Until 2018, I was part of an interdisciplinary research group of the University of Zurich, named "Dynamics of Healthy Aging''. Within this group, we had a weekly, internal research colloquium. Despite the huge variety of different topics covered in the research talks, there was usually one comment of my supervising professor, that he raised in almost every colloquium. He pointed out that, while talking about health, we were looking at disease, assuming that health can be easily defined as the absence of disease and illness.

He didn't get tired in remarking that when we want to talk about health - we should measure health. He was right, in our studies, the "healthy" subset of our samples were those who did not suffer from dementia, depression, anxiety or cognitive impairment, and so forth… So why didn't we do better, you may ask yourself now? Why didn't we come up with a solution to fix that in our research designs, measuring health directly and not indirectly due to the absence of certain types of disease. Altogether, I think we couldn't just quickly fix that, because defining health is a very complex problem and there is a strong tradition in many fields of research to look at health through the lense of disease. I think the easiest go to answer we all have in our heads follows the same line of thought as our definitions, going like "I am healthy when I am not sick." Thinking about it a bit longer, (at least for me) the question "Isn't there more to it?" comes to mind.

Is health the absence of illness?

The World Health Organisation (WHO) assumes there is more to it: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1948)". That feels like a rather strong statement to me.  Applying this definition, I wonder if there is one single person walking the earth who is healthy. Do you know many people who find themselves in a state of "complete physical, mental and social well-being"? 

I wonder:  Can't we be healthy with less than absolute physical, mental and social well-being? It seems that a "good enough" is not good enough here. I don't know how it feels to you, but actually, this definition feels more idealistic than practical or realistic to me. However, I appreciate that health was defined not only as the absence of something, but also by the presence of something: wellness. Now, even if we accept health as the state of absolute well-being: How do we get there?

Health is a dynamic Process

The first model of health in modern science,  focusing on factors that support human health and well-being rather than on factors that cause disease, was formulated by the medical sociologist Aaron Antonovksy in 1979. It is termed Salutogenesis. The "salutogenic model" focuses explicitly on what health is, how people get and stay healthy. It is important to note here that health and disease do not find themselves in an either-or-relationship in this model. We all are, in every point of our life, both healthy and unhealthy at the same time. This remains true until we die. Until then, there is no absolute health or absolute disease in our life. Even chronic disease doesn't prevent health. This means that even during strong illness and disease, there is a part of us that is healthy. And vice versa, no matter how well we feel, there are parts of us that are not perfectly healthy. And most importantly, across time, we dynamically shift along that continuum of "health-ease" to "dis-ease". It actually is the everchanging adjustment of ourselves, our adaption to inner and outer states, that reveals overall health and wholesomeness.

So even though we want to give health (however we understand this vague term for ourselves) an enduring and constant place in life, according to Salutogenesis, health over time is rather ever-changing heterostasis than stable homeostasis. This idea of dynamic change, that our lifeline is marked by ups and downs gets visualized by the shape of the snakes in the Rod of Asclepius (staff with one serpent) respectively in the Caduceus (staff entwined by two serpents, sometimes surmounted by wings), which is used as the symbol for many different medical or health institutions or services (such as the WHO’s logo or printed on ambulance cars).

Health is more than biology

Finally, I want to close that article with adding a younger definition on health by the WHO concerning health, namely their 2015 definition of healthy aging that I always found very helpful in facing the complexities of that topic. As aging starts the day we are born, I feel this definition does not only relate to that subset of us older than 65 years, but basically everyone. According to the WHO's World Report on Ageing and Health (2015), healthy aging is defined as “[…] the process of developing and maintaining the functional ability that enables well-being (…).”. Thereby, healthy aging is understood as the individuals’ ability “to be and to do what they have reason to value”. This definition has broadened my view to understand that health is far more than a bodily phenomenon caused by biochemistry, but a developmental process that addresses body, mind and soul altogether. Being healthy is ultimately about living a life that - with or without health issues - allows us to do things that are important and meaningful to us, that sustain our well-being and quality of life. So being healthy is much more than living in a disease-free body.

I also appreciate that this definition indicates that healthy aging or healthy development is something highly individualistic, as the rather abstract term "being and doing what we have reason to value" may look in some ways very similar from one person to the other - and in some other ways. While most of us share certain values (like being respected for what we are, feeling competent, and living with a sense of purpose), some more specific things could be very different from person to person: like breeding alpacas, being a tattoo artist, walking the woods, or playing cello. In that sense, being healthy is more diverse than the stereotypical and quite narrow ideas of health that we might sometimes carry in our heads.

Health is complex and more than the health industry wants to convey

Both approaches outlined above indicate that health can only be understood by taking all coordinates of human existence into account, not only the physical condition of a person. This is not exactly a genuine thought, but actually resembles the very basic premise of ayurvedic medicine, which is now more than 3000 years old. Ayurvedic medicine assumes that health and wellness depend on a delicate balance between body, mind and soul. Its main goal is to promote good health, not fight disease and take body, mind and soul equally into account during that process. Altogether, this ancient and most modern approach to  health goes against the common assumption that "health" is something that is foremost situated in our physique and then radiates its consequences from there into our lives.

In that sense, I think that health-promoting activities that only address our body are of limited use, especially when they are combined with a neglect of health and well-being in other domains of our existence. So for me, a healthy lifestyle cannot be compromised by drinking kale smoothies, while you actually dislike their taste. Or when we stick to an orthodix fitness routine, that unfortunately must take place at 12pm or 4 am, because most of our waking hours are spent within our professional position, hustling to not be outperformed by others. Please do not misunderstand me, I am not saying that gym routines, goji berries or green smoothies are unhealthy, they certainly are not. However it might be that, in the same way as measuring a person's health status only by the absence of symptoms, we might fall short when we think that nutrition and exercise are the most powerful things to support overall health and well-being on a daily basis.

In my view, a healthy lifestyle also has to do with fostering resilience through self-care and nurturing our emotional well-being so that we can create a life we deem meaningful, a life in which one can "be and to do what they have reason to value". In fact, taking care of our mental health and our social well-being does improve or stabilize aspects of our physical health. Our health and longevity seem to be as much related to our thoughts and feelings as our workout and dieting routines. But this is a whole topic of its own and will be covered in Part II of this blogpost - coming soon.