Machteld Huber: "I expect that the new definition of health will bring the cost of healthcare down"

We interviewed Machteld Huber about her study & career and her new definition of health. She obtained a medical degree and added philosophy later on. "Learning about philosophy and psychology will make you able to connect the scientific background better to reality", she advises students.

Encountering several severe illnesses herself, made her realize the perspective of a patient was not mentioned in her studies. And that the psychological part is important as well. The WHO says being healthy is the absence of any disease, but who is ever healthy then? Huber says its also about resilience and about being able to deal with illness and integrate it in life. Applying every treatment possible to cure a patient, is the current mind set, which is making healthcare too expensive. Focus on what is important to the patient, will help bringing the cost down.

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Where and what did you study? Why did you choose that programme?

Well, that’s a long time ago. At first, I studied biology at the University of Utrecht, aiming at biochemistry, but after ten days I decided to switch to medicine. After finishing this, I chose to specialize as a general practitioner at the Vrije Universiteit Amsterdam. After a few years of work I also studied Philosophy, till my bachelor. I have always been interested in biology and biochemistry and how life functions. I’m from the post-war generation and a friend of my father has been in concentration camps for three years. I’ve always been fascinated how people are able to survive in severe circumstances like that. However, as I’m a practical person, studying medicine suited me better than a basic subject like biochemistry..

How do you look back on your student days?

As I studied in the 70’s, the circumstances were quite different. I was a very busy student. I was active in the student associations and I was involved in several student projects. In an intermezzo year in my medical studies I worked in different hospitals in Canada and the U.S.

Could you tell us something about your own career and how you got to where you are now?

After finishing my medical education, I worked in the hospital for several years and I prepared myself for going to work in the tropics for several years. I aimed to experience a strong connection to the roots of the work. However, after a lecture about medical philosophy I changed my plans and decided to stay in the Netherlands and to study philosophy. This would also create that basic connection. After this I became a general practitioner (GP). During the specialisation year I encountered my first serious illness. Here, I realised that I knew everything about it from a medical perspective but the experience as a patient was completely new to me and not mentioned in my studies. I learned that the psychological part is important as well and that I could influence my recovery positively or negatively.

After I went on with my specialisation and during the first of work as a GP, I was struck by three more severe illnesses and I decided that if I would recover, I would dedicate myself to exploring and adding the perspective of the patient to the medical profession. I recovered and started to do research. Instead of being a general practitioner I started to work with damaged people like drug addicts and later people with a war trauma, to see how if my experiences could also influence their recovery. I was in research for 29 years, where I did research on nutrition and later on a new concept of health.

Can you explain the definition of ‘being healthy’ to us?

First of all, we call it a concept instead of a definition because a concept is more of a characterisation. The present definition of the WHO is ‘health is the state of complete physical, mental and social wellbeing and not merely the absence of diseases or infirmity’, which is a very static and idealistic definition. The definition was formed after world war 2, when the main illnesses were infectious diseases and the people who started the WHO thought mankind could conquer and defeat those in the upcoming decades. However, the diseases changed over time because now more chronic diseases have presented themselves. According to the current definition, nowadays almost no one is ‘completely healthy’. In fact, having a small inconvenience keeps you out of this ‘state of complete wellbeing’, which would mean you are hardly ever healthy. Imagine a person with diabetes or heart failure; the current definition would declare them not healthy but the better question is whether they can manage it. Where the physical wellbeing of a person is concerned, the mind-set of this person can influence this. We created a more dynamic concept which is about resilience and about being able to deal with your illness and integrate it in your life. In my follow-up research, I elaborated on this concept and I identified several indicators that connect to this.

How do you expect this to influence the healthcare in the Netherlands or even worldwide over the next few years?

There is a need to change healthcare because it is becoming much too expensive. The current mind-set is to apply every treatment possible to cure a patient. However, we should focus on what is important to the patient or what’s the main value in life for this person. For example, there was this old lady who couldn’t see well, who experienced heart failure and who needed a hip replacement. However, she said please just help me with my eyes so I can see my grandchildren again and read my paper, the rest is fine like this. I think the change in the healthcare will be that we treat less and pay more attention to the other factors in life as well.

How do you expect this to develop nationally and internationally over the next few years?

First of all, I’m interested in the Netherlands although there is also some interest from other parts of the world. However, it is good to first operationalize this in the Netherlands to ‘test’ it and to ‘showcase’ it to the rest of the world.

How do you think this new definition of health will influence the cost of treatment of patients?

I expect that it will bring the costs down, although I don’t have any hard facts on that yet. I noticed that when general practitioners apply the new concept they take more time for the patients and they get to the ‘question behind the question.’ This results in better help for the patients and less referrals to specialists which in turn decreases the cost of treatment. And patients are very content about this approach.

Do you have any advice for the students in Groningen?

I would advise to work on your personal development as a human being. Learn about philosophy and psychology. Then you will be able to connect the scientific background better to reality. This is also related to the new concept of health, because here we also take the whole human being into account. Develop yourself broadly because then you will be able to recognise what is needed in society.