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What is good health?

Blog post from Councillor David Fothergill on the importance of focusing on generating good health rather than concentrating on sickness and illness to improve our communities.

We all want to be healthy but may pause a little if we are asked what it means to be healthy. Is health something that we can grasp, something that we can measure and can improve, or is it the absence of disease and sickness?

We may have one idea of health when raising a toast to someone’s good health at a social occasion and another idea of health when considering what services are needed to improve the health of local residents.

It is helpful to give some consideration to the definition of health so that we can be on firm foundations when looking to improve health in our communities.

The longstanding definition of health from the World Health Organization (WHO) formulated in 1948 is ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. This was an important definition in that it considered health as something positive rather than an absence of disease.

The focus on generating health rather than concentrating on sickness has opened the way for local health improvement in communities and to a focus on listening to people rather than simply sticking with a medical model of disease. It is also potentially helpful to see health in the context of the three areas of physical, mental and social wellbeing, especially if these are given similar weight when decisions on priorities are being made.

The WHO definition is by no means perfect though and has come under criticism in recent years. It was originally drawn up when rapidly progressing illnesses were more prominent and life expectancy much shorter than it is today. As populations become older, long-term conditions become more common and screening and early diagnosis increases, so conceptions of health change.

A complete state of health may not be possible for someone living with diabetes, but they can still be healthy. A person may be diagnosed as HIV positive but with appropriate support and treatment may have very little or no effect on life expectancy.

Health is about what makes us feel good physically, mentally, socially, and spiritually. It is about how we react to the strains and stresses of life and are not only resilient to them but have the potential to bounce back even stronger.

We can be healthy if we do not have a recognised disease but can also be healthy if we can manage a condition and look to live life to the full.

Focusing on good health and what makes us well, rather than on bad health and what makes us sick, moves us to consider assets rather than deficits. People and communities have assets which determine their health, and these can be built on and strengthened. Looked at from this point of view we can see health as a public good, as something that everyone should work towards and the best attainable health as a human right.

Given the priority of health in our lives as individuals and for communities, it is important to consider how health can be measured and how we can know if a community is becoming healthier. However, measuring health is not as easy as measuring illness. The most straightforward way of seeking to measure health is to consider how long people live.

Life expectancy can be calculated for one area and compared with another, but it is only a snapshot in time and not an accurate prediction. Also, it does not consider quality of life or include any aspect of people’s experience of life.

Healthy life expectancy can also be calculated and may be more useful in comparisons. It uses responses to questions about the level of people’s general health to calculate a figure for how long people will stay healthy. Healthy life expectancy will always be lower than life expectancy and the gap can be used to give an indication of overall levels of ill health.