What is Health?

By Indu Gupta, MD, MPH
Onondaga County Health Commissioner

Everyone uses the word “Health” every day irrespective of age, sex, gender, race, nationality, occupation, species, environment, and even in the context of non-living concept of money. So what is health? The answers vary. From healthy habits to the sense of relief that comes with being cured of a severe illness or the complete recovery from emotional instability. Technically, all of them are correct. We also use this word in the context of economic security, in order to describe the financial health of a household, an institution or a country.

So let’s return to the original question: what is health? According to the Oxford English dictionary, the word “health” originated from the Old English hǣlth, which is of Germanic origin (before the 12th century), meaning whole. Since I am a physician, I personally like the definition of health described by the World Health Organization’s 1948 declaration: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The physical, emotional, and social well-being are interdependent to give us the concept of health.

hpr_logoThis definition was further modified on November 21, 1986 during the International Conference in Ottawa to clearly define the expectations and emerging role of public health in the ever changing and increasingly complex world in the 21st century (see emblem at left). The concept of health promotion was introduced, along with the future vision, with an emblem reflecting the guiding principles for followers of public health.

This conference highlighted the empowering impact of health promotion. It was defined as, “Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being.

This means we have to consider the social determinants such as the place we are born, live, go to school, work, play, seek medical care, socialize, the safety of the neighborhood we live in, transportation, and opportunities we have for growth.

We also have to consider physical determinants such as city or rural living, housing and community design, lighting, presence of trees, sidewalks, bike lanes, roads and old construction hazards for possible toxic substances such as lead.

SDOH_mNow I would like to add the concept of “Healthy People 2020” to our discussion. This concept, coined by the Office of Disease Prevention and Health Promotion, proposes that if we can create a safe social and physical environment, it will result in good health for everyone. Stable economy, education, social and community context, appropriate and timely health care, and a safe neighborhood make up the five factors considered essential for the concept of “Healthy People 2020”. All of these 5 factors have to work together collaboratively, so the needs of a community are fulfilled and a healthy community would be sustainable after its inception.

Health starts where we live, eat, go to school, work, play, take care of ourselves by getting vaccinated, not smoking, following screening guidelines and participating in social activities in the community. For this we need safe neighborhoods to thrive, clean water to drink, safe food to eat, and good quality of air to breath. We also need to understand that our physical health is closely linked to our mental health. Mental health disorders can worsen the outcome of many chronic medical problems such as diabetes, high blood pressure, heart disease, and cancer to name a few. If Mr. Smith is depressed, he may forget to take his blood sugar medication, which can result in poor control of his diabetes, and he may suffer blindness, kidney failure, or heart disease affecting his quality of life as well as longevity.

On a very personal note, I learned this from my late father. He used to visit me from India, to spend time with his grandchildren during the summers. I was very busy in my solo practice of internal medicine in taking care of patients day and night. Everything had to move fast including food and conversations. I often had to rush out without finishing the food on the table and had no time for the kids. Life was chaotic, but I did not see it. One day he gently took me aside and said, “When you were little, I worked hard to provide safe shelter, food, clothing, and education for my family so that you would become something in life; now you have everything including a great job, house, and family but you have no time to sit, talk to your kids, and eat….” I was stunned. My father was very polite, I could see that he was not upset, not even frustrated but was genuinely concerned about his daughter, who seemed quite stressed as a young working mother. His observation was accurate. I was getting extremely stressed with competing demands in my life from work, children, family, and lastly, myself. He wanted to help but did not know how other than giving me advice and I am so thankful that he did! Even though it was painful to hear, he was right. I paused and started to think of ways to make changes. Change is always frightening and difficult; but it is real and is for the better. I restructured my day at home and work, to balance my life, and to take into account my wellness.

Wellness OrangeWellness is not an event, symbol, or logo. It is a process of finding balance in life to get to our maximum potential in what we do- whether it is taking care of children or parents, aging and ailing family members, teaching, proving medical care, entertaining, being custodial, to managing small to large organizations to countries. It truly is a life-long process, which requires us to pay attention to our physical, emotional, social, environmental, intellectual, occupational and spiritual well-being.

If we continue to strive for balance, we will be better equipped to address unexpected events in our lifetime in a much better way, whether it is illness, loss of life, or setbacks in life. How? The balancing act of wellness makes us a driver, not a passive passenger, in our journey of life. This is what I would want, won’t you do the same?

WHO: http://www.who.int/about/definition/en/print.html
The Ottowa Charter for Health Promotion http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
Social Determinants of Health, Healthy People 2020: http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health
Seven Dimensions of Wellness, UC Riverside: http://wellness.ucr.edu/seven_dimensions.html