely expands people’s agency to make informed, conscious choices.
But does knowledge truly enable choice?
Means
While health literacy is essential, it rarely overcomes all barriers. Someone can understand exactly what they need to do to remain healthy, and still be unable to do it, due to a lack of resources.
You might imagine the cost of treatment, or just the possibility of taking a day off when feeling unwell. But economic factors shape health long before any illness, and even before birth. They can determine where people live, what they consume, what risks they encounter, and the support they can access when challenges arise. Limited means is a full determinant of health.
Resource limitations can also be found at the level of an entire country. Recently, the development and distribution of lenacapavir, a highly innovative HIV treatment, has highlighted the tension between medical progress and unequal regional access.6 Intellectual property law, pricing structures, regulatory decisions, and the purchasing power of health systems influence who can actually benefit from innovations. Lenacapavir, a life-saving drug, is now available, yet access depends on whether institutions can afford it.
While knowledge might introduce possibilities, resources largely dictate which possibilities are within reach. True choices only exist when meaningful, accessible alternatives are available. Ultimately, health cannot be separated from means, because the ability to pursue health depends on the resources available to do so.
But not everything is about money: What about the means created, or denied, by political decisions?
Power
In a meeting I attended to present the guidelines on education for youth in Uganda, one of the examples was the case of a pregnant ten-year-old girl.7 On the screen, her small frame was overwhelmed by her swollen belly and the breasts she had developed from the pregnancy.
A tiny girl.
This was presented to us as a striking example of the need for reproductive education in rural communities.
But someone was responsible for this child’s pregnancy.
Beyond individual blame, the question becomes: where were the systems of protection, accountability, and justice? Yet the discussion remained focused on education, and when questioned, it was stated that no investigation had been conducted. This had been framed primarily as a need for education, which cannot replace criminal investigation and the enforcement of rights.
Behind every health issue lies a long series of decisions: whose voice is heard, whose needs are recognized and whose interests are prioritized. Without denying that some accountability rests with individuals, we must always question whether it is politically convenient for institutions to shift responsibility for a failing health system onto people.
It can indeed feel uncomfortable to denounce aspects of society while realizing that many of us have benefited from them: education, access, safety, and institutions that protected us so well that we never really questioned them. But perpetuating the idea that health is primarily a result of personal choices shifts the spotlight away from the actors who typically cause the largest social and environmental consequences. Agency cannot exist without knowledge and meaningful alternatives, and dignity cannot be realized without supportive infrastructure.
Rights
So. Where is health born?
The more closely we examine the concept, the more complicated it becomes.
Health is conceived through politics.
The economy nurses it.
Schools shape it.
And it is cared for by people.
Medicine can only try to repair health. But health is born quietly, every day, in the countless ordinary and extraordinary decisions. Society shares the birth of health.
This reveals an uncomfortable paradox: the more honestly and holistically we understand health, the broader and more diffuse the responsibility becomes.
How can courts order the elimination of poverty? How to deal with global shortages and markets? Can legislation produce social trust?
From everything I have encountered, my instinct is to advocate for a broader interpretation of health rights and a stronger enforcement of their implications. Health needs to be recognized as a foundation of human dignity and of a meaningful life.
After all, what is life without minimal conditions to enjoy it?
If people matter, health must matter. To accept health as a collective creation is to recognize that the right to health entails a collective responsibility: the obligation to protect the conditions that allow dignity.
In the end, I have loved working in trauma because I have loved feeling empowered in chaos. Events cascaded violently, but they were also contained quickly. But where health is born, there is no smooth magic trick and no well-rehearsed performance.
Not yet.
- This study sparked an (exaggerated) uproar on social media regarding the absorption of flavanols when consumed with bananas: Javier I. Ottaviani et al, “Impact of polyphenol oxidase on the bioavailability of flavan-3-ols in fruit smoothies: a controlled, single blinded, cross-over study” (2023) 14:18 Food Funct 8217–8228, online: <https://doi.org/10.1039/d3fo01599h>. ↩︎
- Kenya, Kenya National Bureau of Statistics, Kenya Demographic and Health Survey 2022, Report presentation (Kenya, 2022) at 163, online: < https://www.knbs.or.ke/reports/kdhs-2022/ >. ↩︎
- Ibid at 254. ↩︎
- Ibid at 292. ↩︎
- Pan American Health Organization, | Measles in the Region of the Americas, Regional Situation Report · No. 7, Bi-weekly report EW 1–27, 2026 (4 Jan 2026 – 11 July 2026), (Washington: PAHO/WHO, 2026.) online: < https://www.paho.org/sites/default/files/2026/07/measles-sitrep7-17july-2026.pdf > ↩︎
- Goshen David Miteu, “Lenacapavir and global HIV prevention: a breakthrough at risk of leaving millions behind” (2026) 12: 88(3) Ann Med Surg 2462–2466, online: <https://pmc.ncbi.nlm.nih.gov/articles/PMC12959828/ >. ↩︎
- Presentation by the Ministry of Gender, Labour and Social Development of Kenya, presented by Patience Namanya, Deputy of Youth and Children Affairs (July 10, 2026) National Guidelines on Health Education and Life Skills for Out-of-School Adolescents and Youth, online presentation. ↩︎