Is creating wellness more important than preventing disease?

What causes health? Most doctors would think this an odd question and reply that health is caused by avoiding the causes of disease. A more positive definition of health is offered by WHO. Rather than simply defining it as the absence of disease, it defines health as a state of complete physical, mental and social wellbeing. However, by implying that one is either in that state or not, it suggest health is a binary characteristic. One is either healthy or not.

«Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.»

World Health Organization

This either/or choice does not reflect our everyday experience. We move constantly within a spectrum of feeling good at times and feeling not so good at others and we can move from one state to the other within minutes. How well we feel depends on what is happening in us and around us. And, while our sense of wellbeing depends greatly on external events, it also depends on how we respond to them. In 2011, Huber and colleagues (BMJ 2011;343:d4163) suggested that «Just as environmental scientists describe the health of the earth as the capacity of a complex system to maintain a stable environment within a relatively narrow range, we propose the formulation of health as the ability to adapt and to self manage.»

«Just as environmental scientists describe the health of the earth as the capacity of a complex system to maintain a stable environment within a relatively narrow range, we propose the formulation of health as the ability to adapt and to self manage.»

Huber and colleagues (BMJ 2011)

This notion of adaptability was a feature of the writing of Alvin Toffler who said in his 1990 publication «Powershift, Knowledge, Wealth and Violence at the edge of the 21st century» that «the illiterate of the 21st century will not be those who cannot read and write but those who cannot learn, unlearn and relearn». This echoed thoughts he had written 20 years previously. «To survive, to avert what we have termed future shock, the individual must become infinitely more adaptable and capable than ever before. We must search out totally new ways to anchor ourselves, for all the old roots – religion, nation, community, family, or profession – are now shaking under the hurricane impact of the accelerative thrust.»

«The illiterate of the 21st century will not be those who cannot read and write but those who cannot learn, unlearn and relearn».

Alvin Toffler (1990)

It could be argued that when people become dislocated from traditional cultural anchors and they lack the ability to adapt effectively to new circumstances, the result is dis-ease. There is considerable empirical evidence to support such an argument. On of its strongest proponents was Aaron Antonovsky. His studies of the health of survivors of the holocaust led to him suggesting that health is created through the acquisition of a “sense of coherence”. This, he defined as the ability to make sense of the events around us and the conviction that we have the internal resources to engage successfully with those events. A strong sense of coherence allows us to use effectively the economic, social, environmental and cultural resources available to us and enhances our ability to adapt to stress and be resilient in the face of change. Antonovsky describes this process as salutogenesis – the creation of health. In trying to apply the concept of salutogenesis to the health of the population of Scotland, we have noticed some interesting implications of the theory. The methods we use to support the development of a salutogenic change all seem to lead to a more empathetic and connected community. Already, there is talk of this approach producing more nurturing childhoods, better educational outcome, reduced offending behaviour as well as a healthier population. The potential benefits extend far beyond health. It may, indeed, be that creating wellness turns out to be far more beneficial to society than simply preventing disease.

 

Sir Harry Burns

Chief Medical Officer for Scotland, United Kingdom /
Leiter der schottischen Gesundheitsbehörde, Grossbritannien
Curriculum Vitae >>

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