My friend and colleague Bill Fabrey (founder of NAAFA and current Board Member of ASDAH) recently used the phrase Healthier At Every Size in an email thread. I started thinking about how, maybe, just maybe, a weight-neutral, health-focused approach is really always a Healthier At Every Size approach. Thinking about “healthier” versus “health” inspired me to return to my ongoing exploration of how we define health … hence this blog post.
No Such Thing as Perfect Health
Have you ever noticed how the phrase “in perfect health”—whether used in a news report or in conversation—is almost always followed by the information that the supposedly perfectly healthy person had a fatal heart attack or contracted a deadly disease? And let’s face it, people who promise you perfect health are almost always trying to sell you something. Because (IMO) no responsible health care practitioner would ever guarantee perfect health, for one simple reason: it doesn’t exist.
We have this illusion in our culture that there is a holy grail of health, a magic bullet, some special recipe of behaviors and metrics that means one has achieved health (cue the trumpets and angel voices). I believe health is an idea, not a thing. And if health is an idea, how we think about it and the language we use to talk about it really matter.
Framed negatively, health can be a commodity to be bought and sold or a status that serves to create a hierarchy of judgment around various physiological states or around certain health behaviors that are deemed culturally acceptable or unacceptable.
Framed positively, health may function as a resource we can draw upon or a process for identifying and working towards wellbeing and functionality of mind, body, spirit, and community, regardless of the challenges each of us faces in life.
Health as Capacity
Another way of thinking about health is as a capacity or, if you will, a skill-set. Jon Robison and Karen Carrier, in their excellent treatise on holistic health promotion, suggest a dynamic vision of health: “Health can be redefined as the manner in which we live well despite our inescapable illnesses, disabilities, and trauma” (p. 171). To that which is inescapable, I might also add socioeconomic inequities, bias, stigma, environmental toxins, and other circumstances that can affect our health. So there are all these difficulties that we face, and the question is how are we going to handle them? I have written previously about the theory of salutogenesis, which suggests that our primary goal as health professionals should be to facilitate our clients’ and patients’ “general resistance resources” that promote a “sense of coherence.” Research shows that those with a more robust sense of coherence tend to live better and longer.
Make no mistake: I believe that we should collectively focus our public health efforts on eliminating the bias and stigma, socioeconomic disparities, cultural pathologies (e.g., the thin ideal or our overstressed workplaces), and environmental conditions that negatively affect our health. But the question remains, while these pressures are being exerted on the collective level, how we should be framing health when we work with individuals? When we reframe health as a capacity, our focus shifts from how to achieve the holy grail of perfect health to how to build one’s capacity for joy, vitality, and well-being in the face of all these challenges.
“Empowerment” Starts to Take Shape
The literature of health promotion is replete with references to “empowerment,” but this concept often remains elusively vague. In part, it seems to me, this elusiveness may be traced to our desire to define health as a “state of complete physical, mental and social well-being” (the World Health Organization’s oft-quoted definition).
How in the world can I (as a health educator) empower someone to achieve that level of perfection? The answer is I can’t, because as noted above, such perfection doesn’t exist. But when we reframe health as a capacity—as a set of behaviors, attitudes, and beliefs that we can cultivate to support our ability to thrive—then the abstract concept of “empowerment” morphs into a tangible strategy.
So a better question is, how can we empower people to live well despite the inescapable difficulties we all face? One important thing that we can do as health professionals is to recognize that we neither can nor should attempt to control how our clients and patients define “health” or how they choose to cultivate that capacity for living well. What we can do is facilitate and support that cultivation. For many of us, this means reframing for ourselves how we do our work. As William Benda M.D. writes in his chapter in Consciousness and Healing (p. 37):
If I realize and accept that the patient is the ultimate master of his or her body, mind, and soul, and am willing to relinquish control, the outcome is a sense of empowerment worthy of the word.
The HAES® principles as articulated by ASDAH are completely consistent with this view of empowerment. The beauty of how the HAES principles work is that they accommodate a variety of approaches to health promotion and health care. I am presenting my view here, and I recognize that others may differ as to how to define health. To me, a HAES approach is not about achieving and maintaining some elusive state of perfect health. It’s about setting aside our limited and limiting views of health and affirming our right—at every size—to develop our capacity to live well.