The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In the early portion of my presentations to health professionals, I often ask how they feel about the accuracy, appropriateness and scientific validity of this definition – likely the most oft-quoted one on the planet. Typically most say they feel it is a pretty good definition, although some people do express a bit of discomfort with the word “complete.” I invite everyone to stand and explain that, in a moment I am going to ask those who have the “absence of disease or infirmity” to remain standing. Before we do that, however, I suggest we review a definition of infirmity so we are all on the same page when they make their decisions. I then reveal the following dictionary definition for “infirmity”:
- A bodily ailment or weakness, especially one brought on by old age.
- A failing or defect in a person’s character.
After the laughter subsides, I ask everyone who has “the absence of disease or infirmity” to remain standing. In a group of two or three hundred, typically 10 to 20 people remain standing. I next ask this group to remain standing if they have “complete physical, mental and social well-being.” Usually everyone but one or two sit down. I then remind them that telling the truth is a sign of mental health and everyone has a good laugh as the remaining folks seat themselves.
Traditionally, even when health is defined as more than just the absence or opposite of disease, it is still most often envisioned as some “optimal state” that can be achieved if we just try hard enough. A trip to the local bookstore will reveal a seemingly endless barrage of books by health experts claiming to provide the steps needed to reach this proposed state of perfection. The problem is, of course, that as human beings we all live with varying amounts of physical, emotional, and spiritual baggage. How many people have ever experienced or ever known anyone in “optimal health? What does “optimal health” even look like? As medical writer David B. Morris suggests in his insightful book Illness and Culture in the Postmodern Age:
Complete well-being is a fantasy. Health, whatever else it might be is something that happens not so much in the absence of illness as in its presence.
It helps me to think about the difficulties surrounding the concept of “optimal health” in this way:
If you can start the day without caffeine,
If you can be cheerful, ignoring aches and pains,
If you can resist complaining and boring people with your troubles,
If you can eat the same food everyday and be grateful for it,
If you can understand when loved ones are too busy to give you time,
If you can overlook when people take things out on you when, through no fault of yours something goes wrong,
If you can take criticism and blame without resentment,
If you can face the world without lies and deceit,
If you can conquer tension without medical help,
If you can relax without liquor,
If you can sleep without the aid of drugs –
If you can do all these things …
Then you are probably the family dog!
Dogs and especially golden retrievers (this was ours before she passed a few years ago) just seem to be at peace with the universe and everything in it. The WHO definition is not a bad one; it just doesn’t fit our species. Living skillfully and compassionately with our inevitable struggles, rather than perpetually searching for the latest holy grail of “optimal health” may come closer to what it truly means to be healthy. Furthermore, the constant pressure to strive for this unreachable perfection; the quest for the perfect body, the perfect diet, the perfect exercise program, the perfect risk factors, behaviors, etc. set us up for almost inevitable frustration and failure. In his often cited 1975 article Medical Nemesis, philosopher Ivan Illich addresses this issue head on saying:
“Health is not freedom from the inevitability of death, disease, unhappiness, and stress, but rather the ability to cope with them in a competent way.”
My friend and colleague Laura McKibbin has developed an amazingly creative graphic that she calls the Food For Thought Pyramid (below) as a way of displaying what a truly holistic description of health might look like. It is structured like the food pyramid used to be, with the most important foundations of health at the bottom of the pyramid.
As you can see, the base of the pyramid has little to do with personal strivings for biometric or behavioral perfection, though the issues therein can certainly impact those parameters, and instead has everything to do with the context of our existence and the circumstances we have been dealt. Without the life-sustaining foundation represented by the bottom of the pyramid; fruits and vegetables, exercise and low cholesterol will likely have minimal impact on personal health. Genetics, luck and a range of cultural factors provide the critical platform on which a healthful existence is built and remind us about the complexities and importance of context to understanding the true meaning of human health.
So, what are the practical, life applications of this information? In their groundbreaking book Healthy Pleasures, Sobel and Ornstein nail down a prescription for the pursuit of health, saying:
“We need to restore some sensibility to the pursuit of health. Many of us increasingly view ourselves as fragile and vulnerable, ready to develop cancer, heart disease or some other dreaded disease at the slightest provocation. In the name of health we give up many of our enjoyments. The important point is that worrying too much about anything – be it calories, salt, cancer or cholesterol – is bad for you, and living optimistically with pleasure, zest and commitment, is good. Medical terrorism shouldn’t attack life’s pleasures.”
Making peace with our bodies and our foods—the hallmark of the HAES philosophy—seems like a perfect starting point for this prescription.