What is health?
By Wietse In het Panhuis
“What is healthy?”
You have probably heard this question, asked this question, or answered this question very often. It is a topic that everyone has an opinion about, and therefore a topic of discussion. People often tend to disagree, and argumentation between persons differs frequently. There are countless so called ‘experts’ who have written a book about nutrition, and countless subdivisions of groups of people, all with their own visions and way of living healthy. Nutrition and health can almost be called a religion. With so much diversity in opinion and belief, how do we know what is healthy? And what does ‘healthy’ even mean?
Let’s start with some definitions of health.
According to the World Health Organization (WHO), health can be defined as: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This definition has been established in 1948. A more recent definition states: “Health is the ability of individuals or communities to adapt and self-manage when facing physical, mental or social changes”.
Health has a lot of different meanings. It can say something about the physical and mental status of a person, but also about the lifestyle in which nutrition, physical activity and habits are included. In this article I will mainly talk about health in relation to nutrition, as nutrition can have a great impact on both good and bad health.
From an economical perspective, a population is healthy if health care costs and unemployment due to disease will be low. So in other words, health would be defined as merely the absence of disease. From an environmental point of view, health would be defined as having a dietary pattern that is good for the body, which mainly includes sustainable and environmentally friendly foods. From a cultural perspective, health is simply eating the foods of your own culture. You are healthy if you eat the foods of your (eating) culture. Your own culture’s foods would contribute to a good physical and mental well-being. These three examples show that the meaning of health is determined by perspective, and there are many more perspectives than just these three; to each his own perspective towards life. There is not a single truth.
What if health is defined as happiness? That in turn raises the question: What is happiness? Happiness could be defined as living the way you want to live, not worrying about what you can and can’t eat for example. You can eat only healthy foods, but you may still be unhappy. Being unhappy can be physically unhealthy for you. Just doing whatever you want might make you happy (and therefore healthy), but it might have consequences for the duration of your life. For some people this is a trade-off. Happiness can also be defined as the absence of disease: being sick can decrease your quality of life significantly. Therefore, the absence of disease might be a prerequisite to being happy and healthy.
In conclusion, the definition of health is different for everyone.
Why do these definitions matter?
Why would it matter to have different definitions of health? Isn’t living a lifestyle that is supposed to be healthy beneficial for everyone in general? Of course, exercising, eating healthy, not smoking, not drinking, etcetera can be beneficial for everyone. However, as there are so many definitions of health, there is not a lifestyle that fits all of these definitions. Everyone has their own definition of health, and therefore there might be different ways to approach this. What can be seen as healthy, could not be as healthy or important for another person. Some examples below will illustrate this.
Think of a person suffering from anorexia nervosa (an eating disorder). This person has a mental problem that is causing the inability to eat. When such a person eats, this provokes feelings of fear. For this person it is extremely important to tackle this mental issue and learning to eat again, while proper nutrition and exercise are less important.
Another example: the elderly. It is well-known that muscle mass and functionality decrease with aging. This often results in immobility, such as not being able to rise from a chair, walk the stairs, do groceries, etcetera. Eventually, this will lead to a loss of independence, meaning that elderly can’t take care of themselves anymore. So for elderly the focus could be on maintaining their muscle mass and functionality. This goal requires different dietary factors than what is generally considered to contribute to health. To optimize muscle mass and functionality, one should engage in physical activity (partly cardio, partly strength training) and have sufficient protein intake and total energy intake. A high protein and energy intake are not considered to be good for general health outcomes, such as good organ functionality, healthy aging, absence of disease, etc. Eating vegetables for example is not important for the goal of optimizing muscle mass and functionality.
As was mentioned earlier, happiness and thereby healthiness can be determined by living a lifestyle where you just do what you want to do. There is scientific consensus on the fact that it is best to not drink alcohol, and limit red meat intake[4,5]. For persons who value unhealthy habits this might seem irrelevant, because alcohol and red meat might be important contributors to their happiness.
Everyone has their own definition of health, based on what would be best for their situation or on their view on life. This can depend on age, mental well-being, physical well-being, the presence or absence of disease, the differences in risk people have of getting a disease, and so on. Therefore, health should be seen as a relative concept, and thereby there should also be different ways to approach it. There is not a ‘one-size-fits-all-solution’.
Should you give the same lifestyle recommendations to an anorexic girl of 14 years old and a frail man aged 85? Or to a young woman suffering from depression, a man with terminal cancer who has 1 year to live, or a grandmother with dementia that doesn’t even recognize her own husband anymore? No! They all have different priorities in live. The anorexic girl needs to survive: she has to prevent starving to death by working on her mental issues. The frail man needs to improve his mobility, by exercising and having a high energy high protein diet. The young woman with depression might eat healthy in order to keep her body healthy, but when you suffer from depression this can also make you physically unhealthy, let alone the fact that she is not happy. Mental health is much more important for this woman than physical health. The man with terminal cancer should try to make most of his life that he has left. Should he eat his fruits and vegetables every day in order to be healthy? He is going to die anyway, why not eat the foods he likes and spend time with his family on the couch? Also, why would you keep the grandmother with dementia alive? She does not recognize her family anymore, she doesn’t know where she is, her quality of life has tremendously decreased. Would you want her to eat fruits and vegetables in order to be physically healthy when mentally she is already long gone? In these cases it might seem more humane if death comes soon naturally after years of suffering…
This article might have had a bit of a philosophical approach instead of some clear answers on what is healthy, which is probably what you hoped for when you started reading this article. However, this article might set you thinking about what is important for you. What do you need in your life that makes you happy? What should you emphasize in your life? After all, being happy is more important than being healthy. It is just nice if these two can fit together in your life.
Find your priorities in life, live accordingly and pursue happiness.
 Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
 Huber, M., Knottnerus, J. A., Green, L., van der Horst, H., Jadad, A. R., Kromhout, D., … & Schnabel, P. (2011). How should we define health?. Bmj, 343.
 Aoyagi, Y., & Shephard, R. J. (1992). Aging and muscle function. Sports Medicine, 14(6), 376-396.
 International Agency for Research on Cancer. (2015). IARC Monographs evaluate consumption of red meat and processed meat. press release, (240).
 Alcohol. World Health Organization. Retrieved January 29, 2017, from http://www.who.int/topics/alcohol_drinking/en/