Over a hundred years ago, De Tocqueville, opening a chapter on ‘The Desire for Wealth’ in his famous treatise on Democracy in America wrote: ‘In America the passion for physical wellbeing … is general.’ He saw this passion for bodily comfort, for a sense of individual ease, as an inseparable part of a desire for material well-being. Benjamin McCready, in an essay written for the Medical Society of the State of New York in 1837, said much the same thing: ‘the Americans are an anxious, careworn people.’

Today, one might venture to say that Americans want to be healthy, physically and psychologically, because they are constantly aware of a need to be healthy. This consciousness of need, its degree of intensity, and the forms of behaviour in which it finds expression, is in large measure the product of the cultural forces which play on the individual from childhood to old age. What society expects of the individual as a distinctive individual and, reciprocally, what that individual himself feels is expected of him by his fellows, thus represent, in the effects they have in conditioning attitudes to health, important variables in the demand for medical care. Good health is seen both as a prerequisite for the success of the personality and, simultaneously, as a necessary condition for the enjoyment and exploitation of success. ‘The recollections of the brevity of life,’ as De Tocqueville also wrote, ‘is a constant spur.’ Or, as a contemporary observer puts it, ‘… it was the fear of becoming too old to choose which gave old age and death a bad name in this country’.

In general terms, it can thus be argued that the larger the investment by any society in ‘individualism’ (as a ‘way of life’) the more may ‘health consciousness’ spread. Similarly, the limits to what is personally conceived to be tolerable in feelings of bad health or inadequate function may also rise. And as society becomes more health conscious (in the sense of more individuals becoming aware of the higher standards expected of them) the more may each individual become dependent, or at least feel dependent, in an age of scientific medicine, on other individuals — on resources external to himself for the achievement of good health.