“Health is a state of physical, mental and social well-being, and not merely the absence of disease and infirmity.”
The above definition of health was framed in the year 1948 by the WHO. Seventy two years on, its relevance does not seem to waver, as it serves as a reference point for all global efforts towards healthcare.
As the world attempts to tackle the coronavirus pandemic through treatment of its symptoms, prevention of its transmission, and search for a preventive vaccine, our lives have come to a standstill, quite literally. One of the 81 countries that have been affected by the coronavirus, India is still reporting new cases.
As we fear for our lives and those of our loved ones, while grieving for the ones affected, World Health Day offers an opportunity. It encourages us to reflect and possibly change the course of our future by changing our own lives through introspection. Let’s talk about health, shall we?
Redefining Our Understanding Of Health: Physical + Mental Health
Healthcare system so far has primarily focused on the bio-medical approach to understanding disease sand treating people. This means that any disturbance in the biological functioning of an individual leads to a health problem in the form of illness or disease. To treat such dysfunction, clinical diagnosis and the course of treatment through medication is provided. In many cases (including the case of COVID-19), the medication leads to symptom control and a sense of relief. However, it does not necessarily provide a cure to the condition itself in a way that ensures complete recovery.
Despite the acceptance of the idea that for healthy functioning, mind and body both play a role (in varying or equal degrees), the role of the mind is not given sufficient attention in diagnosis of a disease.
Remember those bouts of stomach aches, headaches, nausea, dizziness and other such complaints experienced before important deadlines? Or before an exam? They were tagged as ‘excuses’ or ‘normal complaints before an exam’. Maybe one would take a painkiller, and life would go on. Research has established that the body alone does not contribute to illness.
A new model of care has been created on this basis, called the biopsychosocial model of care. The model seeks to understand a disease from three angles – the biological processes, psychological processes and social factors, all combined and contributing in varying degrees. In the above example of a headache before an overwhelming event, the diagnosis could be:
- Biological: disturbed sleep during the night, indigestion caused by not eating on time and a resultant feeling of exhaustion
- Psychological: fear of failing, guilt of not putting enough effort, and the rush caused by a lack of time before the event.
- Social – noise of the TV worsening discomfort, repeated instructions by one parent to read instructions carefully, and keeping a track of time, followed by an argument with the other parent over being late again.
Sounds uncomfortable, right? So many things can happen in a short span of time. It may be difficult to pinpoint whether it is biological factors or psychosocial ones that are playing a greater role. Yet, their role cannot be denied.
As someone who has tackled many headaches with 20 minutes of transcendental meditation, along with healthy meals, sufficient rest, and a chat with my best friend, I can personally vouch for the effectiveness of a holistic approach to recovery and health. The understanding and treatment of conditions through the lens of the biopsychosocial model can range from common ailments to even life-threatening diseases, as proven by research.
Tackling The Burden Of Illness: The Illness-Wellness Continuum
While the definition given by the WHO is brief and concise, it is still some steps ahead of the common person’s understanding of health, which is restricted to the latter half of the definition – “the absence of disease and infirmity”. Public health programs promote good health and healthy lifestyles, but they seek to primarily prevent illnesses and diseases, such as diabetes, cardiovascular issues, HIV/AIDS etc. While such efforts are necessary and indeed commendable, mental health and illness programs get overshadowed by other concerns.
Globally, close to 800,000 people commit suicide every year. In India, for the year 2018, National Crime Records Bureau reported 10,159 student suicides. One in 7 Indians are affected by mental disorders of varying severity, as reported by The Lancet in 2017. There is a paucity of resources on the treatment of mental health conditions such as anxiety and depression. There are less than 4,000 mental health professionals in the country. The treatment gap, defined as the prevalence of mental illnesses and the proportion of patients who get treatment, is over 70%, which implies that only 30% people get required mental healthcare.
Other perspectives to control illness through wellness have emerged. Dr John Travis, from the US Public Health Service, introduced an Illness-Wellness continuum: ‘Pre-Mature Death’ on one side, ‘High-Level Wellness’ on the other, and a neutral state falling between the two. While most of the relatively-healthy ones would fall somewhere in the middle, it is possible to move closer towards the illness or the wellness side based on our access to information and the resources we utilise to stay healthy. This strength-based approach proves its effectiveness in two ways:
1. Preventing the occurrence of disease through capacity building.
2. Boosting wellness for a better quality of life, hence reducing dependence on the healthcare system.
Health As A Combination Of Factors: Reiterating Priorities And Listening To Our Inner Selves
Promotion of healthcare in public health primarily focuses on actions and steps individuals can take to move towards the wellness side of the illness-wellness continuum, though they end up sounding clichéd and somewhat unattainable to people. As health conditions keep rising, so does our acceptance of their prevalence.
We all know someone with diabetes, heart disease and cancer. But we don’t think that we will ever get these, and end up ignoring statistics. “He used to eat too much meat, that’s why he got sick. I don’t do that.” So why push ourselves already to be extra healthy when we are fine?
A few examples of commonly-promoted health behaviour are: getting 7-8 hours of sleep every night, regular physical exercise for 50 minutes, eating a healthy diet, limited or no intake of alcohol, and so on. There are just too many steps and consequently, too many fitness fads. Not all may apply to us, since our body and mind may need something else. There is a need to pause and ask ourselves: what do I need to be healthy?
It’s not easy to incorporate all these steps, since our busy and fast-paced lifestyles leave us with very limited time and energy to think about health. Here again, there is not enough emphasis on the psychological and social factors coming into play, such as managing stress through meditation, maintaining a balance between work and personal life, having hobbies, or seeking psychological counselling. While there are many steps that can help us achieve our goal, the ones that help us connect our mind to our body are the most necessary ones.
As the biopsychosocial model explains, since the causes of disease are so many, the steps taken to prevent or treat them must be taken at all three levels as well. Taking pills for everything cannot be the only approach.
For losing weight, one must eat nutritious meals, exercise regularly, cut down on unhealthy habits, monitor the weight, and then keep making subsequent changes to the lifestyle. Merely eating salads and not adopting other health measures will not work.
Challenges to good health and wellness are so common across people, that they are normalised and accepted as factors that are out of control, or ‘not important enough’. Until we are pushed against the wall by health diagnosis given by doctors, or timelines to lose weight or quit smoking, we don’t do it. And even when we do, it is a short-term goal to avoid specific diseases. Once it is controlled, what next? Exercise reduces, casual smoking starts again. As long as productivity and functionality at work, home, and community events is ensured, our worries dissipate.
The ‘To-Do list of Getting Healthy’ can wait. However, the risk may still exist. But once we move from diagnosis prevention to a self-growth and healing mode, we take one step at a time to slowly incorporate healthy behaviour in our life, especially that which our body and mind may need at the time – for example, taking short breaks between work to avoid burnout, eating periodically before our blood sugar level rises, exercising most days but not on the ones when we are sick, skipping get-togethers when all we need is some quiet.
By taking out half an hour for self-care in a day by doing light exercises or reading a novel, we slowly start feeling its benefits – we are less irritable, more present and calm, and find joy in engaging in relaxation. The burden from our mind and body slowly begins to lift.
At the end of the day, we all want to be healthy. We are willing to try out new diets, exercises, journaling habits, and other self-care techniques. Do they actually bring about a sense of feeling healthy? We all want to be able to do a handstand and have abs. But instead of getting immersed in trying out new techniques periodically, only to give up later, what is needed is a philosophical shift in the way we understand health.
Once health is seen as a dynamic state and made an overarching priority in life, it comes in our control and becomes accessible. We no longer choose to remain neutral. Instead, we find ways to move towards wellness, as our efforts start fetching slow but surely-visible results in terms of our physical, mental and social lives. It takes time, no doubt. But it gives us autonomy. Even in periods of sickness, we are capable of working on other aspects of our lives that may make us feel healthy and assist us in our recovery. When life gives you lemons, make lemonade, right?
I do understand that many of us are extremely privileged to be able to think and talk about health in the current context of the pandemic, which has not been kind to many other members of the world. Yet, we must use our privilege to reflect on the ways in which we can make the post-corona world a healthier and a happier place for us and those that we share space with.
Stay healthy, stay safe!