Peer Review, Spring 2000 From The Editor Rafael Heller

If there's any truth to the hospital dramas we see on television, the emergency room is an awfully busy place. Unless you've got chest pains or a head wound, you might wait for hours to get the attention you need. But when your turn does come, the doctors will leap into action, with scalpels dancing and monitors beeping and everybody racing furiously to put you back together again. It's much the same scenario when the topic of college health comes in for treatment by the news media. Consider, for instance, the case of binge drinking. For decades, higher education has struggled with the problem of campus alcohol abuse, while attracting few headlines and only scattered interest from the general public. Now that the media spotlight has turned this way, though, the binge drinking crisis seems to be everybody's concern. Fraternity parties and alcohol-soaked violence have become the stuff of lurid exposé, angry editorials, and the nightmares of frightened parents and anxious administrators.

Not to suggest that this crisis has been exaggerated. Certainly, alcohol abuse demands serious intervention by colleges and universities. Indeed, the Harvard School of Public Health's 1999 College Alcohol Survey shows that roughly 40% of the nation's college students engage in dangerously heavy drinking, and the rate has remained at that level for many years.

Our concern, though, is that higher education relies too much upon a triage system of administration. When a health crisis captures our attention, we throw time, money, and effort into finding a cure. But we rarely listen to our colleagues in the public health professions, who warn us that no symptom is discrete. We might even say (and pardon the expression) that health is contagious. A condition such as binge drinking may seem to have flared up out of nowhere. But if we truly wish to grasp its meaning, then we must learn to account for its related phenomena, such as the dating habits of young people, the influence of marketing agencies, the legacy of academe's In loco parentis doctrine, the cultural significance of "boredom," and so on.

To the extent that we fail to achieve a holistic perspective on health, we will do little to address students' most serious health concerns, such as alcohol abuse, date rape, smoking, or sexually transmitted disease. In fact, as Richard Keeling argues in this issue of Peer Review, the best approaches to promoting student well-being are not medical interventions at all. After all, health doesn't confine itself to the health center. Rather, it spreads across and emerges from our cultural values, educational practices, and institutional priorities.

Yet, in our roles as faculty, deans, provosts, and presidents, we tend to imagine campus and community health to be somebody else's business: it belongs to student services, or maybe the director of housing, or even the local government. In short, and as Robert Fullilove and Mindy Thompson Fullilove describe, we too readily deny our own parts in the collective responsibility for public health, and we too often fail to notice when our own ignorance becomes somebody else's tragedy.

Finally, as David Burns suggests, we may wish to expand our frame of reference even further, beyond a concern with student and community health problems. In fact, we need not see health as a problem at all. Rather, as teachers and students, we might choose to explore the many other meanings of health, conceived not as an impending crisis but as a productive force and a positive value in its own right. We might ask, for example, how does the desire for health figure into our cultural practices, our historical events, and the key political, religious, and ethical debates of our time? In fact, if we wish to provide a truly liberal education, mustn't we help our students to understand the significance of health in their own lives and in the lives of those around them?