In Sickness and in Health

I’ve been thinking a lot about why in a time of pretty well-resourced health care in more economically developed countries, we are showing no signs of reversing the trend of ever worsening health.? Obesity, cardiovascular disease, metabolic syndrome; the prevalence of non-communicable diseases that are killing us is increasing in every country that measures them. Public health campaigns try to change this trajectory, but none have made a dent.? Some individuals or small groups may have amazing results, but at a population level we keep getting sicker. This is unsustainable; managing the consequences of these issues costs individuals, organisations, and the economy more than we can afford, regardless of who the payer is.

It isn’t like this isn’t a really well documented area either.? At one end of the scale there are many incredible organisations researching the issues that surround us, and a huge number of “influencers” at the other, selling us the latest idea that will solve our individual problems. Some of them make a lot of sense and should work. So why isn’t any of it moving the dial?

First of all I think we need to understand what we’re talking about.? It turns out that terms like health, sickness, and illness aren’t actually that well defined.? Yes, you can find them in the dictionary, but if you look deeper there are many discussions and disagreements about what is meant by these terms.

There are those who don’t agree with the World Health Organisation’s definition of health but it remains a reference point nearly 80 years after it was first put forward.

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [i]

Detractors take exception to the use of “complete” in this definition, but if you read this to mean taking a view of the complete person, rather than to mean perfection, then this definition implies that health is a well-rounded view of well-being for any individual.?

It isn’t just the absence of disease, so health and disease are not two ends of the same spectrum.? Disease is a biological process, that Western medicine may (or may not) yet understand, define, and be able to diagnose and treat.

Health is all about well-being though, so what is well-being?? Again, it is not so well defined!? Pulling together various sources I think it relates to how someone feels and functions, viewed both from a personal and societal perspective, and how they evaluate their lives as a whole.? With this definition someone can have a disease and a high sense of well-being if they feel positively about their life as a whole, and function as well as they want to, and society feels they ought to.

So “being healthy” is something that we can define for ourselves, but society may also have an opinion if you’re not seen to be functioning as society feels you ought to.? That is a thought for another day!

Where do sickness and illness fit into this? From the literature I think illness is a perception we have as individuals of not being right.? A “discontinuity in states of being and perceived role performances” [ii]

In contrast, sickness is something that society defines.? Being sick is something you are allowed to be when you meet society’s opinion, and it is what entitles someone to access care, support, and understanding.?

You may feel ill, but you may not be considered sick.? Think obesity.? The WHO defines it as a disease, but not everyone agrees you are sick if you have obesity, even if you feel ill because of it.? Not everyone with obesity is able to access the care they need to treat their illness, because society doesn’t universally agree it is a sickness that must be managed like cancer, asthma, or diabetes.

Where does this get us to?? I think health and illness are on the same spectrum; both are defined by the individual, and neither relate solely to disease.? But sickness is defined by society, and it is sickness that our health systems are geared up to manage.? Their mandates are usually to diagnose and treat disease, to cure sickness.? They are not set up to get to the root cause of illness, and to enable people to live in good health.

If we are really going to tackle the causes of poor health, we need to accept that a sickness system isn’t going to deliver it. ?

However there are many practitioners already working in evidence-based disciplines that focus on the root cause of illness.? It goes under many headings; Functional Medicine, Lifestyle Medicine, Whole Health Medicine, Integrative Medicine, and others. People who practice in this way, and the people they have supported, tell incredible stories of recovery and states of good health that haven’t been experienced in years.? This is personalised healthcare.? The connection between practitioner and person to really understand the problems from the beginning, and to look at the whole person to understand how to support a return to health and stay there. And it really does work. And it really could make a dent in our non-communicable disease pandemic.

We just need to work out how to expand what is often a 1-1 approach to a system level approach.? An approach that can support populations, in a personalised way. An approach that reverses the trend towards living for longer in poor health.? That is what I want to achieve. That is my mission.? Watch this space…

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[i] https://www.who.int/about/accountability/governance/constitution

[ii] https://www.cambridge.org/core/books/abs/health-and-illness-in-close-relationships/defining-health-and-illness/117B6947B2B905833B61888194AFBC0E#

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