The World Health Organization’s (WHO) definition of health has not changed since 1948 when the organization was first created. The organization demonstrated a futuristic vision by defining health as follows:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
The beauty of this definition is that it captures the holistic human being as composed of body, mind and spirit, where the spirit is accurately reflected by the social dimension of being. The WHO definition of health was (and is) futuristic because our health system is traditionally based on the biomedical model which views health much more narrowly as simply the absence of disease or infirmity. In the old perspective an unhealthy person is viewed as a broken machine that needs to be fixed, and the physician is viewed simply as a mechanic. The mechanic is concerned with how to fix (i.e. cure) the problem rather than worrying much about how it could be prevented.
In the old biomedical model of health individual behavior, social structures, culture and environment are assumed to be fixed and the only thing amenable to change is the individual’s biology and biochemistry. An extreme example of this form of health care is the Army doctor who treats combat casualties. It is assumed that combat is an essential aspect of the world and therefore preventing war is not perceived as an important goal of the health care system.
In 1977 George Engel’s biopsychosocial (BPS) model of health began ousting the strongly entrenched biomedical model of health and disease. This model promotes WHO’s definition of health and holds the health care team responsible for evaluating the social, and environmental, psychological and physical causes of disease or infirmity. However, as a society we have a long way to go before the BPS model and WHO’s definition of health can reach its full potential.
The Biopsychosocial Model of Health
If we work with the BPS model we can find root causes of illness and disease that are not simply limited to biology. For example, in the US up to 80% of chronic diseases such as diabetes, heart disease and stroke are preventable with lifestyle, behavior and environmental modification strategies. Because the biomedical model is failing us when it comes to chronic diseases, our government is finally coming around to implementing the BPS approach to health care.
In March of 2016 the Diabetes Prevention Program (DPP) became the first prevention service model ever to become certified for expansion by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. On January 1, 2018 the DPP is scheduled to begin benefiting more medicare beneficiaries. The DPP consists of a coached 1 year program that helps people with pre-diabetes cut their risk of developing diabetes by 58% over a 5 year period through modest weight loss coupled with physical activity of 150 minutes per week.
This monumental transition from treatment of diabetes to prevention of diabetes has taken over 25 years of accumulated research that can be traced at least as far back as the 6-year Malmö feasibility study in Sweden that was published in 1991. Twenty five years later, and following the Diabetes Prevention Programs multicenter clinical research study published in 2002, the US government has come to the conclusion that it can save money by helping people prevent chronic disease rather waiting for them to get sick and then having to pay for many years of treatment . This positive transition in perspective may begin to fundamentally alter the future of health care in America and the world.
Is It Really all about Money?
In a poem by James Brown (pen name James J. Lachard) God says that what surprises him most about humankind is:
“That they lose their health to make money and then lose their money to restore their health.”
It never ceases to amaze me that of all earth’s species only humans are dependent on money in order to retain health! No other animal needs it. Does that make us smarter or in a way dumber than other animals? Our brilliance seems to lie in harnessing the complexity of the brain to create more and more barriers in the path of success (and health) for a large portion of the population. Consider that in 2014 the number of US deaths from suicide totalled 42,773 (ranked number 10 overall) and that suicide was the second highest cause of death for ages 10-34. These statistics bear down directly on the social aspect of health in the biopsychosocial model.
Unfortunately for man (and woman) it truly appears that our oversized cerebral cortex when compared to other mammals has been misappropriated to the task of obfuscation. That is, our ‘smartness’ has been turned against us through centuries of manipulation by the few to control and harness the power of the many. The sad result is thwarted social evolution even as technological knowledge and sophistication continues to increase. This intelligent obfuscation means that humans are often worse off than other animals with far less cognitive ability.
When seen in the proper context it becomes evident that in the BPS model the biggest health challenges arise in the social sphere, because society has been structured to induce loss of health on many levels in order to promote the wealth of the few at the expense of the health of the many.
The Health of the Many Traded into Wealth for a Few
Any factor that reduces the spendable income of Americans ultimately takes a toll on health, especially when it affects food quality choices (i.e. organic vs non-organic, processed food vs fresh food), fitness choices (gym memberships and available time for fitness activities) or family time. Thus excess income inequality, taxes, insurance costs, and interest payment costs create a burden that decreases the holistic health of society.
Take for example how our society entraps college students today. The total student debt has been estimated at 1.3 trillion dollars and in 2016 two-thirds of graduate students owed an average of $35,000 each. Debt needs to be called out as form of slavery! We like to think of ourselves as a free country, but yet we sell our children into the slavery of debt, and in fact the country as a whole is sold into slavery through the national debt.
The BPS model of health gives us a framework for making decisions to change social structures. such as a monetary system based on debt, that inhibit health as defined by WHO.
The Future of Health (Big Picture)
The earth and its biosphere can be viewed as a seed in the relatively lifeless environment of space. Like a seed the earth contains in abundance all of the ingredients for life to develop to a certain extent, after which sustenance must be derived from outside of the seed. In a like manner, the sun which powers our biosphere is a middle-aged yellow-dwarf star that is 4.6 billion years into its main sequence of life. In as little as, 1 billion years we can expect the increase of solar output to begin causing serious challenges to life on earth. This may seem like a long time but there are many technological barriers that must be overcome before life can expand from the earth-seed to other solar systems. In his 2015 State of the Union Address President Barrack Obama stated,
In order for our earth-seed to be successful, optimum health will be required of all of its human and non-human inhabitants. By this I mean health according to the WHO definition: “…a state of complete physical, mental and social well-being.”
From the biopsychosocial model we can see that this will require a complete overhaul of social structures throughout the world. Social structures that are depleting and restricting our human potential must be replaced with new health-oriented structures such as debt-free societies. Then the power of 7 billion human brains can truly be harnessed and applied to the future of the earth-seed.