Changing views of healthSince the mid-1900s, medical practice has been dominated by a biomedical model that focuses more on curing than preventing illness, dividing diseases into categories — for example, targetting a “cirrhotic liver” or “ischemic heart” for treatment. This method tends to separate physical from psychological or emotional problems, which are sometimes dismissed as “all in the head,” not meriting medical attention. However, views of health are undergoing radical changes. The absence-of-disease concept is being supplanted by an image of “wellbeing for body, spirit and mind.” The emerging biopsychosocial model regards mind and body as an intertwined unit and suggests that people be treated as whole persons, taking into account economic, social and psychological factors.In 1948, the World Health Organization (WHO) defined health as a “state of complete physical, mental and social wellbeing, encompassing the ability to achieve full potential, deal with crises and meet environmental challenges.” In other words, health — or wellness, to use a trendy term — is the capacity to undertake physical effort, to live within one’s own potential and carry out tasks with vigour and alertness, leaving enough energy for unforeseen emergencies. The more recent Ottawa Charter for Health Promotion goes further, suggesting as fundamentals for health: “peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity.” For example, people can’t easily stay healthy if they’re starving, if the air is polluted or during wartime.Today’s key buzz words are “disease prevention” and “health promotion”, rather than trying to “treat the symptoms of illnesses” (as is practiced by most madical practitioners nowadays) that are largely preventable. Unfortunately, despite lip service, prevention is often a hard sell as it takes both personal and community action. Yet studies show that even a few words of advice from health professionals can often help to prevent disease by motivating people to modify their lifestyle.Many of us are the “worried well”Although North Americans have an increasing life expectancy, many worry unduly about health. As U.S. physician Dr. Arthur Barsky writes in his book Worried Sick: “Our sense of physical wellbeing has not kept pace with improvements in our collective health status…there is a pervasive atmosphere of dis-ease.” Many feel constantly “out of sorts” — with vague undiagnosable ailments — worriedly scrutinizing everyday actions for their health effects. For example, foods may be dubbed “good” (life-prolonging) or “bad” (health-harming) — instead of being regarded as enjoyable nourishment. Many are confused, even stressed, by trying to keep up with the latest medical pronouncements — eat margarine instead of butter (or not); drink red wine (one glass or two?); take antioxidants, vitamin E (or don’t); shun coffee, drink decaff (or what?).The main determinants of good healthBiology — the genetic make-up (genes inherited from mother and father).Lifestyle habits — such as a nutritious low-fat diet; enough exercise; sufficient, sound sleep; avoiding misuse of tobacco, alcohol and other drugs; motor-vehicle and traffic safety; healthy (safer) sexual practices; and stress-reduction.Emotional balance — good self-esteem, feeling “in control” and able to forge intimate relationships.Economic and social wellbeing — sufficient income for food and shelter; supportive networks (family, friends, colleagues).A health-promoting environment — e.g., not excessively polluted, clean air and water, adequate sewage disposal.Access to adequate medical care when needed.Measuring healthSince the WHO definition of health came out, many have tried to measure its components, which isn’t easy. By definition, people in “good health” have no diagnosable diseases, no significant symptoms of “dis-ease” (unwellness), feel “in control” of their lives, are energetic, satisfied with their social, sexual, occupational and personal existence. But even those with diagnosable diseases such as colitis or diabetes, may also feel well most of the time. Or older people with osteoporosis or atherosclerosis may consider themselves “in excellent health for their age.”Take as a further example a man who inherited a polycystic kidney disease that destroyed both kidneys by midlife. Even though he requires thrice-weekly dialysis (after two failed kidney transplants), he nonetheless enjoys a “healthy existence” in which he swims three times a week, walks to work and leads an active professional life. Similarly, a bank employee considers herself “healthy” even though she lost one breast to cancer 15 years ago, and suffers from carpal tunnel syndrome (pinched wrist nerve), for which she wears a splint at night. In contrast, we all know people with no physical disorders who complain about every little ache or transient pain.Just being fit isn’t enough!In search of good health and longevity, many North Americans devote endless time and effort to fitness. They conscientiously jog, do aerobics, spend time on exercise bicycles, restrict cholesterol intake, avoid aluminum cookware and get medical checkups. Beyond its health benefits, some even view fitness as a way to ennoble the soul, sometimes neglecting family and friends in the effort. Fitness may become an end in itself rather than a way to enhance personal and professional life. Yet the Ottawa Charter specifically states that “health is a means rather than an end in itself — not the object of living.”As one University of Toronto expert puts it, “just being fit isn’t it!” Although physical fitness — muscular strength and flexibility — is a prerequisite for wellbeing, fitness alone does not guarantee good health. Being physically fit when mentally unbalanced, “stressed out,” socially isolated or emotionally disturbed does not add up to good health. Obsessive fitness addicts may consider the slightest tinge of unwellness a slur on their character, making them feel guilty. Yet this kind of “blame the victim” mentality is unhealthy. It is absurd to expect that all illness can be avoided simply by one’s own efforts. See a related article by Loring Windblad, “What is good health, Part 2” for an overview of Loring’s health and what he specifically does to maintain that good health.