Moving Beyond the Physical to a Richer Definition of Health
The definition of health is rooted in what it means to be human.
The first wealth is health.
—Ralph Waldo Emerson
Emerson's axiom sounds good, but what does it mean? What does it mean to be healthy?
When you went to your annual physical, you were measured: your doctor took your heart rate and blood pressure, conducted various tests, and may have even taken x-rays and other images. Controlling and measuring these aspects of our health makes it possible for us to study them scientifically. Western medicine has long linked physical health and medical science, seeking knowledge through the purest forms of the scientific method in studies that are designed to eliminate all subjective influence and confounding variables. This medical science is supposed to give your doctor the most objective and accurate knowledge about your health.
This focus on physical health has become increasingly rooted in our healthcare system through the development of best-practice guidelines, which are created using knowledge from scientific studies and intended to give health professionals the best approach for diagnosis and treatment of a particular illness. These guidelines have become the standard of care by which all health professionals must practice. Those who do not follow suit may face litigation.
Indeed, medical science has led to many advances in our ability to manage and support physical health. But in developing these advances, we have also created a problem: Our society and healthcare system exaggerates the physical aspects of health, promoting a distorted view of what it means to be healthy.
So we must ask, "What does it mean to be healthy?"
It is very difficult to put a finger on what characterizes health. Its definition is elusive. In Enigma of Health, Hans-Georg Gadamer concluded that "defining health is difficult because when we are most healthy is precisely when we are least conscious of our health. Health manifests itself by escaping our attention. Hence, the important task of thinking about health requires a patient and disciplined mind, sensitive to subtlety."
A richer definition of health requires an open-minded approach, which will provide us with a better understanding of how to manage health vital for us in fostering our own health, for health professionals in supporting people back to health, and for politicians and policy developers who make decisions regarding the architecture of the healthcare system.
The definition of health is rooted in what it means to be human. The word "health" is related to the old English word halig, which means "wholeness" the wholeness of who we are as human beings. What does it mean to be whole? The World Health Organization has suggested that health is complete physical, mental, and social well-being. This is the beginning of a richer and more open-minded definition of health but we need to refine things further.
As Gadamer suggests, thoughtfully perceiving what is lacking when someone is ill gives insight into what defines health. As a physician I have the privilege being involved in a patient's healing journey when they are ill, and on occasion I perceive aspects in their life that are out of balance. When health is lacking, it requires patience and attentiveness on the part of the patient and health professional to ascertain aspects of one's health that need to be supported and restored for them to be healthy again.
Consider what can be ascertained about health through a recent patient of mine: Rene, a middle-aged woman, has developed diabetes after gaining 40 pounds in the last two years. In discussing how to manage her diabetes, I ask how she feels about trying to lose some weight. After some hesitation she explains that she started eating excessively soon after losing contact with her daughter, whose life is in turmoil from illicit drug use. She has been overwhelmed with feelings of loss and helplessness. After further discussion, it becomes clear that Rene is using food to suppress these feelings. Rene is burdened because of her daughter's ill health, and now her own health has been affected. Instead of working through her emotions and thoughts, she numbs them through eating. The physical condition of diabetes is just a small part of why she is unwell.
Through medical science, including the Nobel Prize-winning discovery of insulin by Canada's Dr. Fredrick Banting and his assistant Charles Best, health professional have developed very advanced tests and medications to control diabetes and reduce the physical damage of this disease on the body. However, these advances have been primarily focused on the physical aspect of diabetes. It is clear through Rene's diagnosis that a number of aspects in her life need support for healing to begin. Rene needs to develop mental and emotional awareness so she can identify when she is eating to numb her feelings of loss and helplessness. She will then need support to help her work through these feelings and learn how to regain a sense of wholeness. Rene's health is also intimately connected to the desire for a loving, reciprocal relationship with her daughter. This part of her illness is directly connected to her daughter's illness and the many things that will need to be addressed for her daughter to regain health. Because the relationship between daughter and mother is important, these aspects of her daughter's health are important factors in Rene's own health. By paying attention to imbalance in Rene's life, we see that a merely physical definition of health is not sufficient. For Rene to regain health, we need to address the relational, emotional, and mental aspects of her health, along with the physical.
How we define health is vitally important, both for individuals who are working to guide their own healing and for health professionals. The definition must go beyond the physical to include the wholeness of who we are as humans: loving and being loved, purposeful living and belief, spiritual connection and mindful awareness, rest and work, individuality and community, justice and morality, wise governments and economic balance, physiologic homeostasis and environmental connectedness, education and literacy, forgiveness and humility. A marvelous picture of our health is held in the richness of diversity and the interconnectedness that holds it together.
In Vancouver, I had the privilege of working at INSPIRE HEALTH, an integrated health centre. The model of care is a refreshing blend of science-based medicine with various complementary healthcare practitioners who together provide a richer approach to healthcare. Together, the patient and General Practitioner identify aspects of the patient's health that are out of balance. Then, through visits with various practitioners, patients are provided with support and tools to begin their healing journey towards restoring wholeness. Unfortunately, the centre is only funded to provide care for people with cancer, but it does represent a richer and more open-minded approach to healthcare.
Our definition of health shapes the architecture of our healthcare system. In Canada, we are in the midst of preparing legislation for the renewal of the Canadian Health Act. What is the wisest way to spend the billions of dollars that go towards healthcare each year? Many provinces spend nearly half their yearly budgets on a healthcare system that is primarily driven by the same scientific and physical outcomes that guide healthcare professionals. Millions of dollars are being spent on diabetes-management programs, early-detection initiatives, and incentives for health professionals and patients to meet target treatment goals yet the number of those suffering from diabetes continues to rise. It is generally accepted that poor diet and inactivity are closely linked to the development of diabetes, but little funding is directed towards addressing these issues. A move towards a richer and more open-minded definition of health will result will be a better balance between the prevention and acute management of diabetes.
Marc Lalonde, Canada's previous minister of National Health and Welfare, found in his research that individuals' health improved when certain societal aspects were present in communities, like low unemployment, high literacy and low crime rates. The list has expanded in recent years; these aspects are now defined as the social determinants of health. As engaged citizens and politicians, we need to be bold enough to design a healthcare system that supports the wholeness of health.
A definition of health based on wholeness may seem unattainable. We live in an imperfect world that brings inevitable ill health, incomplete wholeness, and societal inequities. But recognizing the insufficiency of the current focus on physical health and moving towards a richer and more open-minded definition is vital for us as individuals, practitioners, policy makers, and good neighbours.