essay about value of health

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• Published: 18 March 2020

A philosophy of health: life as reality, health as a universal value

• Julian M. Saad   ORCID: orcid.org/0000-0002-9323-1021 1 &
• James O. Prochaska 1  

Palgrave Communications volume  6 , Article number:  45 ( 2020 ) Cite this article

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• Health humanities
• Medical humanities

Emphases on biomarkers (e.g. when making diagnoses) and pharmaceutical/drug methods (e.g. when researching/disseminating population level interventions) in primary care evidence philosophies of health (and healthcare) that reduce health to the biological level. However, with chronic diseases being responsible for the majority of all cause deaths and being strongly linked to health behavior and lifestyle; predominantly biological views are becoming increasingly insufficient when discussing this health crisis. A philosophy that integrates biological, behavioral, and social determinants of health could benefit multidisciplinary discussions of healthy publics. This manuscript introduces a Philosophy of Health by presenting its first five principles of health. The philosophy creates parallels among biological immunity, health behavior change, social change by proposing that two general functions— precision and variation —impact population health at biological, behavioral, and social levels. This higher-level of abstraction is used to conclude that integrating functions, rather than separated (biological) structures drive healthy publics. A Philosophy of Health provides a framework that can integrate existing theories, models, concepts, and constructs.

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A philosophy of health.

What is health? Is it a state of the body or the mind? Is health primarily a natural, biological state or a holistic, value-laden state? Naturalistic and holistic philosophies of health have provided very important, but very different, perspectives of population health. Naturalistic views (e.g. as seen in Boorse, 1997 ) provide insight into physical, natural, biological, or physiological processes that are tangible (in the material sense), observable, and measurable with modern technology. Complementarily, holistic views contend that value-laden phenomena (e.g. vital goals, meaning, and purpose) play a central role in population health (Nordenfeldt, 2007 ).

A dialog, or as we see it, an important dialectic among naturalistic and holistic perspectives plays out between the Biostatistical Theory of Health (BST) and the Holistic Theory of Health (HTH). The BST posits that a person is healthy if and only if, all natural organs function normally given a statistically normal environment (Boorse, 1997 ). The HTH posits that a person is healthy if and only if (given standard circumstances) he/she has the ability to attain their vital goals (Nordenfeldt, 2007 ).

In addition to defining health, each philosophy defines disease. The BST poses that disease is the internal state of impairment to the normal functioning of organs (Boorse, 1997 ). In the HTH, an organ dysfunction is a disease if and only if the organ’s process reduces the person’s ability to pursue vital goals or life-purpose (Nordenfelt, 2007 ). In BST health is the absence of disease; and in HTH, health is not the absence of biological disease, but is the whole person’s ability to function in relation to vital goals.

Both naturalistic and holistic perspectives guide important observations of health and disease. When one considers health through the BST one pays close attention to the functions of the internal, biological functioning of the human being. When one considers health through the HTH, one pays close attention to the functioning of an individual, in relation to their external, societal/cultural functions. Is there a hybrid model that accounts for both internal and external functioning?

Wakefield’s ( 2014 ) harmful dysfunction analysis (HDA) creates a hybrid model that integrates natural- and value-laden phenomena when conceptualizing disease. HDA asserts that a person suffers from a disorder/disease if (1) the condition causes harm (as judged by the standards of the person’s culture); or if (2) the person’s internal, natural processes cannot perform normal functioning (as judged by the standards set by evolution). HDA creates a hybrid model that can integrate perspectives of the BST (i.e. by considering internal organ functioning); and the HTH (i.e. by considering external societal/goal functioning). However, while HDA may define health processes in relation to disease, it serves primarily as an integrative model of disease . Is there an integrative model of health that can account for natural and value-laden functions?

Schroeder ( 2012 ) identifies a significant, common thread among these competing (or perhaps complementing) philosophies: functionalism . The researcher suggests that each philosophy is concerned with the functioning of organisms. Although the BST, HTH, and the HDA might not agree on which functions inform the first principles of health, Schroder ( 2012 ) uses higher-level abstraction to identify one common first principle: the state of functioning in an organism impacts its state of health . When paralleling the three philosophies based upon functioning one might observe that (1) BST declares an individual healthy if its organs function normally; (2) HTH declares an individual healthy if he/she can function in relation to vital goals; and (3) HDA declares an individual unhealthy if internal mechanisms cannot perform natural, evolutionary functions, and/or when a condition prevents a person from functioning in relation to goals/norms/values. Through this higher-level abstraction, an integration of seemingly separate philosophies of health is made possible.

Learning from leaders in the field

As we attend to these philosophies of health, we too observe how discussions about functions and functioning produce integrative perspectives. Although a definition of “function” is not explicitly stated in the above research, it appears that Nordenfeldt ( 2007 ), Boorse ( 1997 ), Wakefield ( 2014 ), and Schroeder ( 2012 ) are each discussing functions as pre-existent (i.e. either from evolution, personal goal-setting, cultural tradition) processes - with - purposes . Whether one is describing a value-laden function (e.g. decision-making in pursuit of a valuable career) or an evolutionary-biological function (e.g. the heart beating for circulation), each process (i.e. decision-making processes or cardiac processes) serves identifiable purposes (e.g. maintained financial stability or maintained blood flow). Whether an organ is functioning normally in relation to the body or a human being is functioning in relation to vital goals, it appears that both perspectives consider if an active “process” (i.e. an organ’s activity, an individual’s activity) can express its “purpose” (i.e. evolutionary-purpose, life-purpose).

In the present manuscript we will propose that naturalistic and holistic perspectives can be integrated within a single philosophy of health. We will propose two universal functions—termed precision and variation —that can account for both natural functions and value-laden functions of the existing philosophies. This functional language will support a higher level of abstraction that integrates, rather than separates, biological functions, behavioral functions, and social functions under A Philosophy of Health.

The need for new perspectives in population health

The chronic disease crisis beckons the need for an updated philosophy of health that can account for biological, behavioral, and social functioning. Why? Chronic diseases, which account for 60% of all-cause deaths worldwide (Chartier and Cawthorpe, 2016 ), do not emerge from naturalistic, biological, or physical contact with an illness. Rather, chronic diseases do emerge in biological functions (e.g. tumor proliferation in an organ) after prolonged contact with health risk behaviors and lifestyle factors that active the conditions (Mokdad et al., 2018 ; Edington, 2009 ; Li et al., 2018 ). Chronic diseases are not curable by purely naturalistic or biological means (e.g. pharmaceuticals). Rather, some diseases may be effectively prevented or intervened on through healthy behavior (Dansinger et al., 2005 ; Daubenmier et al., 2007 ).

Population health risk behaviors are unique determinants of population health because researchers can actively observe how they simultaneously alter biological functioning (e.g. chronic smoking alters cells in lung tissue), behavioral functioning (e.g. chronic smoking alters decision-making and daily habits) and social functioning (e.g. chronic smoking creates an economic, social, and healthcare burden) of the population. These behaviors not only have biological, behavioral, and social implications for the individual doing the behavior, but also have intergenerational and interpersonal effects. The individual who binges on refined sugar not only puts themselves at risk of diabetes, but can put their future offspring at risk. The individual who smokes two packs of cigarettes per day not only puts themselves at risk of lung cancer, but can put their housemates at risk of lung cancer from second-hand smoke. Therefore, the chronic disease crisis is neither purely naturalistic, nor purely value-laden; rather it reflects an integration of natural and value-laden phenomena. There remains a real need for principles of health that can integrate existing naturalistic and holistic perspectives of population health.

The principles

Since April 7, 1948, the Constitution of the World Health Organization ( 2010 ) has utilized an intuitive definition of health by suggesting that health is “a state of complete physical, mental, and social well-being.” While this definition might be intuitive and even accessible to a wide audience; the defininition is not necessarily researchable across health disciplines. Integrating principles of health might begin with a common-sense definition of health that can also be upheld across existing naturalistic and holistic perspectives. Without operationally defining functions that drive physical, mental, and social well-being, it is a challenge for multidisciplinary collaborators to unite under the WHO mission. Further, without a common definition of health, important communications from patients to doctors, from subjects to researchers, from researchers to collaborators, and from peer-reviewers to peer-reviewees, can become fragmented or lost in translation. In the proceeding sections, a common-sense definition of health is used to present the first principles of A Philosophy of Health.

Principle 1: “Health” is the state of maintainable-ease of functioning . A “disease” is a state of prolonged-dysfunction that prevents ease

Chronic diseases emerge from prolonged exposure to dysfunctional behaviors like smoking, alcohol abuse, unhealthy diet, and inactivity (Mokdad et al., 2018 ) that also create dysfunctional expressions of life functions. Smoking creates dysfunctional breathing; alcohol abuse creates dysfunctional drinking; sugar binging creates dysfunctional eating; and sedentary behavior creates dysfunctional moving. When these health risk behaviors lead to chronic disease, they have already prolonged dysfunctional breathing, drinking, eating, and/or moving.

The chronic smoker breathes in smoke so frequently that he no longer experiences an ease-of-breathing. Rather, his breathing becomes short and shallow. Prior to the emergence of lung tumors, the chronic smoker prolongs dysfunctional patterns of breathing. The “couch potato” sits so frequently that he no longer experiences an ease-of-movement. Rather his movement becomes rigid and limited. Prior to the emergence of cardiovascular dysfunction or obesity, the sedentary person prolongs dysfunctional patterns of movement.

If chronic smoking facilitates prolonged-dysfunction in breathing, and sedentary behavior facilitates prolonged-dysfunction in movement, what do functional breathing and moving look like? Healthy breathing and moving (as well as eating and drinking) are characteristic of an ease of one’s functioning that can be maintained in normal conditions. For example, the chronic smoker and the “couch potato” might report momentary-ease in breathing and posture when engaging in their health risk behaviors; but they do not maintain that ease outside of smoking or sitting. Conversely, the yogi might report that their yoga practices expose them to momentary dis-ease in breathing and moving that lead to maintainable-ease in breathing and movement in everyday life. In contrast to disease as a prolonged-dysfunction, healthy functioning can be commonly sensed as a maintainable - ease of functioning .

When observing a disease, perhaps we are observing a prolonged-dysfunction that prevents ease. Rather than define health as the absence of disease (as seen in BST), notice here how we instead define disease in relation to health; and we define health in relation to maintainability , ease , and functioning . Consideration of “maintainable-ease of functioning” will allow us to consider how not all “dis-ease” is bad (i.e. exposure to acute dis-ease/stress maintains healthy functioning in the long-term); and not all “ease” is good (i.e. avoidance of stress and prolonged “comfort” creates fragility seen in sedentary behavior). We propose that:

Dysfunction parallels a state of “dis-ease”; and prolonged -dysfunction parallels the state of Disease.

Function parallels a state of “ease”; and maintainable-ease of functioning parallels the state of Health.

This definition of health will be applied in the proceeding principles to integrate naturalistic and holistic perspectives of population health.

Principle 2: Health emerges from maintainable-ease of functioning at multiple levels . Maintainable-ease of functioning in the general population can be observed at the level of the cell , the self , and the society simultaneously

Cooperation across multiple levels of functioning is required for the organization and adaptation of living systems (Nowak and Sigmund, 2005 ; Antonucci and Webster, 2014 ). When developing an integrative model of health, it is important to consider how biological cells, individuals, and the larger society simultaneously play a role in population health (Xavier da Silveira dos Santos and Liberali, 2019 ; Antonucci and Webster, 2014 ). In this philosophy, we define health from three levels: cells , selves, and societies . What happens when these levels do not function in cooperation?

When the functioning of cells disrupts the functioning of the self, a state dis-ease in the self can follow. For example, prolonged dysfunction in autoimmune conditions can lead to prolonged dysfunction for the (individual’s sense of) self by triggering depression, decreased motivation, or anxiety (Lougee et al., 2000 ; Garud et al., 2009 ). The reverse can also be true. When the functioning of the self (i.e. one individual) disrupts the functioning of their cells, a state dis-ease in the cells can also follow. For example, prolonged sugar binging and addictive eating can lead to prolonged high blood sugar and pancreatic dysfunction seen in diabetes (De Koning et al., 2011 ; Imamura et al., 2015 ). Cells and selves are not separate.

When the functioning of the self disrupts the functioning of the society we observe a state dis-ease in the society. For example, one person’s unprotected sex with multiple partners can also lead to epidemics and social conflicts. The reverse can also be true. When the functioning of the society disrupts the functioning of the individual, a state dis-ease in the self can follow. For example, dysfunctional social conditions (as seen in Rutter, 1998 ), can lead to prolonged psychological and behavioral dysfunctions of individuals. Selves and societies are not separate.

When the functioning of society disrupts the functioning of cells, a state of dis-ease in the cells can also follow. For example, prolonged dysfunction in society in the form of misguided values about cleanliness, can lead to over-sanitization practices that create superbugs and antibiotic-resistant bacteria (Zaccheo et al., 2017 ; Finkelstein et al., 2014 ; Bower and Daeschel, 1999 ). The reverse can also be true. When the functioning of cells disrupts the functioning of the society, a state of dis-ease in the society can follow. Prolonged dysfunction in cells from naturally occurring parasites (e.g. Yersinia pestis [Cui et al., 2013 ]) can lead to prolonged dysfunctions like the economic collapse following 14th century Black Death (Haensch et al., 2010 ). Cells and societies are not separate.

What does health look like when these levels work together? Recent reports on the Blue Zones (i.e. the areas of the world where populations live significantly longer and healthier than the average) demonstrate that healthy functioning at these levels enhances physical longevity and mental wellbeing in populations (Buettner, 2012 ; Poulain et al., 2013 ). Buettner ( 2012 ) reports on how Blue-Zone populations intentionally and habitually enrich their physical bodies with healthy eating and physical activity. In addition to integrating physical and behavioral practices, these communities also integrate behavioral and social practices, such as, goal-setting, meditations/prayer, social engagement, pursuit of purpose, and community gathering. Humor is used by individuals and groups as a means to practice ease when challenges present themselves (Buettner, 2012 ). Blue Zone communities place value upon physical/natural, behavioral and social processes, generating them intentionally and habitually.

Both states of ease and dis-ease can teach us about the contributions of cells, selves, and societies to population health. Although it is important to be able to observe the levels separately to describe their contributions, it is also important to consider how the levels integrate to impact healthy publics. We acknowledge that meaningful changes can be observed above and below these levels (e.g. at the level of the biosphere and genome). However, this initial paper will introduce levels that are most proximal and accessible to the experience of a general readership (Fig. 1 ).

Principle 3: Health emerges from systems whose primary purpose is to generate maintainable-ease of functioning at a respective level

We propose that systems exist at each level with the purpose of generating maintainable-ease of functioning at that level. The biological immune system, an individual’s system of health behaviors, and the social system will be observed as systems that generate maintainable-ease of functioning in cells, selves, and societies respectively (Fig. 2 ).

Principle 3a: The biological immune system is directly responsible for maintainable-ease of functioning at the level of the cell

Throughout the course of human evolution, the complexity and biodiversity of the human body continued to increase (Rodríguez et al., 2012 ). What keeps the trillions of cells and microorganisms in cooperation in a human body? The biological immune system maintains functional cells (Rodríguez et al., 2012 ). Although it is documented that the functioning of the biological immune system has implications for behavioral functioning (Ader, 1974 , 2000 ; Johnston et al., 1992 ; CDC, 2016 ) and social functioning (CDC, 2016 ; Reidel, 2005 ; Cutler and Miller, 2005 ) the system’s primary purpose is supporting functioning in the cellular/biological system.

Principle 3b: Health behavior is directly responsible for maintainable-ease of functioning at the level of the self

Throughout the course of time, the complexity of human behavior, has continued to increase (Boulding and Khalil, 2002 ). What keeps an individual in a state of balance during times of rapid change? One’s system of health behaviors (e.g. one’s practices of breathing, drinking, eating, and moving) maintain a functional self. Although it is well documented that the behavior of the individual impacts biological functioning (Fadel, 2013 , 2015 ) and social functioning (Omer et al., 2009 ), one’s system of health behaviors directly impacts one’s experience of (or one’s ‘sense of’) their “self”.

Principle 3c: The social system is directly responsible for maintainable-ease of functioning at the level of the society

Throughout history, the social diversity of human societies continued to increase. During periods of rapid increases in social diversity and cultural integration, what supported cooperation in the society? Social systems (e.g. public governments, private social organizations, religious/spiritual organizations) emerge to maintain a functional society. Although it is well documented that a social system can impact biological functioning (CDC, 2016 ; Riedel, 2005 ; Cutler and Miller, 2005 ) and behavioral functioning (Buettner, 2012 ), the social system’s primary role is to maintain functions at the level of the society.

Principle 3d: By considering health as maintainable-ease of functioning generated by systems , we have the ability generalize health across levels

To observe health at the level of the cell, the self, and the society simultaneously, we consider systems that support maintainable-ease of biological, behavioral, and social functioning. The biological immune system, an individual’s system of health behaviors, and the social system make meaningful contributions to the functioning of cells, selves, and societies, respectively. While these systems are not the only systems that impact each level (e.g. one’s cardiovascular system impacts cells, one’s “personality” impacts the self, the environment impacts society), the biological immune system, health behavior, and the social system have great implications for population health from their respective levels; and they can be operationalized at these levels based upon their functions .

By considering health as maintainable-ease of functioning (rather than maintained biological structures) at multiple levels, we set a point of reference from which to integrate important determinants of population health. When taking the structuralist’s perspective, the biological immune system, health behavior, and social systems appear as distinctly separated. When taking a functionalist’s perspective, the biological immune system (i.e. the integration of host defense functions and microbiota functions), one’s (system of) health behaviors (i.e. the integration of decision-making/executive functions and habits/habitual life functions), and the social system (i.e. the integration of population values and population behaviors) appear together in A Philosophy of Health.

Principle 4: Each system employs two general functions— variation and precision —to generate maintainable-ease of functioning at a level

The functionalist perspective allows us to observe systems based upon their functions . The biological immune system will be observed as an integration of host defense functions and microbiota functions (Hooper and Littman Macpherson, 2012 ); (2) an individual’s system of health behaviors will be observed as an integration of decisions/executive functions and habits/habitual life functions (de Bruin et al., 2016 ; Verplankern, 2005 ; Norman et al., 1998 ; Prochaska et al., 1994 ; Prochaska et al., 1991 ); and the social system will be observed as an integration of actively functioning values and population-wide behaviors that function in relation to those values (Dowling and Pfeffer, 1975 ; Cotgrove and Duff, 1981 ).

By researching the role of these functions at each level, we distilled two general functions of each system: variation and precision. Variation appears in the functions of each system that generate a range of abilities, the “varied-abilities”, that sustain health in presently changing conditions. The microbiota, habits/habitual life functions and population behaviors will be observed (in Principle 4a) as the variation-functions of the biological immune system, health behavior, and the social system, respectively. Precision appears in those functions that prioritize and organize the patterns of variation that can sustain health at a level in future, changing conditions. The host-defense functions, decision-making/executive functions, and values systems will be observed (in Principle 4b) as the precision-functions in the biological immune system, health behavior, and the social system, respectively.

Consideration of a complementary relationship among precision and variation is not novel. Precision and variation have been discussed as central to the development of neural and biological systems (Hiesinger and Bassem, 2018 ). Discussions of precision and variation have also provided important insight into research on the biological immune system (Albert-Vega et al., 2018 ; Brodin et al., 2015 ). Through this philosophy, one can go beyond biological systems to observe how precision (in the form of host-defense functions, decision-making/executive functions, and values) and variation (in the form of microbiota functions, habits/habitual life functions, and population-wide behaviors) integrate to generate to maintainable-ease of functioning in cells, selves, and societies simultaneously (Fig. 3 ).

Principle 4a: Variation is responsible for generating the range of abilities, the “varied-abilities”, that can express ease-of-functioning in presently changing conditions

Without functional variation, life is fragile because the present environment is always changing (Taleb and Blyth, 2011 ). Fragile systems’ inability to experience changing conditions (in part) relates to limited variability. Conversely, adaptive system’s ability to experience changing conditions (in part) relates to functional variability (Taleb, 2012 ). When one microorganism in the microbiome takes over, biological fragility reflects a state of infection. When one habit takes over, behavioral fragility reflects a state of an addiction/dependence. When one population behavior takes over (e.g. when economic participation or access to food is restricted to a small percentage of the population) social fragility reflects a state of social/civil unrest.

The human microbiota is comprised of trillions of microorganisms, such as bacteria, fungi, and viruses. When variability in the human microbiota exists, an ease of functioning, or “homeostasis” in cells can be expressed in the present biological/ecological environment (Parfrey and Knight, 2012 ; Bogaert et al., 2011 ; Claesson et al., 2011 ). Research demonstrates that variation in the microbiota impacts the health of human cells by metabolizing complex carbohydrates, converting proteins to neural signals, and modulating diurnal rhythms that maintain biological homeostasis (Clemente et al., 2012 ; Rothe and Blaut, 2012 ; Blaut and Clavel, 2007 ; De Vadder et al., 2014 ). When variation in the microbiota is dramatically limited or changed (e.g. following antibiotic overuse), cellular tissue in the human body is fragile and vulnerable to infections, allergies, and inflammatory outbreaks (Francino, 2016 ).

When one’s habitual life functions (e.g. breathing, drinking, eating, and moving) and one’s healthy habits (e.g. one’s weekly exercise schedule, or weekly meal preparation) can be expressed freely, an ease of functioning is felt by one-self in the present environment. When life functions are no longer expressed with ease (e.g. breathing and movement are compromised due to prolonged sedentary lifestyle), or when a single habit takes over one’s lifestyle (e.g. smokes breaks “must” occur every 30 min), an individual is vulnerable to stressful outbreaks and chronic states (Al’Absi, 2011 ; Conrad et al., 2007 ; Suess et al., 1980 ; León and Sheen, 2003 ; Parrott, 1999 ; Koob, 2008 ).

When the basic human rights in a society are preserved in the present (e.g. right to life, freedom of speech; right to property), human populations have the ability to freely engage in the population - wide behaviors (e.g. health behaviors, social behaviors, economic behaviors) that support a functioning society. Health behaviors drive health and longevity. Social behaviors drive communication and cooperation. Economic behaviors drive goods and resources. When these population-wide behaviors are chronically restricted in a population (e.g. poor access to health care, oppression of free-speech, economic crash), societies become vulnerable to social/civil unrest [as commented historically by Victor Frankl ( 1985 ), Alexander Solzhenitsyn ( 2003 ), Franklin D. Roosevelt ( 1941 ), and Dr. Martin Luther King ( 1985 )].

Variation is essential so that a system has varied-abilities that can express ease-of-functioning in present environmental conditions . Dramatic and prolonged restrictions to variation in the microbiota, habits/habitual life functions, and population-wide behaviors characterize fragile and vulnerable states in cells, selves, and societies. Conversely, functional-variation supports resilience, robustness, and antifragility (Taleb, 2012 ). This does not mean that infinite variation is desirable; however, in this philosophy, precision is responsible for organizing expressions of variation so that the system does not degrade into unpredictably random variation or chaos (see Principle 4b).

Principle 4b: Precision is responsible for prioritizing and organizing the patterns of variation that maintain ease-of-functioning in future, changing conditions

Some environmental changes are too challenging for ease to be expressed in the present. However, following an exposure to challenging conditions, some systems adapt and become more functional (Taleb, 2012 ). Without the ability to functionally organize after stressors, a system degrades into disorder or chaos over time. Host-defense functions, decision-making/executive functions and values systems prioritize and organize variation in the microbiota, habits/habitual life functions, and population behaviors respectively.

When a pathogen invades the biological system, precise responses must occur to organize this potentially chaotic situation. At the level of the cell, a functional host-defense system (comprised of the innate, adaptive and complement immune system branches) organizes the biological system so that functional invaders (i.e. symbionts) and healthy cells are maintained and dysfunctional invaders (i.e. pathogens) and damaged cells are removed (Hoeb et al., 2004 ; Janeway, 1992 ; Janeway and Medzhitov, 2002 ; Janeway et al., 2014 ). When precision is dysfunctional, the host-defense system may (1) fail to prioritize responses to a costly invasion, leading to a state of infection; or (2) the host-defense system might prioritize dysfunctional responses to the cells of body that prolong a state of autoimmunity (Naor and Tarcic, 1982 ).

When a bad habit emerges, precise responses must occur to organize this potentially chaotic situation. At the level of the self, functional decision-making (or at smaller scales executive functioning) prioritizes and organizes behavior so that functional expressions of habit (or at smaller scales, habitual life functions) are prioritized regularly, and dysfunctional ones are replaced or minimized (de Bruin et al., 2016 ; Prochaska et al., 1994 ; Prochaska and Prochaska, 2016 ; Prochaska et al., 1988 ; Redding et al., 2011 ; Weissenborn and Duka, 2003 ; Bickel et al., 2012 ). When dysfunctional, decisions may (1) fail to prioritize responses that remove a costly expression of habit (e.g. a teen started smoking cigarettes to “be cool” and now has to smoke in the bathroom before each class to get through the day; by not deciding to move at work, one’s breathing becomes shallow and movement becomes rigid); or decisions may (2) prioritize habits that prolong dysfunction despite knowing the dangerous consequences (e.g. an adult continues smoking cigarettes despite knowing the family’s history of lung cancer; an adolescent continues binge on sugar despite a diabetes diagnosis).

When dangerous population-wide behaviors threaten life in a society, precise responses must occur to organize this potentially chaotic situation. At the level of society, the agreed upon values organize the social system so that functional population behaviors are prioritized and dysfunctional population behaviors are minimized. Functional values prioritize behaviors that support the society (e.g. as seen when societies mandate that students get certain vaccines before attending University), while also setting standards that remove/replace behaviors that threaten the society (e.g. new laws create legal repercussions for risk behaviors in society). Without values that functionally prioritize population-wide behavior, society may (1) fail to prioritize responses to a dysfunctional population behavior (e.g. as seen during AIDS epidemic of the 1980s due to insufficient public health values around safe sex); or society may (2) prioritize dangerous behaviors that can prolong societal dysfunction (e.g. the antibiotic resistance crisis (Ventola, 2015 ; Michael et al., 2014 ) has been attributed in part to the over-valuing or over-use of antibiotic medications in healthcare practices).

Precision is essential so that a system can maintain ease-of-functioning in future, changing conditions . When precision does not adequately detect the presence of costly conditions, a response may not be prioritized (e.g. as seen during acute infection, addiction/dependence following a surgery, the AIDs outbreak in the 1980s). When precision prioritizes responses that prevent ease longitudinally, dysfunction is prolonged (e.g. autoimmunity, continued smoking despite family history of cancer, misguided values that create an antibiotic-resistant bacteria). Through dysfunctional -precision, the conditions for life in cells, selves, and societies becomes disordered over time. Through functional -precision, a system prioritizes responses that maintain ease-of-functioning in future conditions. Prioritizing functional microorganisms (i.e. symbionts) supports the developing life of cells; prioritizing functional habits (e.g. weekly exercise) and habitual life functions (e.g. diaphragmatic breathing and relaxed movement) supports the developing life of the self; and prioritizing functional population behaviors (e.g. access to functional health care, economic resources; access to social support) supports the developing life of the society.

Principle 5: Health is valued by a system when precision-and-variation generate maintainable-ease of functioning. Health is de-valued by a system when precision or variation prevent maintainable-ease of functioning

By defining precision-and-variation, we can better understand maintainable-ease of functioning in population health:

Functional-Variation generates ease-of-functioning in the present (e.g. fluid and variable motion reflects an ease and variability of one’s movement); while Functional-Precision prioritizes expressions that can maintain ease-of-functioning in the future (e.g. prioritizing challenging exercise for 20 min each day may lead to an ease in bodily movement long term).

Dysfunctional-Variation prevents ease-of-functioning in the present (e.g. prolonged sitting might lead to rigid movement and shallow breathing); while Dysfunctional-Precision might prioritize expressions that prevent ease in the future (e.g. rather than focus on relaxing breathing and movement on work breaks, one decides to drink alcohol to relax).

Without functional-variation, life is fragile and vulnerable to changing conditions of the present. Without functional-precision, life becomes disorganized from the system’s exposure to changing conditions across time. When functional-and-integrated, precision-and-variation value maintainable-ease of functioning in cells, selves, and societies. When dysfunctional or fragmented, precision or variation can de-value maintainable-ease of functioning in cells, selves, or societies. If maintainable-ease of functioning can be valued in cells, selves, and societies, we will likely observe healthy publics.

Five principles of health are presented: (1) Health is the maintainable-ease of functioning; (2) Maintainable-ease of functioning emerges from multiple levels ; (3) At each level, maintainable-ease of functioning is generated by systems ; (4) Each system employs two functions, precision - and - variation , that generate maintainable-ease of functioning ; and (5) Health is valued by a system if precision-and-variation generate maintainable-ease of functioning. Through these five principles, both naturalistic and holistic perspectives can be considered simultaneously because maintainable-ease of functioning is relevant to biological functioning (e.g. as described in BST) and personal/social, goal-oriented functioning (e.g. as described in HTH). This philosophy can also be used to investigate how naturalistic and holistic phenomena have informed past healthcare interventions. What do vaccine interventions, behavior change interventions, and social change interventions have in common? When successful, these interventions enhance both precision and variation.

Vaccine interventions can enhance both the precision of the host-defense functions and variation in the microbiome. During a vaccine intervention, the microbiome is exposed to a new variation in the form of a new virus (Reidel, 2005 ). Through this exposure, the precision of host defense functions can adapt to prioritize maintainable-ease of functioning in the microbiome in the future. How? The host-defense system produces antibodies that allow the immune system to respond effectively and efficiently to this virus when exposed to it again in the future (Janeyway, 2014 ). Although the precision of the immune system has been enhanced to handle historical threats through vaccines (e.g. for small pox, chickenpox, measles), new viruses like the coronavirus can still emerge. With this philosophy, vaccine developers and public health officials might not only ask the question, “How do we combat the coronavirus?” Researchers, vaccine developers and public health officials may also ask the functional question: “How do we enhance the precision of the host-defense system and the variation of the human microbiome to adapt following an exposure to the coronavirus?”

Behavior change interventions can enhance both the precision in one’s decisions and the variation in one’s habits. During a behavior change intervention, a person’s existing habits are exposed to a new variation in habit. For example, the beginning of a new exercise intervention exposes the individual’s current habits/habitual functioning to changes in movement and breathing (i.e. exercise) that may also change their patterns of eating and hydration. Through this exposure, a person’s decision-making might adapt to prioritize maintainable-ease of functioning in the individual’s lifestyle. How? Some behavior change interventions train one’s decision-making to remove or “counter-condition” unhealthy habits, by replacing them with healthy habits (Prochaska et al., 1988 ). Although modern behavior change interventions have shaped the precision of decision-making during health behavior change (e.g. of smoking, diet, alcohol use, inactivity), new problems for health behavior still emerge when the individual is exposed to a new, potentially addictive technology. With this philosophy, behavior change interventionists and health officials might not only ask the question, “How do we support good decision-making of individuals?” Researchers, behavior change technology developers, and public health officials may also ask the functional question: “How do we enhance the precision of one’s decisions and the variation of one’s habits following the exposure to a new, potentially addictive technology?”

Public health campaigns disseminated by social organizations can enhance the precision of the population’s health values and variation in population-wide health behaviors. Leading up to first Surgeon General’s Advisory Committee on Smoking and Health (1964), the U.S. Department of Health had become increasingly aware of (i.e. exposed to) variations in a population health behavior. If populations smoked, then populations were more likely to develop lung cancer, laryngeal cancer, or chronic bronchitis (CDC, 2018 ). Following this exposure to (the consequences of) population smoking behavior, society’s values shifted to prioritize health. How? The Federal Cigarette Labeling and Advertising Act of 1965 was adopted, and the Public Health Cigarette Smoking Act of 1969 was adopted to create new health values. This shift in values prioritized new variations in population health behavior by: (1) requiring a health warning on cigarette packages; (2) banning cigarette advertising in the broadcasting media; and (3) calling for an annual report on the health consequences of smoking (CDC, 2018 ). Since these first initiatives adult smoking rates have fallen from about 43% (in 1965) to about 18% today; and mortality rates from lung cancer, the leading cause of cancer death, are declining (Department of Health and Human Services, 2014 ). Although the precision of the population’s values has been enhanced to impact population behaviors (e.g. the tobacco laws described above supported healthy change), new chronic states can still emerge following exposure to social changes (e.g. the invention of the Juul impacted high school and college aged populations). With this philosophy, public policy officials and public health researchers might not only ask the question, “How do we create new laws to protect population health from nicotine addiction?” They may also ask the functional question: “How do we enhance the precision of the population’s values and the variation of the population’s behavior following the invention of a new nicotine delivery system technology (e.g. flavored Juuls)?”

Previously we described that without functional variation, life is fragile when exposed to present changing conditions; and without functional precision, life becomes disorganized from exposure to changing conditions across time. When successful, the above interventions upon biological, behavioral, and social functioning have a common theme: each facilitates exposures to biological, behavioral or social conditions that support (1) increasingly complex/diverse variation; and (2) increasingly organizable precision. Exposure, not avoidance , has facilitated population health in these interventions. While healthcare systematically prioritizes biological exposures in the form of vaccine interventions, they do not systematically prioritize behavioral or social exposures. However, it is documented that exposure to healthy behaviors in youth prevents risk behaviors in adolescence (Velicer et al., 2000 ); and exposure to community-based health initiatives can support population health (Dulin et al., 2018 ; CDC, 2018 ). Given that systematic biological exposures in the form of vaccination have led to a global control of some acute infectious diseases (Tangermann et al., 2007 ); might systematic behavioral and social exposures (especially in youth) be needed to enhance global campaigns toward the control of chronic disease?

A functional language of health is central to the success of a Philosophy of Health. Why? The levels are not separate, but rather are continuously connecting with one another. A good philosophy of health should have the ability to discuss assessment, diagnosis, intervention, and prevention across levels, across systems, across cultural populations, and across time. Using the common language of precision and variation creates discussions that connect the levels and integrate research disciplines.

A case (to) study: mental health as between-level functioning in this philosophy

Historically, and still too often, health professionals have an expertise at one level, that limits their prescription of interventions to that level. This can actually create barriers to a complete solution when a health problem is multileveled. While a person’s mental health is typically assessed based upon their first-person experience of thoughts, feelings, and behaviors; symptoms can be triggered by biological, physiological, behavioral, psychological, and/or social dysfunction. Most clinicians typically do not have the ability to assess and address all forms functioning. So if one person, John, is meeting with a clinician who specializes in primary care medicine, he may only be prescribed a biological intervention like medication. If John is meeting with a clinician who specializes in behavioral medicine, he may only be prescribed a health behavior change intervention. If John is meeting with a clinician who specializes in a certain theory of psychotherapy, he may only be prescribed a psychotherapy intervention based on the clinician’s training. If John is meeting with a clinician who specializes in social work, he may only be prescribed a group, community or social intervention. While the above specializations have been helpful in establishing an empirical bases for mental health interventions, over-specialization can be problematic when a multi-leveled solution is needed. In addition, it can also be problematic when a level-specific solution is needed that the clinician cannot provide (e.g. when psychotherapy is needed but a clinician only has the ability to prescribe psychiatric medication).

Technology poses a multileveled issue for population mental health in 2020. Selves have more social connection then ever in history, yet societies are characterized by increasing rates of depression and loneliness (Sum et al., 2008 ; Hammond, 2020 ; Srivastava and Tiwari, 2013 ; Twenge, 2017 ). Researchers might use this Philosophy of Health to facilitate between-level conversations that address seemingly paradoxical outcomes that emerge during this new age of rapid technological growth. To do this, a researcher might first begin by asking questions about functioning at each level ; second , ask questions about processes between the levels ; and third , concurrently ask questions at and between levels .

First: Begin by asking questions at each level

Novel challenges face the iGeneration (and their parents) due to technology’s novel impacts on the development of individual and social functioning (Twenge, 2017 ). For example, if John’s decisions (self-precision) and habits (self-variation) remain consistent during school hours because his parents do not let him have a phone; but his class’ social behaviors around him (society-variation) change dramatically because everyone else at school uses the newest smartphone application to talk during class; will John’s mental health suffer? Although his parents’ intentions are to protect John, the contrast between his behavior (self’s precision-and-variation) and the population social behavior (society-variation) can impact John’s health. Notice here how we have not yet considered functions that connect the self to the society (e.g. John’s thoughts and feelings). Rather we first consider (or contrast) functioning at the level of the self (i.e. John’s decisions-and-habits) and the society (i.e. population social behavior) in accordance with Principles 1–5 (see Figs 1 – 3 ).

Second: Look for functional processes that connect the levels

One person’s thoughts and emotions/feelings are processes that help to integrate the functioning of one-self within the functioning of a society. How might John’s thoughts and feelings connect his (sense of) self to his society? Perhaps John’s parents teach him that it is important to feel separate from his classmates during class so he can think clearly in class; and that he can feel connected to his friends by inviting them over to communicate together after school. This parenting may impact John’s thoughts and feelings during school. If John’s parents do not talk with him about this topic, John may experience different thoughts and feelings during school hours. When kept to one-self, thoughts and emotions are foundational to an internal sense of self as one functions in the larger society; and, when acted upon, thoughts and feelings can become verbal communication (e.g. speech) and non-verbal communication (e.g. body language, facial expressions) that form an external sense of self that is visible to the society. The (internal) experience of and (external) communication of thoughts, feelings and actions form the foundation of all systems of psychotherapy (Prochaska and Norcross, 2018 ). This view can be particularly helpful as researchers begin to investigate how smart technology impacts developmental changes to the self within the society beginning in youth.

Third: Concurrently ask questions at and between levels

Perhaps, a clinical researcher is interested in investigating protective mental health factors in the iGeneration; and they hypothesize that lower rates of loneliness, anxiety, and depression will be seen in subjects that do not respond to text messages immediately. The researcher might investigate further by using the philosophy to develop questions for the research subjects: “(1) Do you use conscious decision-making (self-precision) to prevent yourself from habitually responding to your phone when a text appears (self-variation)? (2) How fast do other’s in your social group typically respond to texts (society-variation)? (3) What changes in thoughts and feelings are experienced (internal self-society connection) after you communicate via text (external self-society connection)?” Perhaps this researcher also wants to investigate how those who are addicted to the technology perceive non-responders. The clinical researcher might again apply the philosophy: “(1) How fast do other’s in your social group typically respond to your texts (society-variation)? (2) Do you experience changes in thought and feeling (internal self-society connection) when others do not respond to you within an hour (society-variation)? (3) How do you communicate those thoughts and feelings (external self-society connection) with others when they do not respond for a prolonged period of time (society-variation)?” Future research might use this method to gather and organize levels of information on mental health factors across different self- and societal-conditions.

The processes that form our mental health form a functional connection between self and society. If mental health is a reflection of the self–society connection, what might be a reflection of the self–cell connection? Physiological health evidences a functional connection between our sense of self and our cells. For example, aerobic exercise is a health behavior that stimulates changes to variations in breathing and movement. By engaging in this behavior, the biological cells of the body are also stimulated via various physiological processes. Breathing will stimulate cellular functioning via the cardiovascular and respiratory systems; and movement will stimulate cellular functioning via the cardiovascular, musculoskeletal, and central nervous systems. While all physiological systems are working in collaboration in the body, certain changes to behavioral and biological functioning will stimulate certain physiological systems. By viewing health through this lens, between-level observations join the philosophy: biological functions emerge at the level of the cell; physiological functioning emerges as the cell–self connection; behavioral functions emerge at the level of the self; psychological/mental functioning emerges as the self–society connection; and social functions emerge at the level of the society. Future papers will explore maintainable-ease of functioning at and between levels.

Future directions: new images of healthcare integration and new perspectives of healthcare innovation

By considering this integrative philosophy, one can define health based upon a tangible connectedness, rather than separateness, of cells, selves, and societies. We provide Image 4 as a way to visualize the common paths to the health of healthy publics. When researchers observe that a host defense system is changing cellular functions following an infection, they may also expect these changes to have an impact [along Path 1] on expressions of habitual or physiological functions (e.g. immune function can stimulate the sensation of “achiness” or “pain” altering one’s physical movement, breath rate, hydration, and hunger) (Kelley, 2003 ; Johnson et al., 1992 ; Danzer, 2009 ). When researchers observe an individual deciding to engage in health behavior change following an addiction, they may also expect these changes to have an impact [along Path 2] on the group-behavior of their family system or social systems. When researchers observe changes to society’s values following a newly detected problem (e.g. laws ban Cigarette Advertising in broadcasting media; public health standards mandate certain vaccines before attending school), they may also expect that these changes can have an impact on behavioral functions of individuals [along Path 2] and biological functions of cells/organs [along Path 3]. These levels are continually integrating along these common paths to the health of healthy publics (Fig. 4 ).

When attending to this connectedness new, important questions can have new answers. What function does modern technology serve in population health and healthcare? If technology algorithms prioritize variations in population behaviors, then they fulfill a role as society-level precision. When modern technologies like machine learning (ML) technology and Computer Tailored Interventions (CTI) prioritize patterns of population behavior, we can see profound impacts on social change in a society. Although one might argue that technologies can be used by individual-level functions, the algorithms that are currently deployed and updated on devices interface with big-data gathered on population behaviors (Manogaran and Lopez, 2017 ; Dinov, 2016 ; Mullainathan and Spiess, 2017 ; Cheng et al., 2017 ).

In this paper, we identified that precision can be functional or dysfunctional. Similarly, technologies can support or prevent healthy population behavior. Some technologies prioritize health behavior in populations by tracking physical activity and providing feedback on activity progress; while others prevent healthy behavior by prioritizing sedentary behavior through video-gaming. Some social media technologies facilitate social communication with distant friends and relatives that supports wellbeing; while others facilitate conflictual communication that diminishes wellbeing. Given that modern technology can support or hinder health, we believe it is important that healthcare can prioritize technological innovations that value health in cells, selves, and societies. To do this, technology innovators might seek to value a higher order construct (e.g. maintainable-ease of functioning) in their algorithms.

Medical technology is currently used to titrate the doses of vaccines so that maintainable-ease of biological functioning (i.e. inoculation) is made available to the general population. When biological exposures are not properly titrated, infections can become active in the population and health is no longer valued at the level of the cell. Similarly, when behavioral and social exposures are not tailored to the needs of individuals and groups, populations can become resistant to healthy change, and health is no longer valued at the level of the self and the society. Behavior change researchers Prochaska and Prochaska ( 2016 ) report that when individuals and populations are not ready for a change, interventions that force individuals or populations to take action can increase resistance and prolong dysfunction. By tailoring (or what they term “staging”) behavioral and social level interventions, Computer Tailored Interventions upon behavioral and social functioning are made possible (Prochaska et al., 2001 ; Velicer et al., 2000 , Prochaska and Prochaska, 2016 ). Despite these advances, there remains a need for technological advances that can make maintainable-ease of behavioral and social functioning available to the general population.

Future healthcare interventions could benefit from ML algorithms that tailor behavioral and social exposures to enhance precision-and-variation. Research already demonstrates that tailoring interventions for biological precision (Albert-Vega et al., 2018 ) and biological variation (Brodin et al., 2015 ) can impact long-term biological functioning. Future innovations might seek to use technology to tailor behavioral and social interventions to generate maintainable-ease of functioning. Through the functional language used in this paper we hope readers are inspired to present new questions, new comments, and new perspectives about needed healthcare innovations.

This philosophy of health investigates three levels of health: cell, self, and society. The level of the cell accounts for biological functioning within human beings. The level of the self accounts for first-person functioning of each human being. The level of the society accounts for group functioning of human beings.

Each system is responsible for generating maintainable-ease of functioning at a level. The biological immune system is responsible at the level of the cell. A human's system of health behaviors is responsible at the level of the self. The social system is responsible at the level of the society.

Maintainable-ease of functioning is generated by two functions in each system: precision and variation. The human microbiota, habits, and population-wide behaviors evidence variation in cells, selves and societies respectively. The host defense system, decisions, and values evidence precision in cells, selves and societies respectively.

Population health is generated along common paths that integrate the levels. The biological functioing of cells impacts fluctuations of habits/habitual functioning; and vice versa. The behavioral functioning of each self impacts fluctuations in population behavior; and vice versa. The biological functioning of cells also can impact fluctations in population behavior; and vice versa.

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Saad, J.M., Prochaska, J.O. A philosophy of health: life as reality, health as a universal value. Palgrave Commun 6 , 45 (2020). https://doi.org/10.1057/s41599-020-0420-9

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Home — Essay Samples — Nursing & Health — Nursing — Good Health And Wellness

Good Health and Wellness

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The importance of good health and wellness, the impact of good health and wellness, achieving and maintaining good health and wellness, the broader implications of good health and wellness.

• In addition to physical health , mental and emotional well-being are equally important. Practices such as mindfulness, meditation, and therapy can help manage stress and improve overall mental health.
• Building a strong support network and nurturing meaningful relationships also contribute to emotional wellness.
• Furthermore, it is essential to prioritize self-care and relaxation. Taking time for oneself, engaging in hobbies, and setting boundaries are crucial for maintaining a balanced and healthy lifestyle.
• Lastly, regular check-ups with healthcare professionals and staying informed about one's health are vital for early detection and prevention of illness.

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• Health is Wealth Essay

Importance of Working Towards Good Health

Health is God’s gift to us. Health refers to the physical and mental state of a human being. To stay healthy is not an option but a necessity to live a happy life. The basic laws of good health are related to the food we eat, the amount of physical exercise we do, our cleanliness, rest, and relaxation. A healthy person is normally more confident, self-assured, sociable, and energetic. A healthy person views things calmly, and without prejudice.

Introduction

“The Dalai Lama, when asked what surprised him most about humanity, answered "Man! Because he sacrifices his health to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.” This signifies that individuals don’t prioritise their mental health to earn money. Some even work 24 hours a day or seven days a week. 

However, you have the option to remain balanced. So, balance work and fitness daily. Always strive to keep a cheerful as well as a concentrated routine. It is necessary to plan ahead of time. In any case, one must maintain a good mental, bodily, and emotional state, and no professional or counsellor can assist you unless you desire to live. The will to live in the moment and make the most of it awakens the ideal strength within you, and you are the only one who can never let yourself fall apart. 

Importance of Maintaining Health

We live in a super-fast age. The Internet has shrunk the world dramatically and people are connected 24x7. Multitasking is the order of the day, as we struggle to fulfill our responsibilities for everyone in life. In this fight, we often forget to spare time for ourselves. The stress levels continue to build up until one day a major collapse may make us realize that in all this hectic activity, we have forgotten to take care of one important thing – our health.  

As we spend days shuttling between hospital and home, putting our body through one test after another, trying to find out what has gone wrong, we are forced to remember that ‘Health is indeed Wealth’.  

In earlier days, life was very simple. People worked for a stipulated time, often walked everywhere, ate more homemade food, did household chores, and enjoyed a healthy balance in life.  

Now people have cars and bikes to commute, so they walk less. With the demand for more working hours, people are awake till late at night and indulge in more junk food than home-cooked food. Modern equipment at home has reduced the labour work and increased dependency on this equipment.  People don’t have enough time to exercise or even get enough sunlight. Nowadays people are living very unhealthy lifestyles.  

Unhealthy living conditions have increased the contraction of people to various diseases like obesity, diabetes, heart attacks, hypertension, etc. This has alarming implications in the near future. So it is very important to focus on our health as much as we focus on our work. Moderation in food habits, daily exercise, and balanced work-life can surely make a big difference to our health and body. When a person stays mentally and physically fit, his actions and decisions are more practical and logical and hence he is more successful in life. Furthermore, good health has a direct impact on our personality.

It's crucial to consider how much self-control you have to keep a healthy lifestyle. Research reveals that changing one's behaviour and daily patterns are quite tough. According to the data, whether a person has a habit of smoking, drinking alcohol, doing drugs, or any other substance, it is extremely difficult to quit. A study found that 80% of smokers who tried to quit failed, with only 46% succeeding.

Importance of Good Health 

A healthy body has all the major components that help in the proper functioning of the body. The essential component is the state of physical health. Your life term extends when you maintain good physical fitness. If you are committed to exercising with a sensible diet, then you can develop a sense of well-being and can even prevent yourself from chronic illness, disability, and premature death.  

Some of the benefits of increased physical activity are as follows. 

It Improves Our Health  

1. It increases the efficiency of the heart and lungs. 

2. A good walk can reduce cholesterol levels.  

3. Good exercise increases muscle strength. 

4. It reduces blood pressure. 

5. It reduces the risk of major illnesses such as diabetes and heart disease.

Improved Sense of Well-being  

1. It helps in developing more energy. 

2. It reduces stress levels. 

3. Quality of sleep improves. 

4. It helps in developing the ability to cope with stress. 

5. It increases mental sharpness. 

Improved Appearances  

1. Weight loss contributes to a good physique.  

2. Toned muscles generate more energy. 

3. Improved posture enhances our appearance. 

Enhanced Social Life  

1. It improves self-image 

2. It increases opportunities to make new friends. 

3. It increases opportunities to share an activity with friends or family members. 

Increased Stamina  

1. Increased productivity. 

2. Increased physical capabilities. 

3. Less frequent injuries. 

4. Improved immunity to minor illnesses. 

Along with physical fitness, a good mental state is also essential for good health. Mental health means the emotional and psychological state of an individual. The best way to maintain good mental health is by staying positive and meditating. 

However, unlike a machine, the body needs rest at regular intervals. A minimum of six to seven hours of sleep is necessary for the body to function optimally. Drinking plenty of water and a balanced diet is also very important for your body.  If you violate the basic laws of good health, like working late hours, ignoring physical exercise, eating junk food, it will lead to various ailments like hypertension, heart attacks, and other deadly diseases. 

What is National Health Day? 

Every year on April 7th, World Health Day is celebrated. The World Health Organization (WHO) hosted the inaugural World Health Day on April 7, 1950, to draw the entire world’s attention to global health. 

Every year, the World Health Organization (WHO) comes up with a new theme for public awareness, such as "Support Nurses and Midwives" in 2020. This supports the situation of COVID-19, where healthcare workers are saving lives day and night without worrying about their health.

The WHO also operates a global health promotion initiative to align equality so that individuals can take control of their lives, "every life matters," and consider their fitness. The government promotes numerous health policies, including food security, workplace quality, and health literacy, in schools, colleges, workplaces, and various community activities. 

Good Health for Children 

Children need to maintain good physical and mental health. With an increase in the pressure of studies and over-indulgence in modern gadgets, children are losing the most precious thing, which is health. These days, they barely play in the playgrounds, they are more inclined towards junk food and spend more time on the screen. These unhealthy activities are slowly sabotaging their health. Parents should concentrate on the physical and mental health of their children, and inculcate good habits for maintaining a healthy lifestyle from a tender age.   

Cleanliness also has a major role to play in maintaining good health. Taking a bath every day, washing hands before eating meals, brushing twice a day, changing clothes regularly, etc. are important habits to maintain good health.  

Society is witnessing gloomy faces as a result of children and their parents' excessive usage of a computer, mobile phone, and the Internet. They are constantly using these technological items, oblivious to the fact that they may harm their health. Teenagers are frequently discovered engrossed in their electronic devices, resulting in mishaps. 

The usage of electronic devices frequently results in anxiety and hostility. Excessive usage of these products has been linked to cancer, vision loss, weight gain, and insomnia. 

Emotional development is another crucial component that should not be disregarded because it determines whether or not a person is healthy. An emotionally healthy person should have a solid sense of logic, realisation, and a realistic outlook. 

Conclusion 

Health is Wealth because if we are not healthy then all our wealth, fame and power can bring no enjoyment. Keeping fit and healthy is indeed not an option but a necessity.  

FAQs on Health is Wealth Essay

1. Why is Health Considered as Wealth?

Health is wealth because it is one of God’s most precious gift to human beings. Good health refers to a balanced and healthy physical and mental state of an individual. If any individual is not healthy, wealth, fame, and power can bring no enjoyment. So health has more value than materialistic things.

2. When is World Health Day Celebrated?

World Health Day is celebrated on 7 th April to raise awareness about health and fitness.

3. How Can You Maintain Good Health?

You can maintain good health by following a balanced and healthy diet. Have a good lifestyle by balancing work and life. You should have a moderate physical fitness regime every day. Go for brisk walks regularly or do other forms of exercise. Also, meditate and be positive to take care of your mental health.

4. Who came up with the phrase "health is wealth"?

If a man begins to live a lifestyle without a plan or unhealthy manner, he will confront numerous difficulties. He'd be depressed on the inside, untidy and filthy on the outside, and emotionally unstable all the time. A person who lives an unhealthy lifestyle will wake up late at night and early in the morning. Not only would this affect their mental condition, but it would also poison their surroundings. 

There would be a lot of wrath and sadness, and they would have fits from time to time.

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Institute of Medicine (US) Committee on Using Performance Monitoring to Improve Community Health; Durch JS, Bailey LA, Stoto MA, editors. Improving Health in the Community: A Role for Performance Monitoring. Washington (DC): National Academies Press (US); 1997.

Improving Health in the Community: A Role for Performance Monitoring.

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2 Understanding Health and Its Determinants

W hat is health? Multiple definitions of health exist, ranging from a precise biomedical or physical definition such as the absence of negative biologic circumstances (altered DNA, abnormal physiologic states, abnormal anatomy, disease, disability, or death) to the broad definition of the World Health Organization: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (WHO, 1994). The former definition offers the advantages of easy measurement and relatively clarity of the causal connections between the medical and public health care systems and the measured outcomes. The latter definition views health more broadly but risks assigning to the "health" system full responsibility for the economic and social welfare of members of society. Neither definition explicitly takes account of how individuals experience disease. Individuals can feel ill in the absence of disease and vary dramatically in their responses to a disease. Indeed, what matters to individuals is not simply the absence of disease, disability, or death, but also their responses to symptoms or diagnoses; their capacity to participate in work, family, and community; and their sense of well-being in many spheres (e.g., physical, psychosocial, spiritual).

• A Broader Definition of Health

The successful implementation of initiatives to improve community health requires an understanding of the complex and diverse processes that produce health in communities. For both individuals and populations, health can be seen to depend not only on medical care, but also on other factors including individual behavior and genetic makeup, and social and economic conditions. The committee has adopted a broad definition of health, echoing a WHO (1986) health promotion perspective, that acknowledges multiple possible goals for the health system and underscores the important contributions to health that occur outside the formal medical care and public health systems. The committee definition allows improvement efforts to target not only the reduction of disease, disability, or death, but also an improvement in individuals' response to and perceptions of their illnesses; their functional capacity both now and in the future; and their overall sense of physical, emotional, and social well-being. The value of a broad measure thus rests in part upon the value attached to it by the population. Working within a definition of health that explicitly relies, in some measure, on community values is particularly important in a context of decision making for the allocation of limited resources.

Committee definition of health: Health is a state of well-being and the capability to function in the face of changing circumstances. Health is, therefore, a positive concept emphasizing social and personal resources as well as physical capabilities. Improving health is a shared responsibility of health care providers, public health officials, and a variety of other actors in the community who can contribute to the well-being of individuals and populations.

As Syme (1996) notes, viewing health as a biomedical construct has limited our ability to integrate processes that produce health and to address the underlying causes of disease. Death, disability, and disease incidence—ascertained by using traditional biologic or epidemiologic measures—are all important and valid indicators of the health of a population. A broader definition, however, allows efforts to measure community health to go beyond traditional public health measures, incorporating measures of functional status and general health perceptions. Communities embarking on health improvement initiatives should consider carefully their definition of health and ground their work in an evidence-based conceptual model of the determinants of health. Three arguments supporting such action are discussed below.

The origins of good health are multiple and cross-sectorial . Origins of good health include factors such as genetic makeup, environmental conditions, nutrition and exercise, access to health care, social support systems, and many others. Some of the factors, such as genetic makeup, are nearly impossible to alter whereas others are amenable to change. In addition, some of the factors influence a variety of health outcomes (e.g., on a population basis, dietary habits and education are known to influence multiple health outcomes). Careful consideration of what is known about the determinants of health highlights the tension between factors that are easily measurable now (e.g., hospitalization rates) and factors that may be equally or more important in the long run (e.g., teenagers' perception of their future) but are much more difficult to measure and monitor. Grounding community health improvement in a broad model of the determinants of health can remind communities to consider multiple and cross-sectorial influences when selecting health issues to target and when designing possible interventions.

A focus on the origins of health emphasizes the need for cross-sectorial assumptions of responsibilities . For various stakeholders to be accountable, the roles of those stakeholders in producing illness or health must be defined. A broad conceptual model of the determinants of health includes the full spectrum of possible influences on health. Such a model provides a valuable framework for communities to use as they consider the roles (and potential contributions) of the various stakeholders and thus each stakeholder's responsibility for health improvement in the community.

A focus on the origins of health creates multiple options for intervention . A conceptual model of the determinants of health can serve as the starting point for communities to identify what is known about issues they wish to address. Options for intervening can reflect the unique characteristics of the community vis-à-vis available resources, cultural norms, and target populations. Performance measures can then be developed as the basis for strategic actions.

The rationale for adopting a broad definition of health lies not only in its value to the population served by the health system and its usefulness in identifying measures of the origins of health. A broad definition of health also is appropriate for the changing nature of the "health care system," reflects the interconnectedness of health and social systems, and is consistent with current scientific evidence about how health is produced in communities (Aguirre-Molina, 1996; Warden, 1996).

Changing Nature of the "Health Care System"

Many Americans view health as a simple biomedical construct in which health is determined by the provision of health care (Lamarche, 1995). This perspective on health developed during this century, beginning in the 1930s with well-baby clinics and services for "crippled children" and expanding in the 1950s with national investments in biomedical research facilities such as the National Institutes of Health and construction and funding of hospitals through the Hill-Burton program (Guyer, 1990). With advances in medical science and increases in the number of hospitals, policymakers and health care providers became concerned about differential access to health care resources, especially for underserved and hard-to-reach populations. Poverty and geography were viewed as barriers to health care and thus to good health.

Beginning in the 1960s, programs designed to improve access to health services were created, including Medicare and Medicaid. These programs markedly reduced financial barriers for the poor and elderly, and they also ensured a supply of well-trained physicians by providing funds for medical school and residency training programs.

The biomedical model of health has fostered the development of a personal health care system centered around technologically advanced hospitals and highly trained medical specialists. However, the high cost of maintaining these resources is the subject of current public debate. In addition, questions have been raised about the overall contribution of the biomedical model to improvements in health status. Although important, health care has probably been overemphasized as a determinant of health. Of the 30-year increase in the life expectancy achieved this century, only 5 years can be attributed to health care services (Bunker et al., 1995).

The roles of the public sector in managing the health care system and in providing clinical and personal preventive care services as well as public health services are undergoing dramatic changes. Historically, public health departments have provided population-based services and, together with public hospitals and community health centers, have delivered clinical and personal preventive services to poor and uninsured populations. For many public health departments located in the South and in large metropolitan areas, the delivery of clinical and personal preventive services is a primary focus. In the late 1980s, however, the activities of public health departments were reexamined, and the Institute of Medicine (IOM, 1988) recommended a focus on three core functions—assessment, policy development, and assurance. In this framework, the direct provision of clinical and personal preventive services is only a small portion of the assurance function of public health departments. In many states, this transition is in progress. Public hospitals and community health clinics, however, remain important providers of these services.

Currently, most local public health departments do not play a significant role in assuring the quality of personal health care services that they do not purchase or provide. the quality assurance roles of state agencies have also been limited. Private-sector organizations, however, have developed complex and sophisticated quality assurance systems, often more in response to market forces than to demands of the public sector. As more public health departments become involved in quality assurance activities, providers and health plans can be expected to experience the influence of more public-sector demands via standard setting and licensure requirements as well as market forces.

The recent surge in the growth of managed care organizations has taken place in an environment that seeks to continue the delivery of high-quality clinical and personal preventive health services while constraining the costs of care. Managed care organizations are viewed as more capable of responding to the demands of third-party payers for performance and accountability than are clinicians practicing independently. Market forces, which spurred the recent growth of managed care organizations, have influenced the structure of the health care system (Rodwin, 1996). The experience of the Pacific Business Group on Health illustrates the changing relationships in the health system vis-à-vis new roles for purchasers and providers (see Box 2-1 ).

THE PACIFIC BUSINESS GROUP ON HEALTH. The experience of the Pacific Business Group on Health, a private-sector employer purchasing coalition based in the San Francisco Bay Area, demonstrates how "purchasers can shift the focus of the health care system (more...)

Interconnectedness of Health and Social Systems

It has long been recognized that the health of a community has a tremendous impact on the function of its social systems and that the condition of the social and economic systems has a significant impact on the health of all who live in a community (Patrick and Wickizer, 1995). For example, a healthy workforce is more productive, a healthy student body can master lessons more readily, and a healthy population is better able to make progress toward societal goals. Working conditions, economic well-being, school environments, the safety of neighborhoods, the educational level of residents, and a variety of other social conditions have a profound impact on health. Only recently, however, has substantial attention been devoted to understanding and acting upon the interdependence of health and social systems (Ashton and Seymour, 1988).

Health is a growing concern of employers, community-based organizations, schools, faith organizations, the media, local governmental bodies, and community residents, even though their roles are not viewed as part of the traditional domain of "health activities." As communities try to address their health issues in a comprehensive manner, all parties will have to sort out their roles and responsibilities. By reaching out to new partners in the community, traditional partners in health can ensure that all relevant sectors are engaged in efforts to improve health. A recent IOM report on primary care (IOM, 1996) also emphasizes the need for better collaboration among the diverse groups that can influence health. The Health Care and Community Services Project in Escondido, California, illustrates this kind of collaboration among diverse groups and the interconnectedness of health and social systems (see Box 2-2 ).

ESCONDIDO HEALTH CARE AND COMMUNITY SERVICES PROJECT. The Escondido Health Care and Community Services Project aims to reduce the harmful effects of alcohol and other drug use in the community of Escondido, California (population, 120,000; county population, (more...)

• A Model of the Determinants of Health

A resurgence of interest in broader definitions of health and its determinants is, in part, a response to the growing realization that investments in clinical care and personal preventive health services were not leading to commensurate gains in the health of populations (Evans and Stoddart, 1994). In the early 1970s, an ecologic or systems theory approach to understanding health and its determinants generated a multidimensional perspective. Some grouped the factors influencing health into four principal forces: (1) environment, (2) heredity, (3) lifestyles, and (4) health care services (Blum, 1981). A Canadian government white paper, often referred to as the Lalonde Report (Lalonde, 1974), brought wider attention to this "force-field" paradigm.

Initial responses tended to focus on individual behavior as the target of both responsibility and clinical and policy interventions. In the United States as well, the broadened emphasis on health promotion was aimed primarily at modifications of individual behavior that could be, and often were, undertaken as clinical and community interventions (USDHHS, 1991).

Responding, in part, to this focus on individuals largely to the exclusion of the communities in which they live. Evans and Stoddart (1994) proposed an expanded version of this model, illustrated in Figure 2-1 , that identifies both the major influences on health and well-being and the dynamic relationships among them. In developing a model that is consistent with current knowledge about the determinants of health, they identified nine components of interest:

A model of the determinants of health. Source: Reprinted from R.G. Evans and G.L. Stoddart, 1990, Producing Health, Consuming Health Care, Social Science and Medicine 31:1347–1363, with permission from Elsevier Science Ltd, Kidlington, UK.

social environment,

physical environment,

genetic endowment,

individual response (behavior and biology),

health care,

health and function,

well-being, and

prosperity.

Unlike a biomedical model that views health as the absence of disease, this dynamic framework includes functional capacity and well-being as health outcomes of interest. It also presents the behavioral and biologic responses of individuals as factors that influence health but are themselves influenced by social, physical, and genetic factors that are beyond the control of the individual. The model emphasizes general factors that affect many diseases or the health of large segments of the population, rather than specific factors accounting for small changes in health at the individual level. It takes a multidisciplinary approach, uniting biomedical sciences, public health, psychology, statistics and epidemiology, economics, sociology, education, and other disciplines. Social, environmental, economic, and genetic factors are seen as contributing to differences in health status and, therefore, as presenting opportunities to intervene. It is important to note, as Evans and Stoddart (1994) have done, that each component of the model represents complex sets of factors that can be examined in greater detail (see Evans et al., 1994).

The committee found the model proposed by Evans and Stoddart—which is referred to in this report as the field model —broad enough to encompass its vision. Although not yet widely tested, the model has been adapted for health policy and community planning in several Canadian provinces (Roos et al., 1995). Several features of the model were important to the committee. The model

• emphasizes the importance of considering the origins of health and the underlying causes of disease in individuals and populations;
• encourages explicit hypothesizing about the production of health in the community;
• underscores the interdisciplinary and multisectorial efforts often required to achieve health improvement in communities;
• makes explicit the possible trade-offs and benefits that occur across sectors; and
• encourages communities to identify possible performance and outcome measures from all of the categories.

In selecting indicators for performance monitoring, the determinants of health approach is useful in expanding the potential universe of indicators that should be considered. In addition to these practical reasons for adopting a model of the determinants of health such as that proposed by Evans and Stoddart, the field model provides an accurate representation of the complex contributions of physical environment, social environment, individual behavior, genetics, and health services to the well-being of communities.

Components of the Field Model: Some Examples

The components of the field model were discussed at the committee's second workshop. 1 the material below has been drawn from the summary of that workshop (see Appendix D ).

Social Environment and Prosperity

Among the elements of the social environment that have been linked to health are family structure, the educational system, social networks, social class, work setting, and level of prosperity.

Family structure, for example, is known to affect children's physical and mental health. On average, children in single-parent families do not do as well on measures of development, performance, and mental health as children in two-parent families. Children's relationships with their parents, social support, nurturance, and sense of self-efficacy have been shown to be related to their mental and physical health and even to their future economic productivity (Schor and Menaghan, 1995).

Education has an effect on health status separate from its influence on income. Years of formal education are strongly related to age-adjusted mortality in countries as disparate as Hungary, Norway, and England and Wales (Valkonen, 1989). Although most research is based on years of formal schooling, evidence suggests a broader relationship that includes the preschool period. An assessment at age 19 of participants in the Perry Pre-school Study, which randomized children into a Head Start-like program, showed that participation in the preschool program was correlated with better school performance, attending college, and avoiding involvement with the criminal justice system (Weikart, 1989). Critical periods for education, particularly at young ages, may prove to be important in determining health. In addition, studies show that maternal educational attainment is a key determinant of child welfare and survival (Zill and Brim, 1983).

"Social networks" is a term that refers to an individual's integration into a self-defined community and the degree of connectedness to other individuals and to institutions. There is a strong inverse correlation between the number and frequency of close contacts and mortality from all causes, with odds ratios of 2:1 or higher and a clear "dose-response" relationship (Berkman and Syme, 1979). Other aspects of physical and mental functioning also appear to be influenced by the quantity and quality of social connections (Seaman, 1996). Although it is possible to see the impact of social networks on health, the pathways responsible for those effects are not yet known.

Social class is another well-described determinant of health, independent of income. Major studies have been done in Britain, where social class is defined more explicitly than in the United States. In the Whitehall study of British civil servants, Marmot and colleagues (1987) demonstrated a clear relationship between social class (based on job classification) and mortality. The relationship persists throughout the social hierarchy and is unchanged after adjusting for income and smoking. The effect of social class may raise uncomfortable issues in the United States but is important to consider in dealing with issues of health and equity.

The health effects of work-related factors are seen in studies of job decision latitude, autonomy, and cardiovascular mortality (Karasek and Theorell, 1990). Involuntary unemployment negatively affects both mental and physical health. Economic prosperity is also correlated with better health. Throughout history, the poor have, on average, died at younger ages than the rich. The relationship between prosperity and health holds across the economic spectrum. For every decile, quintile, or quartile of income, from lowest to highest, there is a decline in overall age-adjusted mortality. In international comparisons by the Organization for Economic Cooperation and Development, the difference in income between the highest and lowest deciles of income shows a stronger relationship with overall mortality rates than does median income (Wilkinson, 1992, 1994).

Physical Environment

The physical environment has long been recognized as an important determinant of health. The public health movement of 1840–1870 emphasized environmental changes as a successful strategy for reducing the epidemic rates of infectious diseases, which flourished in the overcrowded housing with poor sanitation in industrial cities in Europe and North America (Ashton and Seymour, 1988).

The physical environment affects health and disease in diverse ways. Examples include exposures to toxic substances, which can produce disorders such as lung disease or cancers; safety at home and work, which influences injury rates; the design of vehicles and roadways, which can alter crash survival rates; poor housing conditions and overcrowding, which can increase the likelihood of violence, transmission of infectious diseases, and mental health problems; and urban-rural differences in cancer rates.

Genetic Endowment

The contribution of genetic makeup to the health of an individual is a new and emerging area of scientific inquiry. As scientific knowledge about genetics increases, this component of the field model is likely to become increasingly important.

For the most part, genetic factors are currently understood as contributing to a greater or lesser risk for health outcomes, rather than determining them with certainty. One area of particular interest is the link seen between genetics and behavior. Studies of twins separated at birth demonstrate a high concordance rate in alcoholism, schizophrenia, and affective disorders (Baird, 1994). Even so-called voluntary behaviors such as smoking and eating habits may be subject to genetic predispositions (e.g., Carmelli et al., 1992; de Castro, 1993; Falciglia and Norton, 1994). Health behaviors are complex, and the influences that determine them are likely to be extremely complex.

Genetic factors also interact with social and environmental factors to influence health and disease. It will be important to understand these interactions to learn why certain individuals with similar environmental exposures develop diseases whereas others do not (e.g., why most smokers do not develop lung cancer).

In the field model framework, behavior is seen as a response to other factors and can be treated as an intermediate determinant of health. Rather than a voluntary act only amenable to direct intervention, behavior is shaped by multiple forces, particularly the social and physical environments and genetic endowment. At the same time, behavior change remains a goal. Behaviors related to health care, such as adherence to treatment regimens, are influenced by these forces as are behaviors directly influencing health, such as smoking.

Health Care

Health care is an essential determinant of health. In the United States, however, its contribution has probably been over-emphasized. As noted above, about 5 years of the 30-year increase in life expectancy achieved in this century can be attributed to health care (Bunker et al., 1995). The greatest share of this gain can be attributed to diagnosis and treatment of coronary heart disease, which contributes 1 to 2 of these additional years of life.

Linking the Determinants

The committee was impressed by several implications of the field model's theoretical perspective. First, the model clearly reinforces the interrelatedness of many factors. Health outcomes are the product of complex interactions of factors rather than of individual factors operating in isolation. Indeed, these interactions are probably as important as the actions of any single factor. Currently incomplete, however, are descriptions of mechanisms underlying the linkages among the various determinants and full characterizations of the interactions among factors. The committee encourages the continued research needed to gain a better understanding of these mechanisms.

Second, not all of the determinants, viewed as causes, act simultaneously. The effects of some determinants, in fact, may be necessary antecedents to others, and some may have their primary influence by modifying the effects of others. Some may also differ in their relationship to health according to when they are present in the life cycle. Evidence suggests that there are certain times in the human life cycle that are critical for future health and well-being. During infancy and early childhood, crucial neurologic, cognitive, and psychosocial patterns are established (Carnegie Task Force on Meeting the Needs of Young Children, 1994; Entwisle, 1995). Experiences in childhood and adolescence may also have a critical influence on adult health risk factors such as weight and smoking (Dietz, 1994; IOM, 1994).

Another Perspective

Patrick and Wickizer (1995) have extended the field model framework by focusing on factors in the social and physical environments that operate at the community rather than the individual level. These two components are seen as affected by cultural, political, policy, and economic systems. In turn, they influence elements such as community response, activation, and social support, and ultimately community outcomes including social behaviors, community health, and quality of life. For example, establishing a smoke-free workplace policy exerts an influence on exposure to tobacco smoke separate from the smoking practices of individuals. This perspective points both to the influence of community-level factors and to the opportunities for community-level interventions.

• Interventions to Improve Health

Many factors can influence the impact of interventions to improve health. It is possible to target various determinants of health to produce change at an individual level, a community level, or both. All aspects of each broad determinant of health are not equally amenable to intervention, however. For example, the social environment of isolated senior citizens can be improved by increasing contact with others, but their genetic makeup is not amenable to change.

Time frames for measuring health changes vary widely, from days to decades. Some successful interventions will produce observable results within a year or two, but others may be followed by long latency periods before significant changes in health status can be observed. The impact of an intervention may also be influenced by when it reaches an individual because, as noted above, there appear to be "critical periods" in human development. Certain interventions in childhood may have long-delayed yet long-lasting results. In addition, the population effects of interventions are also important to consider. Small changes at the individual level may have important ramifications when applied to a whole community (Rose, 1992).

The traditional targets for intervention have been specific diseases or behaviors, and categorical funding streams for both research and the delivery of services encourage this approach. The field model of the determinants of health encourages consideration of a wider array of targets. For example, if adolescents' sense of well-being can be improved by reducing their feelings of alienation and hopelessness, can unintended pregnancies, alcohol and other drug use, crime, and the school dropout rate all be reduced? A multidimensional approach would be required, focusing on education, social and community involvement, family preservation, and improved social networks for teens and their parents. Community-level interventions might include after-school programs, athletics (e.g., midnight basketball), and church-based programs.

Whether focused on individuals or the community as a whole, health improvement efforts should be targeted at specific causal pathways or should employ interventions that have been proven effective. There is an obvious tension between what is now known and what we need to know to improve health. For example, the biologic pathways through which poverty or low social class influence health have not been adequately elucidated. A tension also exists between what is now measurable with valid and reliable indicators and what is not measurable, but may be important.

The multidimensional approach may be unfamiliar to health professionals because it is new and relies on partnerships with people from fields beyond those traditionally encompassed by a medical model. It is, however, consistent with the field model and may provide expanded opportunities for performance monitoring and improving the community's health.

• Implications for Communities

An examination of the field model points to the importance of considering both individual- and community-level data. Performance monitoring should include measures of inputs, process, and outcomes for health and health improvement activities. It may prove useful to monitor some key determinants, regardless of whether they are amenable to change at the local level, so that communities can understand the range of important factors. In addition, qualitative data may contribute important information about community needs. For example, information on social support, perceived barriers to service utilization, and attitudes toward the community and its resources are all relevant to performance monitoring and can be obtained from community surveys.

Performance monitoring provides an opportunity for a community to define and articulate expectations for organizations' contributions to the population's health. Although organizations might disagree with the appropriateness of the expectations, a useful dialogue may ensue. Communities may want to focus special attention on expectations regarding managed care organizations (MCOs) and the business sector. MCOs, for example, have generally defined "community" as their enrollees and not considered the entire community or public health as their area of concern. A community expectation that the health of the entire local population is part of an MCO's corporate and social responsibility could lead to their broader involvement in public health activities. Businesses, including MCOs, that have strong ties with a city or region may have a history of interest in local health issues. As corporations expand to multiple regions, however, they may require added encouragement to become involved and accountable in the local communities where they have a presence.

• Conclusions

Contributing to the interest in health improvement and performance monitoring is a wider recognition that health embraces well-being as well as the absence of illness. For both individuals and populations, health can be seen to depend not only on medical care but also on other factors, including individual behavior and genetic makeup, and social and economic conditions for individuals and communities. The field model, as described by Evans and Stoddart (1994), presents these multiple determinants of health in a dynamic relationship. The model's feedback loops link social environment, physical environment, genetic endowment, an individual's behavioral and biologic responses, health care, disease, health and function, well-being, and prosperity. The committee found this model to be an effective basis for its work.

This multidimensional perspective reinforces the value of public health's traditional emphasis on a population-based approach to health issues. It also provides a basis for looking to segments of the community beyond those traditionally associated with health to address factors affecting health and well-being. Some of the additional parties who can be brought to the table as interested stakeholders and accountable partners include, among many others, schools, employers, community-based organizations, the media, foundations, and public safety agencies. A performance monitoring program can promote the articulation of roles and responsibilities among these participants.

The committee has concluded that entities engaged in performance monitoring for community health improvement should

• adopt a broad definition of health;
• adopt a comprehensive and conceptual model of the way in which health is produced within the community; the field model, as elaborated by Evans and Stoddart, is a good starting point; and
• develop a concrete and specific hypothesis of how the multiple sectors of the community and individual stakeholders in each sector can contribute to the solution of a health problem.

In addition, federal agencies and foundations should provide support for further research on the determinants of health to clarify pathways, to develop reliable and valid measures useful for performance monitoring related to these pathways, and to identify community programs and clinical and public health interventions that are successful in addressing the underlying causes of ill health in communities.

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The workshop discussion was based on a presentation by Jonathan Fielding.

• Cite this Page Institute of Medicine (US) Committee on Using Performance Monitoring to Improve Community Health; Durch JS, Bailey LA, Stoto MA, editors. Improving Health in the Community: A Role for Performance Monitoring. Washington (DC): National Academies Press (US); 1997. 2, Understanding Health and Its Determinants.
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18 The Value of Health

Daniel M. Hausman earned his philosophy PhD in 1978 at Columbia University, and has taught at the University of Maryland at College Park, Carnegie Mellon University, and since 1988 at the University of Wisconsin-Madison

• Published: 07 April 2015
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Health is valuable both instrumentally, in terms of its consequences for autonomy, opportunity, and well-being, and intrinsically, at least with respect to the mental states it encompasses. Quantifying the value of health is problematic, because there are many different ways in which people may suffer diminished health. Because of this multidimensionality, the “healthier than” relation is incomplete, and health has no quantity or magnitude. Health must be measured by its value. But it has different values, and the same token health states will have different values in different environments or for people who have different goals and activities. The value of types of health states must thus be some sort of average of the varying values of tokens. Assigning those average values is challenging, and actual techniques, which rely on preference surveys, are problematic.

This chapter will be concerned exclusively with the value of human health. In particular, I shall be concerned with the value of a person’s health to that person, with the ways in which health is good for people. One important way in which health is good for a person is if health contributes to that person’s well-being. But I shall not assume that the only way that health can be good for someone is through its bearing on well-being. Health may, for example, also contribute to freedom and independence, or it may constitute a personal good of its own kind.

It is uncontroversial that health is extremely valuable. Every culture values health highly, even as cultures disagree on details concerning what constitutes health. Health is not, however, always good for people. Those German men who were too unhealthy to serve in the Nazi armies were fortunate to miss out on the Eastern Front. Yet exceptions such as this one do not impugn the generalization that health is usually very good for people.

One obvious explanation of this generalization is that a minimal level of health is required for action, consciousness, and life itself. Without some minimal level of health, nothing else can make people’s lives go well. Health beyond what is required for life and basic functioning is also of great value. Why? Three immediate answers come to mind, all of which are correct as far as they go. First, health is an extremely important cause of well-being. But this answer tells us little until we have some account of how health contributes to well-being. A second quick answer is that people value health. But this claim, true as it is, does not tell us much without an account of health that explains and justifies the value that people place on health. A third answer is that health promotes other values such as opportunity and autonomy. But again one must ask how health does so.

To understand the value of health, one needs to clarify what health is. That will be the task of the first two sections. Section 18.3 begins the task of explaining what constitutes better health and whether health has a scalar value, and section 18.4 considers whether preferences can serve as measures of better health, as is assumed by most of those working on health measurement. Section 18.5 addresses the question of whether a measurable scalar value can be assigned to health, and section 18.6 assesses three accounts of the value of health. Section 18.7 concludes.

18.1. Evaluative Views of Health

There is a large literature concerning the concept of health. Most of it takes health to be the absence of physical or mental disease or impairment. Although I shall take for granted this negative characterization of health, it is not uncontested. In 1947, the World Health Organization famously defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (1948: 100). But this definition conflates health and well-being, and, without ever explicitly repudiating it, the World Health Organization itself relies on narrower characterizations of health. Lennart Nordenfelt defends a positive “holistic” view of health as a second-order ability to realize one’s goals (2000: 79–81). Carol Ryff has written extensively on positive health, which she identifies primarily with possessing purpose in life and quality relations with other people, although in her view other goods such as self-esteem and mastery are closely connected. She writes, “Positive health is ultimately about engagement in living” ( Ryff and Singer 1998 : 10).

Rather than interpreting those who see health as well-being (or a generalized ability to realize one’s goals or as engagement with living) as disagreeing about the properties of some single thing called “health,” I think these contrasting claims reveal that there are multiple notions of health. According to the broad concept of health I shall discuss—health as the absence of pathology—which is the concept employed by pathologists and physiologists, health depends on the functioning of the parts and processes within people’s bodies and minds. Although being Jewish was likely to be fatal condition if one lived in Eastern Europe in the early 1940s, it was not itself a physical or mental pathology (though some Nazis mistakenly believed otherwise). Even those who maintain that there is a great deal more to health than what is “within the skin” can recognize a “negative” notion of health as the absence of pathology.

Having in this way limited the notion of health under discussion, controversies remain concerning what constitutes pathology. The many detailed accounts are of two general kinds: naturalist and evaluative. According to evaluative views, it is part of the concept of health that it is good for an organism, and our evaluative standards—particularly concerning well-being—help to define health. It might appear that evaluative theorists are obviously right. 1 Whether something is a disease apparently depends on whether it is bad for an organism in ordinary environments. 2 Tristram Engelhardt provides a memorable example of the way in which values have affected disease classification in his discussion of the history of masturbation, which for a couple of centuries was widely regarded as a disease in Europe and the United States ( Engelhardt 1974 ). Consensus was never complete, and there were disputes about whether masturbation is a physical or a mental disease and about whether masturbation is a cause of disease rather than a disease itself. But much of the medical community regarded it as a medical disorder, and doctors prescribed treatments ranging from opium, cold baths, and visits to prostitutes for men to clitoridectomies for women. It is obvious in retrospect and was obvious at the time that moral judgment influenced disease classification. Tissot’s influential mid-eighteenth-century treatise asserts, “We have seen that masturbation is more pernicious than excessive intercourse with females. Those who believe in a special providence account for it by a special ordinance of the Deity to punish this crime” (1758; quoted in Engelhardt 1974 : 239).

Engelhardt sums up as follows:

Insofar as a vice is taken to be a deviation from an ideal of human perfection, or “well-being,” it can be translated into disease language. . . . The shift is from an explicitly ethical language to a language of natural teleology. To be ill is to fail to realize the perfection of an ideal type; to be sick is to be defective rather than to be evil. . . . The notion of the “deviant” structures the concept of disease providing a purpose and direction for explanation and for action, that is, for diagnosis and prognosis, and for therapy. A “disease entity” operates as a conceptual form organizing phenomena in a fashion deemed useful for certain goals. The goals, though, involve choice by man and are not objective facts, data “given” by nature. They are ideals imputed to nature. ( Engelhardt 1974 : 247–48)

Engelhardt concludes that health is the absence of defect or deviance, where defect and deviance are evaluative notions that depend on views of well-being, perfection, virtue, and duty.

It is, however, questionable whether the case of masturbation supports an evaluative view of health such as Engelhardt’s ( Boorse 1997 : 72–78). Whether historical claims concerning attitudes toward masturbation are true depends on what people in the nineteenth century believed and why they believed what they did, rather than the definition of health. If one believes that masturbation involves physical or mental states that are bad for people, then according to the evaluative theorist, one ought to believe masturbation is a disease. Thus evaluative theorists regard nineteenth-century physicians as justified in their belief that masturbation (as an activity that issues from and causes harmful physical or mental states) is a disease, given their belief that masturbation is bad for people. The naturalist in contrast denies that harmful physical and mental states are automatically diseases and that diseases must be harmful. In some circumstances heresy is a fatal mental condition and flat feet a life-saving escape from the draft. Yet flat feet are pathological, while heresy may be healthy.

There has, of course, been a huge change in values concerning masturbation, and that change in values has been both a cause and an effect of a change in attitudes toward whether masturbation is a disease. But when one looks more closely, it turns out that the claim that masturbation is a disease was not defended by normative condemnation. The case rested instead on a long list of false assertions about the effects of masturbation on the functioning of other organ systems and about the mechanisms through which masturbation had these effects. Those false assertions were no doubt often motivated by moral objections to masturbation, but the causal connections show only that moral commitments can cause people to make false factual claims, not that morality defines pathology. The effects of masturbation were supposed to derive from debilitation caused by the loss of semen. But the loss of semen is not debilitating and has few effects on other organ systems. Masturbation does not result in the loss of more semen than intercourse, which was held to be harmless (apart from the risks of venereal disease), and some other theory had to be concocted to generate a mechanism whereby female masturbation diminished the functioning of body parts. Whether via the loss of semen or in some other way, masturbation does not cause stomach aches, epilepsy, blindness, deafness, vertigo, heart irregularities, or rickets—all of which were alleged to be its effects. If masturbation had these effects, then masturbation would be a disease or a cause of disease such as anorexia or cutting oneself. To the extent that those who regarded masturbation as a disease felt it incumbent on them to show that it had other physiological consequences than a morally condemnable self-induced orgasm, they seem to be repudiating rather than presupposing the view that Engelhardt defends. They apparently did not believe that it was sufficient to point out that masturbation is “a deviation from an ideal of human perfection.”

Even though those who regarded masturbation as a disease were not content to point out that it was a normative defect, Engelhardt might still be right. Why shouldn’t someone who regards masturbation as a defect regard masturbators as sick, just as most Americans are inclined to regard necrophiliacs as sick? 3 If God or evolution designed our sexuality exclusively to lead us to seek intercourse with living members of the opposite sex, then there is a malfunction in those who masturbate or have homosexual encounters or have intercourse with animals or cadavers, just as there is a malfunction in those who prefer a meal of mouse droppings to a decent dinner. (But notice that this thought shifts from a view of disease as morally, prudentially, or aesthetically bad to a view of disease as malfunction.)

Evaluative theorists maintain that it is a conceptual truth that health matters to what people value (see, for example, Cooper 2002 ; Engelhardt 1974 ; Reznek 1987 ). Poor health is supposedly an automatic excuse for certain behavior, a justification for sympathy and the provision of care, and something that diminishes overall well-being. But these claims appear to be false. 4 For example, infertility in young adults is unquestionably pathological. It is a failure of the reproductive system to do what it is designed to do. It may justify medical treatment. Yet many people seek infertility, at least temporarily. Women who are reversibly infertile because they are taking birth-control pills (and by virtue of lacking normal capacities thus not fully healthy) or men who have had vasectomies after having fathered as many children as they want are typically not worse off all things considered. They do not have a condition requiring medical treatment or excusing behavior that would ordinarily be condemned, and their condition does not call for sympathy or care from others.

An evaluative theorist has three possible ways of conceding that apparently better health can be worse for a person. First, even if circumstances are such that better health in a particular regard has harmful consequences, it might still be better in other respects. Second, evaluative theorists might question whether the physical and mental states that people take to be healthy are, regardless of the circumstances, always in fact healthy. On this view, premenopausal women who are sexually active and want to avoid pregnancy are healthier if infertile, because infertility is better for them than fertility, while infertility is unhealthy in those premenopausal women in whom it is involuntary and unsought. A third possibility for the evaluative theorist is to maintain that it is a conceptual truth that states of better health are typically or usually better for people rather than invariably so. Cases in which it is better to be less healthy do not constitute counterexamples to these loose conceptual connections.

These three ways in which the evaluative theorist can meet the challenge posed by cases in which it seems that it is worse to be healthier, leave one wondering how substantial the disagreements between evaluative and nonevaluative views of health actually are. On the first alternative, it is a conceptual truth that setting aside their consequences (which may in unusual cases be harmful) states of better health are better for people. Most nonevaluative theorists agree that apart from unusual circumstances, better health is typically better. So the disagreement turns on whether it is a conceptual or contingent truth that health is a good thing. If evaluative theorists protect their claim in the second way by labeling physical and mental states that serve people’s purposes as states of better health regardless of the functional deficiencies they may involve, then it seems that the evaluative theorist is concerned with a different notion of health than the one that is employed in pathology and physiology. The disagreement collapses into an argument about how to use the word “health.” With the proper translation manual, it is questionable whether the evaluative theorist is asserting anything that the nonevaluative theorist denies. On the third alternative, it is also doubtful whether any important disagreement remains between evaluative and nonevaluative or naturalistic views of health. The evaluative theorist maintains that it is a conceptual truth that good health is generally good for people. The naturalist agrees that good health is generally good for people, but denies that this is a conceptual truth. What is at issue?

Perhaps the source of disagreement lies in the independent characterization of health that the naturalist provides and to which we shall now turn. Notice that evaluative views of health make it difficult to see how the term “health” can be used univocally to refer to states of people, animals, plants, or (more debatably) ecosystems. Health is usually a very good thing both intrinsically and instrumentally, and an evaluative view is defensible. But, as we have seen, to mount a successful defense of a conceptual connection between health and benefit requires some fancy footwork.

18.2. Naturalistic Views of Health

The leading nonevaluative “naturalistic” view of health is Christopher Boorse’s biostatistical view (1977, 1987, 1997; see also Wakefield 1992 and Hausman 2012a ). In Boorse’s view, a pathology obtains when the functioning of parts or processes of the body or mind is appreciably less efficient than what is statistically normal in the relevant reference class in typical environments. Boorse defends a goal-contribution view of functions, whereby the function of a part of a directively organized system consists of the contribution that the part makes to how well or how probably the system achieves its goals. A directively organized system is one that shows resilience in the pursuit of its goals, where that resilience is explained by the structure of the system. Central goals of human beings, like other living things, are survival and reproduction. These goals are not determined by moral or prudential considerations. They are instead enforced by evolution. The functions of parts of human beings are the contributions those parts make to survival or reproduction or to the achievement of narrower goals of particular subsystems to which the parts belong. The functioning of the parts of people is healthy when it is not much below the median level of functional efficiency in a typical environment for the relevant reference class. Reference classes are narrower than whole populations, because unimpaired capacities of male and female and of different age groups differ. Infertility is not pathological in seventy-year-old women, and men who are unable to breastfeed have no disease.

Figure 18.1 , drawn by Boorse (1987 : 370 and 1997 : 8), 5 helps clarify the view. Although Boorse draws what looks roughly like a normal distribution, there is no reason why the distribution of functional efficiency should be symmetrical, single-peaked, or continuous. There might be a small number of discrete levels. Median functional efficiency (which in a skewed distribution could be less than or greater than the mode) defines what is statistically normal.

The Biostatistical Theory

Although the median in the distribution of levels of functional efficiency (in a typical environment) determines a benchmark, the distribution plays no further role in locating the line between pathological and healthy part function. Among the levels of functional efficiency that are lower than the median level, the level of functioning (as determined by the contribution the part makes to the goal-achievement of the systems to which the part belongs) determines whether functional efficiency is adequate and hence healthy or not. Functional efficiency that is “significantly” worse than the median level is pathological. Although functional efficiency is a matter of how well a part is functioning and is thus an evaluative notion, the standards of good functioning depend on a part’s contribution to the systems to which it belongs and ultimately to survival and reproduction. Considerations of well-being, aesthetics, and virtue are irrelevant.

In denying that there is any conceptual connection between health and well-being or other human values, naturalistic theories need not maintain that the relationship between health and well-being is solely instrumental. Health states may also be constituents of well-being, but whether certain levels of functional efficiency contribute to or constitute elements of well-being or other human values in specific environments is a separate question from their contribution to system goals and ultimately survival or reproduction.

18.3. Why Is It Better to Be Healthier?

What is it that makes it better to be healthier? To answer this question, more needs to be said about what it is to be healthier. This turns out to be trickier than it might at first appear, because pathology and health are multidimensional. One person may be in pain, another suffering a cognitive deficiency, a third unable to see. How are these different health states to be compared? To impose some order and to value these health states, health economists have constructed health state classifications and have then assigned values to the health states so classified. 6 Unlike someone’s health, which depends not just on her instantaneous physical and mental states, but on their trajectories through time, health economists take a person’s health state to be a snapshot at a moment, without reference to past or future. Just as the distance an object travels over an interval is the time integral of its instantaneous velocity, so a person’s health during a period is the time integral of the person’s health states. So, for example, the health state now of a woman with a symptomless cancer that will kill her in a few weeks could be little different from the health state of someone in full health. The fact that her health (as opposed to her instantaneous health state) is very poor shows up in her expected trajectory through increasingly terrible health states. Once one has classified the instantaneous health states, one can define people’s health in terms of actual or expected trajectories through these health states. The classification of health states is fundamental to this way of describing people’s health. For an example, the Health Utilities Index distinguishes eight “dimensions” of health: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain, and distinguishes five or six levels of severity of deficiencies along each dimension, for a total of 972,000 health states.

As health-classification systems such as the Health Utilities Index recognize, people’s health states are multidimensional. In this regard health states are analogous to consumption bundles in consumer choice theory. A person’s consumption bundle consists of quantities of fruits, fish, water, wine, haircuts, home heating, and so forth, and though one bundle of commodities and services may cost more than another or provide an individual with greater happiness, there is no way to say that one bundle of commodities is literally larger than another, apart from the special case of dominance in which one bundle contains at least as much of each commodity as another and more of some commodities. Although Mitt Romney is much richer than most readers of this volume and consumes a more expensive bundle of commodities, as a Mormon, his beer consumption is probably much lower than that of an average college student. The bundle of commodities he consumes is probably neither literally larger nor smaller than the bundles of commodities and services consumed by different readers of this essay.

Just as one person’s commodity bundle is often neither larger nor smaller than the commodity bundle of another, so it is frequently the case that one person has no larger or smaller quantity of health than another. One can compare how happy people are in various health states or what their median income is or how much on average they prefer one health state to another, but there is no way to say that Jack has literally more health than George, unless Jack’s health state dominates George’s—that is, unless Jack’s health state is no worse than George’s along any dimension and better along at least one dimension. It is tempting to suppose that one might make comparisons in terms of something like “overall functioning,” but this is an illusion. 7 How is one to judge whether Jack, who has a very limited short-term memory, is healthier than Jane, who needs a walker to get around, or Jessica, who is very hard of hearing? What evidence bears on this question?

The relation “is at least as healthy as” is massively incomplete : most health states cannot be compared in their quantity or magnitude of health. It is not just that we cannot tell: there is no truth condition for the claim that one set of functional deficiencies constitutes a greater quantity or magnitude of health than another, unless the former dominates the latter. There is no such thing as a quantity or magnitude of health, just as there is no such thing as the “size” of a commodity bundle.

But, of course, we compare people’s health all the time. If Jack is bedridden, senile, and deaf but has good vision, he seems to be clearly less healthy than George, who is color-blind, but otherwise healthy. Health comparisons such as this one are, I suggest, in fact comparisons of the value of different health states, of how good different health states are. When we say that one person is healthier than another, we usually mean that the first person’s health is better . Similarly, when we say that Mitt Romney has more goods than the typical steelworker, we mean that his goods are more expensive or that most people would gladly trade the steelworker’s bundle of commodities for Romney’s. Though one person rarely possesses literally more or less health than another, it is often the case that one person’s health is better or worse than another’s.

Rather than finding a basis for the value of health in clarifying the measure of health, we have found that there is no measure of health apart from its value. So we might as well ask directly: what is it for one person’s health to be better than another’s or for someone’s health to be better at one time than at another? One finds different answers in the literature. Norman Daniels cashes out the value of health in terms of opportunity (1985, 2007). In his view, someone’s health at t is better than their health at t ′ (or than someone else’s health at some time) if he or she has greater access to the normal opportunity range for someone of that age and sex in that social position and with those talents. Paul Dolan disagrees. He maintains that the value of a health state consists in the quality of subjective experience it involves ( Dolan and Kahneman 2008 ). John Broome (2002 : 94) and Dan Brock (2002 : 117) assert that how good someone’s health is is a matter of the contribution that their health makes to their well-being either as cause or component. The health measure in use in England and some other European countries takes the value of health to be a component of well-being, which health economists call “health-related quality of life.” In practice, health economists usually take one health state to be better than another if and only if people prefer the former to the latter, regardless of the reasons for the preference.

None of these views seems satisfactory. The value of health cannot be cashed out entirely in terms of opportunities. Subjective experience is also important, whether or not it affects opportunities. But opportunity and capacities are important: health cannot be measured entirely in terms of subjective experience either. Subjective experiences are often good indicators of our health—indeed one can conjecture that the evolutionary point of many of our feelings is precisely to indicate what states of our bodies are healthy or diseased. But if our evidence is faulty or we have nervous, cognitive, or affective disabilities, our subjective experience may be excellent when our health is poor. Those with congenital analgesia (an inability to feel pain) are not in better health than those who feel pain.

Nor does the measure of health consist in its bearing on well-being. People with disabilities such as deafness who have coped successfully with their disability may be as well off as people without any disabilities. Whether deafness is a disability does not depend on whether it diminishes the quality of life. It sounds more plausible to maintain that the value of health consists in health-related quality of life, but I suspect that this view appears to be more plausible mainly because it is unclear what health-related quality of life is. What would it mean to say of someone who is deaf and is living an excellent life that her “health-related quality of life” is worse than someone who can hear? As John Broome has argued (2002), there is no way to decompose someone’s well-being into some set of components, with a subset constituted or caused by the person’s health. For example, as Allotey and coauthors (2003) vividly document, the extent to which paraplegia diminishes the quality of life differs dramatically depending on whether one confronts social, natural, and technological circumstances like those in Australia or like those in Cameroon.

18.4. Preferences and the Value of Health

What about preferences? Do they enable health economists to value health states sensibly? Economists do not typically define what they mean by preferences, and when they do offer definitions, they often make indefensible claims that are inconsistent with their own practices. In Preference, Value, Choice and Welfare (2012), I argue that the interpretation of preferences that best fits the practice of economists takes preferences to be subjective total comparative evaluations. What this means is the following:

Preferences are subjective states that combine with beliefs to explain choices. They cannot be defined by behavior. Even in the simplest case in which Sally faces a choice between just two alternatives, x and y , one cannot infer that she prefers x over y from her choice of x without making assumptions about her beliefs. If Sally mistakenly believes that the choice is between x and some alternative other than y , then she might choose x from the set {x, y} despite preferring y to x .

Preferences are comparative evaluations . To prefer x to y is to judge how good x is in some regard as compared to y . To say that Sally prefers x is elliptical. If Sally prefers x , she must prefer x to something else.

Third, preferences are total comparative evaluations—that is, comparative evaluations with respect to every factor that the individual considers to be relevant. Unlike everyday language where people regard factors such as duties as competing with preferences in determining choices, economists take preferences to encompass every factor influencing choices other than beliefs and constraints.

Fourth, as total comparative evaluations , preferences are cognitively demanding. Like judgments, they may be well or poorly supported and correct or incorrect.

On this understanding of preferences, there are strong reasons to deny that one health state H is better than another, H ′, if and only if people prefer H to H ′. First, people might prefer H to H ′, despite believing that H ′ was a state of better health. For example, a manic-depressive may prefer not to treat her disease, because of what she is able to achieve during manic periods, without believing that she is in better health when not medicated.

Health economists might respond that cases in which people judge that H ′ is a better health state than H but prefer H are unusual and may be ignored. Though not defining what it is for one health state to be better than another, perhaps preferences are reliable indicators of how good or bad health is. But it is questionable whether preferences are reliable indicators of health, because people’s preferences among health states are likely to be mistaken. When economists measure people’s preferences among flavors of ice cream or makes of cars, they are asking people for their comparative evaluations of alternatives that the respondents understand well, that they have had ample opportunity to consider, and concerning which they have a great deal of information. When, in contrast, health economists ask people to express their preferences among health states, they are asking people to appraise unfamiliar alternatives concerning which respondents typically have no secure preferences at all.

This concern about the reliability of survey respondent’s comparative evaluations is not just a theoretical qualm. Consider, for example, the “quality weights” that are assigned to health states as classified by the EQ-5D, a health classification system used in Europe, including by the National Institute for Health and Clinical Excellence in England (which uses these weights to determine whether treatments are sufficiently cost-effective to be paid for by the National Health Service). The EQ-5D has five dimensions along which health states vary: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Along each dimension, there are three levels: no problems, moderate problems, and severe problems. There are thus 3 5 , or 243 distinguishable health states, to which “quality weights” are assigned. Death is assigned a quality weight of zero, and 1 is assigned to full health—that is, to no problems along any of the five dimensions. Apart from a few health states that may be worse than death, health states have some value between zero and 1. To assign values or “quality weights,” members of the population are asked questions such as the following:

Suppose that you faced a choice between (a) ten years of life remaining in health state 11112 (that is, with no problems on any of the dimensions of health except for moderate anxiety/depression) or (b) eight years of life with no problems on any of the dimensions of health. Which would you prefer?

This is not a choice that people have previously faced. It is far from well defined. What constitutes a “moderate” problem of anxiety or depression? If one actually faced such a choice—perhaps if one were faced with a choice of whether to take an antianxiety drug that would shorten one’s life by two years—it would be an extremely important choice that would demand serious reflection. One would want to know more about how disabling the anxiety or the depression would be. Exactly what counts as “moderate” anxiety or depression? Would one still be able to work, to live independently? How would it affect one’s social life or one’s income? What sort of burdens would it impose on one’s family and friends? To make a serious total comparative evaluation of these two alternatives—eight years in full health versus ten years with moderate anxiety or depression—one would need to gather a great deal of information and deliberate with care.

In fact, when those surveyed are asked whether they would prefer eight years in full health to ten years with moderate anxiety, they answer in a few seconds. What cognitive processes enable them to give immediate answers to questions that are unfamiliar, not well defined, and extremely difficult? They are probably substituting some easier question for the incredibly difficult question they have been asked ( Kahneman 2011 ). Why should one take their answers as good measures of the value of health states? These problems with surveys have no easy solution. Rational survey respondents are never going to invest the effort that is required in order to have settled and well-supported preferences among alternatives such as these. 8

These reasons to deny that H is a better state of health than H ′ if and only if people prefer H to H ′ raise a further question: Why defer to the judgment of survey respondents concerning the values of health states rather than making the judgment oneself? Unable themselves to figure out how to value health states, health economists instead elicit the views of people whose off-the-cuff answers show that they have not grappled seriously with the problems.

So the proposal to measure the values of health states by preferences fares no better than the proposals to measure the values of health states by opportunity, feelings, or well-being. The preferences people express should not be taken seriously as comparative evaluations to which they are committed. One should also wonder why, when faced with the difficult problem of providing a comparative evaluation of the health states defined by the EQ-5D, health economists should rely on the judgments of laypeople who know less about the health states and have had less opportunity to think about them.

18.5. Do Health States Have Values?

Regardless of whether one holds an evaluative or a naturalistic view of health, there is a serious additional problem with the proposal to measure health in terms of the value of health. If two individuals are in the same physical and mental state, then their health is the same. If their health is the same, then any acceptable measure of their health must assign the same number to their health. If health is measured by its value, then if health states are the same, their value must be the same. But the same health state has different values for different people in different environments. Being unable to walk is a devastating blow if one lives in an impoverished swampy or mountainous country with few paved roads. Its impact on well-being or opportunity is far less serious in a wealthy country with wheelchair-accessible transportation and buildings. A strained tendon that most people would find trivial may cost a violinist her career. If, as these examples illustrate, the same health states often have different values, then their values cannot be measures of health. But it is only in terms of their values that health states are generally comparable. So it appears that health is not measurable at all!

There is a way out of this conundrum ( Hausman 2012b ). One can distinguish between token health states—that is the health state of a particular individual at a particular time and place—and kinds or types of health states. The argument above shows that the values of tokens of the same type differ depending on the environment and the values and interests of individuals. Rather than concluding that kinds of health states have no single value, one can instead assign to health state types either the average value of their tokens weighted by the frequency of different circumstances or the value of their tokens in some “standard” context.

If the value of token health states were uniformly extremely sensitive both to the environment and to individual interests, there would be little point to considering their weighted average or the token value in some standard context, because these would tell us little about the values of the actual token health states. Fortunately the values of many token health states are not widely dispersed. A broken toe is a very serious injury to some dancers and athletes, but it has much the same value to a large majority of the population. A migraine headache is pretty much just as miserable whether one is walking through a rainforest or skiing across frozen tundra, whether one is a doctor, a dogcatcher, or a dockworker. But it is questionable whether average or standard values will serve all the purposes for which health measures are designed.

If the values of health state types are the values of tokens in some “standard” environment or averages of the values of tokens, then our inquiry into the value of health leads us to inquire about what constitutes or determines the value of token health states. That value depends jointly on the “within-the-skin” functioning of parts and processes as described by some system of health state classification, on the individual’s specific environment—cultural, technological, biological, and geographical, and on the interests and values of the individual.

18.6. Valuing Token Health States

What makes a token health state better or worse? What constitutes its value? There are three main answers in the literature. Philosophers have argued that the value of health lies in its contribution to well-being, to opportunity, or to capability. Defenders of these three accounts take them as competing, but it is possible to regard the value of health as arising from some combination of its bearing on all three.

18.6.1. Health and Well-Being

Health obviously contributes to well-being, and minimal levels of health are a necessary condition to possessing a life worth living. Most health economists probably see the value of health as deriving from its contribution to well-being. Though they measure the value of health in terms of preferences, they implicitly take greater preference satisfaction to indicate greater well-being. Some philosophers such as Brock (2002) and Broome (2002) have also defended the view that the value of health lies in its bearing on well-being.

Yet, as already argued, health does not always contribute to well-being. Health improvements are not necessarily improvements in well-being both because of perverse environments such as wars, which may reward health deficiencies, and because certain disabilities, such as deafness, need not limit an individual’s overall prospects of living well, despite limiting the variety of good lives that are open to them.

There are two responses to these objections. First, those who find the value of health in its contribution to well-being might argue that even if overall well-being is not necessarily lowered by poor health, the health-related aspect of well-being—the “health-related quality of life”—is diminished. This response seems merely to paper over the difficulty without seriously addressing it. Second, one might concede that poor health does not always diminish well-being, while insisting that it typically does, and that one is consequently justified in measuring the value of a health state by its bearing on well-being.

It is sensible to maintain that better health generally improves well-being, but health has value even when it does not promote well-being. Even if losing one’s hearing does not make one worse off, it is a loss of something of value. A further problem with locating the value of health in its contribution to well-being is that it is no easier to understand or measure well-being than it is to understand or measure health. For the same reasons that one cannot identify the value of health with the quality of mental states, one cannot identify well-being with the quality of mental states. For many of the same reasons that preference satisfaction does not constitute health, it does not constitute well-being either. Like health, well-being is multidimensional, and assigning a scalar measure (for example, in terms of preferences or subjective experience) is problematic.

At the end of the day, one can still say that it is usually the case that those whose health is better are, other things being equal, better off, and if their health is much better, then, other things being equal, they are usually much better off. But these platitudes are not very informative.

18.6.2. Health and Opportunity

As Norman Daniels has argued, health is critical for opportunity. Indeed one way to understand how impairments such as deafness, blindness, or paraplegia can count as disabilities, even when they do not diminish well-being, is to point out their consequences for opportunity. Regardless of the social accommodations society may provide, those who are blind cannot be bus drivers and those who cannot walk cannot be Navy Seals.

The value of health is not exclusively a matter of the bearing of health on occupational opportunities, and Daniels never intended to make such a claim. He uses “opportunity” in a broader sense as the range of valuable activities and experiences available to individuals. Even though poor health may not limit the occupational opportunities of someone who is past a mandatory retirement age, it may limit her opportunities for social interactions, recreation, or enjoyment.

One could stretch the notion of opportunity still further than Daniels does, so that physical or mental states that do not limit activities also count as limiting opportunities, such as opportunities to be free of pain, to avoid anxiety, or to have normal sensory or cognitive functioning. Unless we are to stretch opportunity all the way to include these, Daniels’s account of the value of health will not be adequate. Bouts of pain constitute health deficits regardless of whether they affect opportunities for activities. But if (unlike Daniels) one stretches opportunity so as to include opportunities not to be in pain, then the account is uninformative. It says that health states are bad insofar as they involve subnormal part functioning—that is to say that health states are bad insofar as they are unhealthy.

18.6.3. Health and Capability

Amartya Sen’s proposal (1992, 1993; Robeyns 2005 ) to conceptualize what is of value to human beings in terms of various kinds of functioning (which he takes to be activities as well as states of affairs) and in terms of capabilities (which he takes to be sets of functionings that are available to people) has had a significant influence on contemporary thinking concerning health and its value. Health is one of the ten central human capabilities that Martha Nussbaum identifies (2000). Jennifer Prah Ruger argues that what is of value is not just health but “health capability,” which consists of both health and the capability to pursue health (2010). Sridhar Venkatapuram (2011) argues that health is a “meta-capability”—a capability to acquire other capabilities—and that its value derives from the value of those capabilities, which is in part a matter of freedom and in part a matter of the value of the functionings that the capabilities make possible. Without using the language of capabilities, I have argued elsewhere that the value of health states depends jointly on the feelings they entail and on the activities they permit ( Hausman 2010 ).

Unlike the claims that the value of health states consists in their bearing on well-being or in their consequences for opportunity, the claim that the value of health states depends on the capabilities they imply or, in my variant ( Hausman, 2015 ), on the feelings and activity limitations they involve seems to be true. But one may reasonably question whether it is useful. Sen offers no way to evaluate functionings or capabilities except when capability sets are nested or all relevant evaluative criteria point in the same direction. Indeed he is skeptical about both the possibility and the desirability of scalar measures, which he believes lead people to overlook the complexities of evaluating ways of being and acting. Such skepticism is reasonable, and it may be that the best answer to the question “What is the value of health?” is to insist that health has many different values for different people in different circumstances. But Sen’s skepticism does not respond to the practical need for measures that will help identify the diseases and risks that most diminish health or that will guide the allocation of health-related resources. That practical need does not demand a single context-independent measure of health, but it does demand some function from contexts to health state values, and Sen is skeptical about even such a context-sensitive measure.

18.7. Conclusions

The thrust of this discussion should be discouraging to those, like the staff at the Institute for Health Metrics and Evaluation, who seek to generate summary measures of population health and to measure the burden of different diseases, accidents, and risk factors. It is similarly unhelpful to others, like those at the National Institute for Health and Clinical Excellence in England, who need a scalar measure of the health benefits of alternative treatments in order to determine their cost effectiveness. But Sen has good reason to be skeptical of scalar measures of capabilities because all of the existing systems that purport to measure health or the burden of disease have serious flaws.

The questions that the Institute for Health Metrics and Evaluation address are important and real: how large a contribution to ill health do different diseases, injuries, and risk factors make? Without a scalar measure of health, one can only look at rough indicators, such as the contribution different diseases make to premature mortality. Similarly, within the constraints set by considerations of fairness, if the United Kingdom wants to allocate healthcare resources so as to improve health as much as possible, it apparently needs a scalar measure of health.

What is needed for health measurement or scalar evaluation is unfortunately not necessarily forthcoming. There is no good way to put the many values of different health states on a single scale that will serve all the purposes for which a generic health measure is intended. Those concerned to measure health have to make do with rough indicators of the values of health states.

Philosophers who are not concerned to measure health need not be discouraged by the incompleteness of health comparisons or the difficulties of locating health states along some single scale. If the concern is to understand the values of health rather than to measure health, no scalar unit is required. Neither is there any need for complete comparisons. Health states differ in many ways and have different values. Some health states may have aesthetic values. Consider upright posture or a clear speaking voice. The values of some states of mental health are akin to the values of traditional virtues such as courage or moderation. Other health deficiencies, both physical and mental, are unpleasant in a variety of ways. Others undermine the possibilities of undertaking various activities or pursuing certain objectives. These variegated values are real and palpable, even if there is no good way to put them all on any single scale.

Acknowledgments

I have had a great deal of help thinking through the issues in this chapter from many people over a long period of time. I am particularly indebted to Andrew Altman, Christopher Boorse, Dan Brock, Norm Fost, Paul Kelleher, Elselijn Kingma, Peter Schwartz, Russ Shafer-Landau, Alan Sidelle, and Reuben Stern.

That is Dominic Murphy’s view. He assumes that everyone concedes that part of what defines a disease is harm (2009) and that the debate between “objectivists” and “constructivists” (neither of whom accepts a naturalistic view) turns on whether objective malfunction is a necessary condition for the existence of disease or pathology.

By an “ordinary” environment, I mean to rule out environments like the Nazi wartime draft or the systematic slaughter of Jews, in which traits that usually enhance well-being and opportunity or that are irrelevant to them can be very harmful.

According to the fourth edition of Diagnostic and Statistical Manual of the American Psychiatric Association , necrophilia is not a mental disorder unless it causes distress to the individual or harm to others. Earlier versions of the DSM did classify it as a disorder. What constitutes a mental disorder is much more controversial than what constitutes a physical disorder. Some societies have approved of intercourse with the dead under certain circumstances.

One central desideratum for an account of the concept of health is that it conform to the judgments of pathologists and physiologists. Their judgments are, however, fallible, and some are more central and more firmly held than others. So an account of the concept of health may conflict with some of the claims physiologists or pathologists make. This essay does not document its uncontroversial claims about their views.

Boorse accidentally mislabels the axes.

The methods employed in the global burden of disease studies carried out by the World Health Organization (2000) and the Institute for Heath Metrics and Evaluation ( Murray et al. 2012–13 ) are somewhat different, but the differences are not material to the issues in this chapter.

One might resist this claim by arguing that fitness permits one to compare health states. But comparisons of fitness are not comparisons of health, if for no other reason than the much greater importance of reproduction to fitness than to health.

In addition there are systematic differences in the way individuals value health states, with those with experience of disabilities such as deafness judging them to be far less bad than those without those disabilities. So at least one of these groups has to be mistaken in their valuations. There is no good reason to believe that the values gleaned from preference surveys are correct.

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English that goes straight to the heart

Importance of Health Essay

An essay is a piece of writing that revolves around a particular theme and contains the academic opinions of the person writing it. A basic essay mainly consists of three parts: Introduction, Body, and Conclusion.

Wealth matters but is not as important as health. Good health helps an individual to keep a positive attitude toward work and life in general. After going through this post, you will be able to understand the Importance of Health.

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Importance of Health Essay (1000+ Words)

Due to his highly developed brain, man has been able to control nature, which is his superiority over other creatures. However, it is crucial for man to maintain the health and fitness of both his mind and body, as a healthy man is considered wealthy. Regular exercise not only helps in physical fitness but also keeps the mind alert. A sound and healthy well-being ensure an active and agile mind. Conversely, a weak and unfit body negatively affects an individual’s psychological well-being, as an individual’s state of mind and emotions are reflected in their health.

Recent studies have indicated that the increased stress of a fast-paced life can lead to various medical conditions, mainly heart and neurological problems. Good health helps an individual maintain a positive attitude towards work and life in general.

Despite the obstacles and difficulties we encounter in life, it is meant to be positive and enjoyable. To relish and cherish the wonderful things in life, we need the energy and enthusiasm for life, which can only happen when the body is healthy enough to face life’s challenges.

Caring for good health begins right from childhood and depends on various factors such as the mother’s health during pregnancy, a balanced diet containing necessary nutrients, and the hygienic surroundings in which the baby and mother reside. These are the fundamental necessities for a feeding mother and baby. Some children suffer from severe illnesses like polio, diphtheria, typhoid, etc. Preventive care is of utmost importance to maintain children’s health.

Parents have a great desire for their children to be healthy, intelligent, and bright. They hold a special place in their hearts for their children and wish for their physical and mental well-being. While parents have the primary responsibility of child care, others in the community share the responsibility for ensuring that children are healthy, as they represent the future of the country and the hope of all.

It is often said that the child is the father of the man, meaning that a healthy child grows into a healthy adult. A person’s development in childhood lays the foundation for their future abilities and potential contributions to society. It is, therefore, beneficial for others to lend their services to help children maintain good health. Educators, neighbors, friends, athletes, physical and mental trainers, media, social workers, doctors, and gymnasts can all play a significant role in inspiring children to prioritize their health.

In addition to the responsibility of parents and community members, schools also play a role in a child’s physical and mental development. While good health has always been important, it is even more crucial in today’s fast-paced and competitive world, where modern requirements demand optimal physical and mental health.

As educational expectations and competitions increase, students are required to spend long hours in the classroom studying. Therefore, it is essential for educational institutions to prioritize physical exercise and recreational activities to promote good health and enhance academic performance.

The presence of ideal sports facilities and recreational programs in a school or educational institution helps to ensure a positive experience for students. Engaging in outdoor activities serves as a mental break from academic work and boosts mental resilience.

A strong academic record and good health are fundamental to achieving one’s goals in life, regardless of the career path chosen. Good health and education instill confidence and enable individuals to overcome challenges, leading to progress and success.

Both physical and mental health are equally crucial for optimal performance and results in any profession. It is crucial for individuals to prioritize their health to become successful and productive individuals.

Through the virtue of good health, even an untalented person can manage his job. Those who have good physical condition can be seen working on farms all day, putting in their energy to earn their bread and support their families. This brings them mental satisfaction and a night of peaceful sleep at night. Moreover, physically fit and mentally sharp people can provide better support to society and earn appreciation from people.

Several professions demand good health as a primary eligibility requirement. Armed forces, paramilitary, police, and similar forces require individuals who are physically strong and mentally fit. We have seen many personnel in these forces decorated with awards for their exceptional performance and heroism while fighting against enemies or showing courage in extremely adverse conditions.

A healthy person has various job options available to them. Even in the private sector, where professional skill is the primary criterion, a physically fit person with a robust appearance is highly sought after. Health holds immense importance everywhere and proves to be beneficial throughout a person’s life.

A person’s negative thoughts and malignancy reflect on their face, while positive thoughts emanating from a healthy mind bring radiance to the face. Since the mind and body are closely interconnected, they constantly influence each other. If not controlled, they can trigger a cycle of reactions.

Improving good health is important as it holds immense value. There are many areas where people are in dire need of healthcare centers as hospitals in several rural areas are operating without doctors and medicines. The lack of proper medical facilities is leading to a scenario where people with multiple diseases or injuries are not receiving the treatment they require. Those who are financially disadvantaged cannot afford the treatment available in big cities or private hospitals.

Merely having medical facilities available will not solve the issue. It is necessary to raise awareness among people regarding regular physical exercise to promote sound health and efficiency at work. People who prioritize their health join Gymnasiums and Yoga camps, and their example inspires others to follow suit, making them disease-free and leading them toward robust health.

By freeing the mind of negative thoughts like self-indulgence, a person can develop the will to improve his body, leading to a healthier lifestyle. This, in turn, frees him from most illnesses of psychological origin, leading to a superior state of mind as he continues to work towards good health.

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Benefit-cost analysis: valuing life and health, related articles, the importance of getting the message right in your risk communication strategy, how to value a life.

by Lisa D. Ellis

The “value of a life” sounds like an existential question, more suited for philosophers and ethicists than economists. Yet we make economic decisions almost every day that reflect the value we each place on reducing our own risk of dying. We might pay more for safer food, for a house in a safer neighborhood, or for a car with added safety features. We might buy protective sports equipment, hand sanitizer, or face masks. The examples are almost endless, according to Lisa Robinson , senior research scientist and deputy director of the   Center for Health Decision Science   at the Harvard T.H. Chan School of Public Health. Robinson also directs the Harvard Chan School’s online professional development program, Benefit-Cost Analysis: Valuing Life and Health . That program aids those who conduct these analyses and those who use the results in understanding these methods and their implications.   

In benefit-cost analysis, the “value of a life” – or more precisely, the “value per statistical life” (VSL) – refers to these day-to-day tradeoffs, although the language is confusing, Robinson explains. Economists use surveys and other data to estimate the monetary value we each place on small changes in our own risks, then aggregate the results to estimate the expected value of averting future deaths. They use a similar approach to estimate the value of averting nonfatal illnesses and injuries. By doing so, they are able to directly compare the monetary value of these and other benefits against the costs of alternative interventions and policies.  

Policymakers and other stakeholders find these comparisons crucial for evidence-based decision-making, as illustrated by the requirements of many government agencies and other organizations. Benefit-cost analysis is often used to evaluate approaches for reducing environmental, transportation, occupational, nutritional, behavioral, and other risks, including climate change. It is applied to interventions that may be financed directly by government programs or other organizations, or that may be funded by imposing costs on industry, households, and other entities through regulations or through taxes and subsidies aimed at changing behavior, Robinson adds.  

Why Benefit-Cost Analysis?  

Robinson points out that benefit-cost analysis is often used to aid in determining how to best allocate scarce resources – labor, materials, and other things that money can buy – in order to achieve the greatest improvements in health and longevity, as well as welfare more generally. Perhaps most importantly, conducting benefit-cost analysis ensures that the impacts of alternative policies are rigorously investigated. Such exploration is essential to avoid unintended or unexpected consequences.  

“A benefit-cost analysis is a way of determining what the impact of a policy would be before it’s enacted,” she says. “It forces us to look more closely at the policy in a systematic way and to ask questions that no one might otherwise think to ask.” We may find information that reveals that the policy won’t be effective, or that it will have far more beneficial effects than anticipated.  

The Role of the Value per Statistical Life  

When it comes to valuing reduced mortality, Robinson says using value per statistical life (VSL) estimates is most appropriate methodology. “Before implementing a new policy, we don’t know whose life that policy might be saved,” she says. “What we do know is that the policy will reduce the risk of dying among those affected.”  For example, reducing air pollution in a large metropolitan area will decrease the mortality risks faced by that population. Requiring back-up cameras in cars will reduce the risks of death among those in their proximity.  

Usually, the risk changes associated with these policies are very small on an individual level, around 1 in 10,000 or 1 in 100,000, but the number of deaths averted can be quite large when the policy affects a sizable population. For example, a policy that reduces the annual risk of death by 1 in 10,000 among the 4 million residents of Los Angeles would avert 400 deaths per year.  

In the U.S., research on individuals’ willingness to exchange their own money for a change in the risk they would experience suggests that on average a U.S. resident is willing to pay about $1,200 for a 1 in 10,000 reduction in their own risk – or $12,000,000 when converted to a VSL estimate.  So preventing those 400 deaths annually would be valued at $4.8 billion in any given year, suggesting that it may be worth investing a substantial amount to achieve these benefits.   

Putting VSL in Proper Context  

Despite the importance of these estimates, Robinson points out that this concept is often misunderstood. Many incorrectly believe VSL refers to the value of saving an individual’s life—how much their life is deemed to be truly worth in a moral or ethical sense. But in fact it is derived from how much that individual is likely to pay to reduce their own risk of dying by a small amount. Not surprisingly, this willingness to pay likely varies depending on the characteristics of the individual, such as their age and income, as well as the characteristics of the risk, such as whether it is caused by something outside of their own control or whether it involves significant pain and suffering prior to death. Estimating the effects of these factors can be difficult. Nonetheless, Robinson says that getting as close as possible to the appropriate value is essential for informed decisions.  

Weighing the Costs and Benefits  

This brings Robinson to an example. “Let’s say a government agency is thinking about a new requirement that will cost $400 million per year, and is expected to reduce annual deaths by 200. With a VSL of $12 million, the costs are clearly exceeded by the benefits. But if the costs were instead $4 billion, the policy would no longer be cost-beneficial. By understanding this early in the process, policymakers can consider whether alternative policies are worth pursuing, given the likelihood that the benefits will exceed the costs.  

“Remember, if we spend money for one thing, we can’t spend that money on something else,” she says. Therefore, it’s essential that we invest limited resources wisely, weighing the costs and benefits to identify the policies that lead to the greatest improvement in wellbeing.

Harvard T.H. Chan School of Public Health offers Benefit-Cost Analysis: Valuing Life and Health , an online program that teaches the advantages and limitations of this method, and improves your ability to evaluate the results.

Sources:   

Robinson, Lisa A. Deputy Director, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Zoom interview April 2024 and follow-up May 2024.  

Rising global temperatures are threatening our health—but there are reasons to be hopeful   News. (2023, May 17). http://www.hsph.harvard.edu/news/?p=111354859339    

Essay on Health Awareness

Students are often asked to write an essay on Health Awareness in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Health Awareness

Understanding health awareness.

Health awareness is about knowing and understanding health issues. It’s like learning about different diseases, their causes, and how to avoid them. Health awareness helps us make better choices for a healthier life.

Importance of Health Awareness

Health awareness is important because it can save lives. It helps us know what’s good and bad for our health. With this knowledge, we can avoid harmful habits like smoking and eating junk food, and adopt healthy habits like exercising and eating balanced meals.

Health Awareness and Disease Prevention

Health awareness helps in preventing diseases. It tells us about vaccines and regular check-ups that help catch diseases early. Also, it teaches us about hygiene practices like washing hands to prevent disease spread.

Role of Schools in Health Awareness

Schools play a big role in health awareness. They teach students about nutrition, physical education, and hygiene. Schools also organize health camps and invite doctors to talk about different health topics.

Health awareness is a key to a healthy life. It helps us make wise choices, prevent diseases, and lead a happy, healthy life. So, let’s all be aware and spread health awareness for a healthier community.

Also check:

• Speech on Health Awareness

250 Words Essay on Health Awareness

What is health awareness.

Health awareness is about knowing and understanding health issues. It helps us make the right choices for our health. It is about learning how to stay fit, eat right, and take care of our bodies.

Why is Health Awareness Important?

Being aware of health is important for many reasons. It helps us live longer and better lives. When we know about health issues, we can prevent them. For example, knowing that smoking is bad for our lungs can stop us from starting to smoke.

How Can We Improve Health Awareness?

There are many ways to improve health awareness. We can read books, watch videos, or talk to doctors. Schools can also help by teaching students about health. Parents can set a good example by eating healthy food and exercising regularly.

Role of Media in Health Awareness

Media plays a big role in health awareness. TV shows, news, and social media can spread information about health. They can tell us about new research or health risks. But, we must be careful to check if the information is correct. Not all information on the internet is true.

In conclusion, health awareness is very important. It helps us make good choices for our health. We can improve health awareness by learning and sharing information. Let’s all try to be more aware of our health.

500 Words Essay on Health Awareness

Health awareness is knowing about the state of your body, how to keep it healthy, and what can harm it. It is like a guide to help you live a healthy life. It tells you about good habits like eating right, exercising, and getting enough sleep. It also warns you about bad things like smoking, drinking too much alcohol, or not getting enough exercise.

Health awareness is very important for everyone. It helps you stay healthy and avoid diseases. If you are aware of your health, you can take steps to prevent illness. For example, if you know that eating too much sugar can lead to diabetes, you can choose to eat less sugar. This can help you avoid getting diabetes in the future.

Health awareness also helps you know what to do if you get sick. If you are aware of the symptoms of a disease, you can recognize them early and get treatment. This can help you recover faster and prevent the disease from getting worse.

Ways to Increase Health Awareness

There are many ways to increase health awareness. One way is to learn about health from reliable sources. You can read books, watch videos, or talk to health professionals like doctors and nurses. You can also learn about health in school or at health awareness events.

Another way to increase health awareness is to practice healthy habits. This means eating a balanced diet, exercising regularly, getting enough sleep, and avoiding harmful substances like tobacco and alcohol. By doing these things, you can improve your health and learn more about how your body works.

Schools play a big role in health awareness. They teach students about health in science and physical education classes. They also provide healthy meals and opportunities for physical activity. Some schools even have health clinics where students can get check-ups and treatment.

Schools also organize health awareness events. These events can include health fairs, where students can learn about different health topics and get free health screenings. They can also include campaigns to promote healthy habits, like eating fruits and vegetables or walking to school.

In conclusion, health awareness is very important. It helps us stay healthy and avoid diseases. We can increase our health awareness by learning about health and practicing healthy habits. Schools play a big role in health awareness by teaching students about health and organizing health awareness events. By being aware of our health, we can live healthier, happier lives.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

• Essay on Health Promotion On Diabetes
• Essay on Health Promotion On Alcohol
• Essay on Healthcare Affordability

Apart from these, you can look at all the essays by clicking here .

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Importance Of Good Health (Essay Sample)

The importance of good health.

Good health is crucial to everything we do in our everyday lives. The importance of good health can be clearly seen in how we function as human beings in the daily tasks that define our functionality in the society. Without good health, we are not able to reach our individual potentials and this can hinder us from achieving our personal goals in the social environment that we exist in.

True enough, defining good health moves beyond the physical sense; it also includes emotional and mental. Good health means the different aspects of well-being which are mold together. For one individual to function properly, he or she should be physically fit, as well as emotionally and mentally. Having one missing aspect in an individual’s health can have heavy implications for an individual.

In both home and work, health is also required in building social relationships. If we are unfit to build these connections, it can imply that we are depriving ourselves of social stimulation that can help in improving our outlook and disposition in everything we do. In most cases, it can be said that good health can be equated to an individual’s self-actualization. An individual who is actualized has a nurtured sense of disposition in the society which makes him or her energetic enough to be able to face different problems that may arise during the day.

At home, good health can be a collective concept for it is also crucial to the well-being of the good family. This means that healthy relationships are required in order for families to function as a single organ. Without health, relationships may fall apart and this can bring both short term and long term damages to how we perceive life.

In professional spaces, health is crucial in dealing with different workplace situations and conflicts. If one is unfit in any of the mentioned aspects above, this can heavily affect how an individual becomes productive in the workplace. Of course, good health can be equated to productivity in this context and without it, more conflicts may arise that may be very hard to deal with.

To achieve good health, we as individuals should know the proper steps in nurturing ourselves. We need to be able to take care of ourselves in order to also know how to take care of others around us. Knowing to take the right meals, eat healthy food, drink the proper amount of water and get the right hours of sleep are the basic things that we need to master. What comes after these are more self-conscious steps that can then nourish our mental health; this includes engaging in healthy discussions with other people as well as lively and productive conversations that nurture positivity instead of negativity. We must also know to surround ourselves with the right people so that we can continue living a live with less worry. Emotional health is also a crucial part in us, as individuals. This is heavily influenced by our social relationships as well as our perception of our own selves. The key in ensuring emotional health is to always gauge our feelings and knowing how to deal with it properly. If our own selves are not capable of ensuring all these, seeking our family, friends and even professionals for help is always an option. The worst thing that we can do is to deprive ourselves of good health. Good health is not a myth; it is something that we can rally achieve as long as we put our minds in it and as long as we remember how to properly value ourselves. All it takes is the right perception of our self-worth and some self-esteem.

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The Importance of Mental Health

It's not just a buzzword

Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities.

Westend61 / Getty Images

Risk Factors for Poor Mental Health

Signs of mental health problems, benefits of good mental health, how to maintain mental health and well-being.

Your mental health is an important part of your well-being. This aspect of your welfare determines how you’re able to operate psychologically, emotionally, and socially among others.

Considering how much of a role your mental health plays in each aspect of your life, it's important to guard and improve psychological wellness using appropriate measures.

Because different circumstances can affect your mental health, we’ll be highlighting risk factors and signs that may indicate mental distress. But most importantly, we’ll dive into why mental health is so important.

Mental health is described as a state of well-being where a person is able to cope with the normal stresses of life. This state permits productive work output and allows for meaningful contributions to society.

However, different circumstances exist that may affect the ability to handle life’s curveballs. These factors may also disrupt daily activities, and the capacity to manage these changes. That's only one reason why mental health is so important.

The following factors, listed below, may affect mental well-being and could increase the risk of developing psychological disorders .

Childhood Abuse

Childhood physical assault, sexual violence, emotional abuse, or neglect can lead to severe mental and emotional distress. Abuse increases the risk of developing mental disorders like depression, anxiety, post-traumatic stress disorder, or personality disorders.

Children who have been abused may eventually deal with alcohol and substance use issues. But beyond mental health challenges, child abuse may also lead to medical complications such as diabetes, stroke, and other forms of heart disease.

The Environment

A strong contributor to mental well-being is the state of a person’s usual environment . Adverse environmental circumstances can cause negative effects on psychological wellness.

For instance, weather conditions may influence an increase in suicide cases. Likewise, experiencing natural disasters firsthand can increase the chances of developing PTSD. In certain cases, air pollution may produce negative effects on depression symptoms.  

In contrast, living in a positive social environment can provide protection against mental challenges.

Your biological makeup could determine the state of your well-being. A number of mental health disorders have been found to run in families and may be passed down to members.

These include conditions such as autism , attention deficit hyperactivity disorder , bipolar disorder , depression , and schizophrenia .

Your lifestyle can also impact your mental health. Smoking, a poor diet , alcohol consumption , substance use , and risky sexual behavior may cause psychological harm. These behaviors have been linked to depression.

When mental health is compromised, it isn’t always apparent to the individual or those around them. However, there are certain warning signs to look out for, that may signify negative changes for the well-being. These include:

• A switch in eating habits, whether over or undereating
• A noticeable reduction in energy levels
• Being more reclusive and shying away from others
• Feeling persistent despair
• Indulging in alcohol, tobacco, or other substances more than usual
• Experiencing unexplained confusion, anger, guilt, or worry
• Severe mood swings
• Picking fights with family and friends
• Hearing voices with no identifiable source
• Thinking of self-harm or causing harm to others
• Being unable to perform daily tasks with ease

Whether young or old, the importance of mental health for total well-being cannot be overstated. When psychological wellness is affected, it can cause negative behaviors that may not only affect personal health but can also compromise relationships with others. 

Below are some of the benefits of good mental health.

A Stronger Ability to Cope With Life’s Stressors

When mental and emotional states are at peak levels, the challenges of life can be easier to overcome.

Where alcohol/drugs, isolation, tantrums, or fighting may have been adopted to manage relationship disputes, financial woes, work challenges, and other life issues—a stable mental state can encourage healthier coping mechanisms.

A Positive Self-Image

Mental health greatly correlates with personal feelings about oneself. Overall mental wellness plays a part in your self-esteem . Confidence can often be a good indicator of a healthy mental state.

A person whose mental health is flourishing is more likely to focus on the good in themselves. They will hone in on these qualities, and will generally have ambitions that strive for a healthy, happy life.

Healthier Relationships

If your mental health is in good standing, you might be more capable of providing your friends and family with quality time , affection , and support. When you're not in emotional distress, it can be easier to show up and support the people you care about.

Better Productivity

Dealing with depression or other mental health disorders can impact your productivity levels. If you feel mentally strong , it's more likely that you will be able to work more efficiently and provide higher quality work.

Higher Quality of Life

When mental well-being thrives, your quality of life may improve. This can give room for greater participation in community building. For example, you may begin volunteering in soup kitchens, at food drives, shelters, etc.

You might also pick up new hobbies , and make new acquaintances , and travel to new cities.

Because mental health is so important to general wellness, it’s important that you take care of your mental health.

To keep mental health in shape, a few introductions to and changes to lifestyle practices may be required. These include:

• Taking up regular exercise
• Prioritizing rest and sleep on a daily basis
• Trying meditation
• Learning coping skills for life challenges
• Keeping in touch with loved ones
• Maintaining a positive outlook on life

Another proven way to improve and maintain mental well-being is through the guidance of a professional. Talk therapy can teach you healthier ways to interact with others and coping mechanisms to try during difficult times.

Therapy can also help you address some of your own negative behaviors and provide you with the tools to make some changes in your own life.

The Bottom Line

So why is mental health so important? That's an easy answer: It profoundly affects every area of your life. If you're finding it difficult to address mental health concerns on your own, don't hesitate to seek help from a licensed therapist .

World Health Organization. Mental Health: Strengthening our Response .

Lippard ETC, Nemeroff CB. The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders . Am J Psychiatry . 2020;177(1):20-36. doi:10.1176/appi.ajp.2019.19010020

 Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

National Institutes of Health. Common Genetic Factors Found in 5 Mental Disorders .

Zaman R, Hankir A, Jemni M. Lifestyle Factors and Mental Health . Psychiatr Danub . 2019;31(Suppl 3):217-220.

Medline Plus. What Is mental health? .

National Alliance on Mental Health. Why Self-Esteem Is Important for Mental Health .

By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

English Compositions

Short Essay on Health [100, 200, 400 Words] With PDF

In today’s lesson, I will discuss how you can write short essays on Health within different word limits. All the essays will be written here with a simplistic approach for a better understanding of all students. 

Short Essay on Health in 100 Words

Health is an important aspect of one’s life. A person is considered healthy when he or she is free from illness or injury. Health can be categorised as physical health, mental health, emotional health, social health, et cetera. However, all these categories are interrelated.

While low physical activity can impact overall mental health, mental stress can adversely affect heart health and poor emotional health can deteriorate one’s quality of life. Being in good health enables a person to function optimally and live their life happily.

Some of the basic rules for maintaining good health include going to bed and waking up on time, exercising regularly, eating healthily and drinking at least eight glasses of water daily. 

Short Essay on Health in 200 Words

Health is one of the most important aspects of one’s life. One can be a billionaire but if he is not in good health, he can not enjoy the luxuries that money can buy. Thus, health is considered as the real wealth. Health can be categorised as physical health, mental health, emotional health, social health, et cetera.

However, all these categories are interrelated and impact each other. For example, not exercising regularly can make a person irritable and cause mental health problems, while chronic stress can lead to health diseases and diabetes. Poor emotional and psychological health can also make people withdrawn and impact their overall health. 

Being in good health enables a person to function optimally and live their life happily. When one feels healthy and is not troubled by pain or discomfort in the body, he can be more active, participate in various activities and be more present in the daily happenings. Being mentally in good health is also very important as suffering from anxiety, depression and other issues can severely deteriorate one’s quality of life.

One can easily improve his health by making some changes in his lifestyle. Some of the basic rules for maintaining good health include going to bed and waking up on time, exercising regularly, eating healthily and drinking a lot of water. 

Short Essay on Health in 400 Words

Health is a key aspect of one’s life. A person is considered healthy when he is free from all illness and injury and can conduct his life well. One can be a billionaire but if he is not in good health, he can not enjoy the luxuries that money can buy. Thus, health is considered as the real wealth and being in good health is very important. Health can be categorised as physical health, mental health, emotional health, social health, et cetera.

Everyone can be healthy but good health does not come without the necessary discipline and care. Going to bed and waking up on time, exercising regularly, avoiding junk food, eating healthily, drinking a lot of water and getting some sunlight are a few good habits that can improve one’s health. However, it cannot be achieved in a day. One needs to change their lifestyle and practice healthy habits daily. 

Sometimes, one’s external environment can also be the reason for their poor health. Living in shabby conditions, breathing in heavily polluted air, consuming unhygienic food and contaminated water can more often than not, result in bacterial, fungal and viral diseases. Hence, cleanliness is an important factor if one wants to be healthy. One should also take care of their diet and include greens and other nutritious food, limit their caffeine intake, stop smoking and drinking as well as follow the basic health protocols. 

Good health is necessary if one wants to achieve their goal in life. One cannot study well or work hard when they are not feeling at ease or are suffering from pain. Adopting a healthy lifestyle makes us healthy and boosts our energy as well as immunity. Thus, good health is the key to enjoying a good life. 

In this session above, I have mentioned everything that could be necessary to write short essays on Health. Through the simple words and sentences, I hope now you have understood the entire context. If you still have any doubts regarding this session, kindly let me know through some quick comments. If you want to read more such essays on various important topics, keep browsing our website. 

Join our Telegram channel to get the latest updates on our upcoming sessions. Thank you. 

Essay on Importance of Health – Tips for Healthy Lifestyle

Essay on Importance of Health – Health is defined as a state of complete mental and physical well-being. It may also be defined as the ability to adjust physical, mental, and social challenges throughout our life.

As Health and Wellness is a very wide topic and we are not able, to sum up, everything in one article, so, we are trying to give you an idea on  Importance of Health in our day to day life as a student point of view.

Table of Contents

100 Words Essay on Importance of Health

Maintaining good health is one of the best practices as it gives us a feeling of complete physical, mental and social well-being. Living a healthy lifestyle can prevent long-term illnesses like such as Asthma, Diabetes, heart diseases, and many more.

It provides us freedom from almost all diseases.  It is very necessary for all of us to maintain a healthy lifestyle in order to be fit and fearless of diseases. We must eat healthy food and do regular physical exercises to stay fit always. Being healthy brings happiness to our lives and helps us to live a stress-free and disease-free life.

200 Words Essay on Importance of Health

According to the World Health Organisation, better health is the reason behind human happiness and well-being. It also contributes to the economic progress of the world as healthy populations are more productive and live longer.

There are so many different factors that influence the health status of a person. Some of them are discussed below.

Regular physical exercise and a balanced diet is the only way to stay fit & healthy. It reduces the risk of Heart Attack and Type 2 Diabetes. Moreover, to have strong bones and muscles, physical activity is a must-needed thing.

We must maintain a healthy weight in order to stay fit. By doing this, we can reduce the risk of stroke, heart disease, and anemia among many others. It also helps us in controlling non-insulin-dependent diabetes and increasing our energy levels along with optimizing our immune system.

We must get enough sleep in order to stay healthy and fit. Most of us need daily 7 to 8 hours of sound sleep to keep our health and minds healthy. It has a strong effect on our ability to think and work in our lives. Getting sufficient time of quality sleep at the right times helps us to protect our both physical and mental health.

Wildlife Conservation Essay

Long Essay on Importance of Health

Joyce Meyer said, “I believe that the greatest gift you can give to your family and the world is a healthy you”.

If a person stays healthy physically, he will stay healthy mentally too. Physical and mental health is linked fundamentally. If we are able to keep our bodies fit and healthy by taking the right food and doing physical activities regularly, our bodies will definitely help us to deal with daily stress.

Our body cells are made up of a variety of chemical substances and they move from place to place. Moreover, there are lots of other activities are happening in our body, for which, our body needs lots of energy and raw material. For the well-functioning of our cells and tissues, food is necessary.

For living a healthy lifestyle, good nutrition is one of the best things we should make habit of. If we combine good nutrition with regular physical activities, we are able to maintain a healthy weight which may reduce our risk of chronic diseases like heart disease and cancer. Below are some of the possible ways to do things right to have good health.

Eating and drinking the right things – Eating and drinking the right things can make our health better. Though it is not an easy task to keep a healthy diet in this world of Junk Food, we must maintain a balance in our diet of each food group.

Our balanced diet must include carbohydrates, protein from non-dairy sources, fruit, vegetables, etc. A balanced diet includes the right drinks also as our body needs to stay hydrated to keep ourselves healthy. We must avoid caffeine and sugary drinks as they can cause mood swings and affect our energy levels.

Along with good eating & drinking habits, physical activity & exercise can improve our health and reduce the risk of several diseases like Type 2 diabetes and cardiovascular disease, etc.  Regular physical activity can boost our endurance and improve our muscle strength. It also stimulates our health and increases our feelings of happiness and calm.

Final Words – In this “Essay on Importance of Health”, we tried to cover the things like, what are the importance of Health in our life, how to maintain a healthy lifestyle, etc.

Though it is a very general topic, and covering each and everything related to Health and Fitness is next to impossible in a single article, we tried our best to cover as much as we can from a student’s point of view.

Essay on Wildlife Conservation: From 50 Words to Long Essay

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• Open access
• Published: 15 May 2024

Learning together for better health using an evidence-based Learning Health System framework: a case study in stroke

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BMC Medicine volume  22 , Article number:  198 ( 2024 ) Cite this article

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In the context of expanding digital health tools, the health system is ready for Learning Health System (LHS) models. These models, with proper governance and stakeholder engagement, enable the integration of digital infrastructure to provide feedback to all relevant parties including clinicians and consumers on performance against best practice standards, as well as fostering innovation and aligning healthcare with patient needs. The LHS literature primarily includes opinion or consensus-based frameworks and lacks validation or evidence of benefit. Our aim was to outline a rigorously codesigned, evidence-based LHS framework and present a national case study of an LHS-aligned national stroke program that has delivered clinical benefit.

Current core components of a LHS involve capturing evidence from communities and stakeholders (quadrant 1), integrating evidence from research findings (quadrant 2), leveraging evidence from data and practice (quadrant 3), and generating evidence from implementation (quadrant 4) for iterative system-level improvement. The Australian Stroke program was selected as the case study as it provides an exemplar of how an iterative LHS works in practice at a national level encompassing and integrating evidence from all four LHS quadrants. Using this case study, we demonstrate how to apply evidence-based processes to healthcare improvement and embed real-world research for optimising healthcare improvement. We emphasize the transition from research as an endpoint, to research as an enabler and a solution for impact in healthcare improvement.

Conclusions

The Australian Stroke program has nationally improved stroke care since 2007, showcasing the value of integrated LHS-aligned approaches for tangible impact on outcomes. This LHS case study is a practical example for other health conditions and settings to follow suit.

Peer Review reports

Internationally, health systems are facing a crisis, driven by an ageing population, increasing complexity, multi-morbidity, rapidly advancing health technology and rising costs that threaten sustainability and mandate transformation and improvement [ 1 , 2 ]. Although research has generated solutions to healthcare challenges, and the advent of big data and digital health holds great promise, entrenched siloes and poor integration of knowledge generation, knowledge implementation and healthcare delivery between stakeholders, curtails momentum towards, and consistent attainment of, evidence-and value-based care [ 3 ]. This is compounded by the short supply of research and innovation leadership within the healthcare sector, and poorly integrated and often inaccessible health data systems, which have crippled the potential to deliver on digital-driven innovation [ 4 ]. Current approaches to healthcare improvement are also often isolated with limited sustainability, scale-up and impact [ 5 ].

Evidence suggests that integration and partnership across academic and healthcare delivery stakeholders are key to progress, including those with lived experience and their families (referred to here as consumers and community), diverse disciplines (both research and clinical), policy makers and funders. Utilization of evidence from research and evidence from practice including data from routine care, supported by implementation research, are key to sustainably embedding improvement and optimising health care and outcomes. A strategy to achieve this integration is through the Learning Health System (LHS) (Fig.  1 ) [ 2 , 6 , 7 , 8 ]. Although there are numerous publications on LHS approaches [ 9 , 10 , 11 , 12 ], many focus on research perspectives and data, most do not demonstrate tangible healthcare improvement or better health outcomes. [ 6 ]

Monash Learning Health System: The Learn Together for Better Health Framework developed by Monash Partners and Monash University (from Enticott et al. 2021 [ 7 ]). Four evidence quadrants: Q1 (orange) is evidence from stakeholders; Q2 (green) is evidence from research; Q3 (light blue) is evidence from data; and, Q4 (dark blue) is evidence from implementation and healthcare improvement

In developed nations, it has been estimated that 60% of care provided aligns with the evidence base, 30% is low value and 10% is potentially harmful [ 13 ]. In some areas, clinical advances have been rapid and research and evidence have paved the way for dramatic improvement in outcomes, mandating rapid implementation of evidence into healthcare (e.g. polio and COVID-19 vaccines). However, healthcare improvement is challenging and slow [ 5 ]. Health systems are highly complex in their design, networks and interacting components, and change is difficult to enact, sustain and scale up. [ 3 ] New effective strategies are needed to meet community needs and deliver evidence-based and value-based care, which reorients care from serving the provider, services and system, towards serving community needs, based on evidence and quality. It goes beyond cost to encompass patient and provider experience, quality care and outcomes, efficiency and sustainability [ 2 , 6 ].

The costs of stroke care are expected to rise rapidly in the next decades, unless improvements in stroke care to reduce the disabling effects of strokes can be successfully developed and implemented [ 14 ]. Here, we briefly describe the Monash LHS framework (Fig.  1 ) [ 2 , 6 , 7 ] and outline an exemplar case in order to demonstrate how to apply evidence-based processes to healthcare improvement and embed real-world research for optimising healthcare. The Australian LHS exemplar in stroke care has driven nationwide improvement in stroke care since 2007.

An evidence-based Learning Health System framework

In Australia, members of this author group (HT, AJ, JE) have rigorously co-developed an evidence-based LHS framework, known simply as the Monash LHS [ 7 ]. The Monash LHS was designed to support sustainable, iterative and continuous robust benefit of improved clinical outcomes. It was created with national engagement in order to be applicable to Australian settings. Through this rigorous approach, core LHS principles and components have been established (Fig.  1 ). Evidence shows that people/workforce, culture, standards, governance and resources were all key to an effective LHS [ 2 , 6 ]. Culture is vital including trust, transparency, partnership and co-design. Key processes include legally compliant data sharing, linkage and governance, resources, and infrastructure [ 4 ]. The Monash LHS integrates disparate and often siloed stakeholders, infrastructure and expertise to ‘Learn Together for Better Health’ [ 7 ] (Fig.  1 ). This integrates (i) evidence from community and stakeholders including priority areas and outcomes; (ii) evidence from research and guidelines; (iii) evidence from practice (from data) with advanced analytics and benchmarking; and (iv) evidence from implementation science and health economics. Importantly, it starts with the problem and priorities of key stakeholders including the community, health professionals and services and creates an iterative learning system to address these. The following case study was chosen as it is an exemplar of how a Monash LHS-aligned national stroke program has delivered clinical benefit.

Australian Stroke Learning Health System

Internationally, the application of LHS approaches in stroke has resulted in improved stroke care and outcomes [ 12 ]. For example, in Canada a sustained decrease in 30-day in-hospital mortality has been found commensurate with an increase in resources to establish the multifactorial stroke system intervention for stroke treatment and prevention [ 15 ]. Arguably, with rapid advances in evidence and in the context of an ageing population with high cost and care burden and substantive impacts on quality of life, stroke is an area with a need for rapid research translation into evidence-based and value-based healthcare improvement. However, a recent systematic review found that the existing literature had few comprehensive examples of LHS adoption [ 12 ]. Although healthcare improvement systems and approaches were described, less is known about patient-clinician and stakeholder engagement, governance and culture, or embedding of data informatics into everyday practice to inform and drive improvement [ 12 ]. For example, in a recent review of quality improvement collaborations, it was found that although clinical processes in stroke care are improved, their short-term nature means there is uncertainty about sustainability and impacts on patient outcomes [ 16 ]. Table  1 provides the main features of the Australian Stroke LHS based on the four core domains and eight elements of the Learning Together for Better Health Framework described in Fig.  1 . The features are further expanded on in the following sections.

Evidence from stakeholders (LHS quadrant 1, Fig.  1 )

Engagement, partners and priorities.

Within the stroke field, there have been various support mechanisms to facilitate an LHS approach including partnership and broad stakeholder engagement that includes clinical networks and policy makers from different jurisdictions. Since 2008, the Australian Stroke Coalition has been co-led by the Stroke Foundation, a charitable consumer advocacy organisation, and Stroke Society of Australasia a professional society with membership covering academics and multidisciplinary clinician networks, that are collectively working to improve stroke care ( https://australianstrokecoalition.org.au/ ). Surveys, focus groups and workshops have been used for identifying priorities from stakeholders. Recent agreed priorities have been to improve stroke care and strengthen the voice for stroke care at a national ( https://strokefoundation.org.au/ ) and international level ( https://www.world-stroke.org/news-and-blog/news/world-stroke-organization-tackle-gaps-in-access-to-quality-stroke-care ), as well as reduce duplication amongst stakeholders. This activity is built on a foundation and culture of research and innovation embedded within the stroke ‘community of practice’. Consumers, as people with lived experience of stroke are important members of the Australian Stroke Coalition, as well as representatives from different clinical colleges. Consumers also provide critical input to a range of LHS activities via the Stroke Foundation Consumer Council, Stroke Living Guidelines committees, and the Australian Stroke Clinical Registry (AuSCR) Steering Committee (described below).

Evidence from research (LHS quadrant 2, Fig.  1 )

Advancement of the evidence for stroke interventions and synthesis into clinical guidelines.

To implement best practice, it is crucial to distil the large volume of scientific and trial literature into actionable recommendations for clinicians to use in practice [ 24 ]. The first Australian clinical guidelines for acute stroke were produced in 2003 following the increasing evidence emerging for prevention interventions (e.g. carotid endarterectomy, blood pressure lowering), acute medical treatments (intravenous thrombolysis, aspirin within 48 h of ischemic stroke), and optimised hospital management (care in dedicated stroke units by a specialised and coordinated multidisciplinary team) [ 25 ]. Importantly, a number of the innovations were developed, researched and proven effective by key opinion leaders embedded in the Australian stroke care community. In 2005, the clinical guidelines for Stroke Rehabilitation and Recovery [ 26 ] were produced, with subsequent merged guidelines periodically updated. However, the traditional process of periodic guideline updates is challenging for end users when new research can render recommendations redundant and this lack of currency erodes stakeholder trust [ 27 ]. In response to this challenge the Stroke Foundation and Cochrane Australia entered a pioneering project to produce the first electronic ‘living’ guidelines globally [ 20 ]. Major shifts in the evidence for reperfusion therapies (e.g. extended time-window intravenous thrombolysis and endovascular clot retrieval), among other advances, were able to be converted into new recommendations, approved by the Australian National Health and Medical Research Council within a few months of publication. Feedback on this process confirmed the increased use and trust in the guidelines by clinicians. The process informed other living guidelines programs, including the successful COVID-19 clinical guidelines [ 28 ].

However, best practice clinical guideline recommendations are necessary but insufficient for healthcare improvement and nesting these within an LHS with stakeholder partnership, enables implementation via a range of proven methods, including audit and feedback strategies [ 29 ].

Evidence from data and practice (LHS quadrant 3, Fig.  1 )

Data systems and benchmarking : revealing the disparities in care between health services. A national system for standardized stroke data collection was established as the National Stroke Audit program in 2007 by the Stroke Foundation [ 30 ] following various state-level programs (e.g. New South Wales Audit) [ 31 ] to identify evidence-practice gaps and prioritise improvement efforts to increase access to stroke units and other acute treatments [ 32 ]. The Audit program alternates each year between acute (commencing in 2007) and rehabilitation in-patient services (commencing in 2008). The Audit program provides a ‘deep dive’ on the majority of recommendations in the clinical guidelines whereby participating hospitals provide audits of up to 40 consecutive patient medical records and respond to a survey about organizational resources to manage stroke. In 2009, the AuSCR was established to provide information on patients managed in acute hospitals based on a small subset of quality processes of care linked to benchmarked reports of performance (Fig.  2 ) [ 33 ]. In this way, the continuous collection of high-priority processes of stroke care could be regularly collected and reviewed to guide improvement to care [ 34 ]. Plus clinical quality registry programs within Australia have shown a meaningful return on investment attributed to enhanced survival, improvements in quality of life and avoided costs of treatment or hospital stay [ 35 ].

Example performance report from the Australian Stroke Clinical Registry: average door-to-needle time in providing intravenous thrombolysis by different hospitals in 2021 [ 36 ]. Each bar in the figure represents a single hospital

The Australian Stroke Coalition endorsed the creation of an integrated technological solution for collecting data through a single portal for multiple programs in 2013. In 2015, the Stroke Foundation, AuSCR consortium, and other relevant groups cooperated to design an integrated data management platform (the Australian Stroke Data Tool) to reduce duplication of effort for hospital staff in the collection of overlapping variables in the same patients [ 19 ]. Importantly, a national data dictionary then provided the common data definitions to facilitate standardized data capture. Another important feature of AuSCR is the collection of patient-reported outcome surveys between 90 and 180 days after stroke, and annual linkage with national death records to ascertain survival status [ 33 ]. To support a LHS approach, hospitals that participate in AuSCR have access to a range of real-time performance reports. In efforts to minimize the burden of data collection in the AuSCR, interoperability approaches to import data directly from hospital or state-level managed stroke databases have been established (Fig.  3 ); however, the application has been variable and 41% of hospitals still manually enter all their data.

Current status of automated data importing solutions in the Australian Stroke Clinical Registry, 2022, with ‘ n ’ representing the number of hospitals. AuSCR, Australian Stroke Clinical Registry; AuSDaT, Australian Stroke Data Tool; API, Application Programming Interface; ICD, International Classification of Diseases; RedCAP, Research Electronic Data Capture; eMR, electronic medical records

For acute stroke care, the Australian Commission on Quality and Safety in Health Care facilitated the co-design (clinicians, academics, consumers) and publication of the national Acute Stroke Clinical Care Standard in 2015 [ 17 ], and subsequent review [ 18 ]. The indicator set for the Acute Stroke Standard then informed the expansion of the minimum dataset for AuSCR so that hospitals could routinely track their performance. The national Audit program enabled hospitals not involved in the AuSCR to assess their performance every two years against the Acute Stroke Standard. Complementing these efforts, the Stroke Foundation, working with the sector, developed the Acute and Rehabilitation Stroke Services Frameworks to outline the principles, essential elements, models of care and staffing recommendations for stroke services ( https://informme.org.au/guidelines/national-stroke-services-frameworks ). The Frameworks are intended to guide where stroke services should be developed, and monitor their uptake with the organizational survey component of the Audit program.

Evidence from implementation and healthcare improvement (LHS quadrant 4, Fig.  1 )

Research to better utilize and augment data from registries through linkage [ 37 , 38 , 39 , 40 ] and to ensure presentation of hospital or service level data are understood by clinicians has ensured advancement in the field for the Australian Stroke LHS [ 41 ]. Importantly, greater insights into whole patient journeys, before and after a stroke, can now enable exploration of value-based care. The LHS and stroke data platform have enabled focused and time-limited projects to create a better understanding of the quality of care in acute or rehabilitation settings [ 22 , 42 , 43 ]. Within stroke, all the elements of an LHS culminate into the ready availability of benchmarked performance data and support for implementation of strategies to address gaps in care.

Implementation research to grow the evidence base for effective improvement interventions has also been a key pillar in the Australian context. These include multi-component implementation interventions to achieve behaviour change for particular aspects of stroke care, [ 22 , 23 , 44 , 45 ] and real-world approaches to augmenting access to hyperacute interventions in stroke through the use of technology and telehealth [ 46 , 47 , 48 , 49 ]. The evidence from these studies feeds into the living guidelines program and the data collection systems, such as the Audit program or AuSCR, which are then amended to ensure data aligns to recommended care. For example, the use of ‘hyperacute aspirin within the first 48 h of ischemic stroke’ was modified to be ‘hyperacute antiplatelet…’ to incorporate new evidence that other medications or combinations are appropriate to use. Additionally, new datasets have been developed to align with evidence such as the Fever, Sugar, and Swallow variables [ 42 ]. Evidence on improvements in access to best practice care from the acute Audit program [ 50 ] and AuSCR is emerging [ 36 ]. For example, between 2007 and 2017, the odds of receiving intravenous thrombolysis after ischemic stroke increased by 16% 9OR 1.06 95% CI 1.13–1.18) and being managed in a stroke unit by 18% (OR 1.18 95% CI 1.17–1.20). Over this period, the median length of hospital stay for all patients decreased from 6.3 days in 2007 to 5.0 days in 2017 [ 51 ]. When considering the number of additional patients who would receive treatment in 2017 in comparison to 2007 it was estimated that without this additional treatment, over 17,000 healthy years of life would be lost in 2017 (17,786 disability-adjusted life years) [ 51 ]. There is evidence on the cost-effectiveness of different system-focussed strategies to augment treatment access for acute ischemic stroke (e.g. Victorian Stroke Telemedicine program [ 52 ] and Melbourne Mobile Stroke Unit ambulance [ 53 ]). Reciprocally, evidence from the national Rehabilitation Audit, where the LHS approach has been less complete or embedded, has shown fewer areas of healthcare improvement over time [ 51 , 54 ].

Within the field of stroke in Australia, there is indirect evidence that the collective efforts that align to establishing the components of a LHS have had an impact. Overall, the age-standardised rate of stroke events has reduced by 27% between 2001 and 2020, from 169 to 124 events per 100,000 population. Substantial declines in mortality rates have been reported since 1980. Commensurate with national clinical guidelines being updated in 2007 and the first National Stroke Audit being undertaken in 2007, the mortality rates for men (37.4 deaths per 100,000) and women (36.1 deaths per 100,0000 has declined to 23.8 and 23.9 per 100,000, respectively in 2021 [ 55 ].

Underpinning the LHS with the integration of the four quadrants of evidence from stakeholders, research and guidelines, practice and implementation, and core LHS principles have been addressed. Leadership and governance have been important, and programs have been established to augment workforce training and capacity building in best practice professional development. Medical practitioners are able to undertake courses and mentoring through the Australasian Stroke Academy ( http://www.strokeacademy.com.au/ ) while nurses (and other health professionals) can access teaching modules in stroke care from the Acute Stroke Nurses Education Network ( https://asnen.org/ ). The Association of Neurovascular Clinicians offers distance-accessible education and certification to develop stroke expertise for interdisciplinary professionals, including advanced stroke co-ordinator certification ( www.anvc.org ). Consumer initiative interventions are also used in the design of the AuSCR Public Summary Annual reports (available at https://auscr.com.au/about/annual-reports/ ) and consumer-related resources related to the Living Guidelines ( https://enableme.org.au/resources ).

The important success factors and lessons from stroke as a national exemplar LHS in Australia include leadership, culture, workforce and resources integrated with (1) established and broad partnerships across the academic-clinical sector divide and stakeholder engagement; (2) the living guidelines program; (3) national data infrastructure, including a national data dictionary that provides the common data framework to support standardized data capture; (4) various implementation strategies including benchmarking and feedback as well as engagement strategies targeting different levels of the health system; and (5) implementation and improvement research to advance stroke systems of care and reduce unwarranted variation in practice (Fig.  1 ). Priority opportunities now include the advancement of interoperability with electronic medical records as an area all clinical quality registry’s programs needs to be addressed, as well as providing more dynamic and interactive data dashboards tailored to the need of clinicians and health service executives.

There is a clear mandate to optimise healthcare improvement with big data offering major opportunities for change. However, we have lacked the approaches to capture evidence from the community and stakeholders, to integrate evidence from research, to capture and leverage data or evidence from practice and to generate and build on evidence from implementation using iterative system-level improvement. The LHS provides this opportunity and is shown to deliver impact. Here, we have outlined the process applied to generate an evidence-based LHS and provide a leading exemplar in stroke care. This highlights the value of moving from single-focus isolated approaches/initiatives to healthcare improvement and the benefit of integration to deliver demonstrable outcomes for our funders and key stakeholders — our community. This work provides insight into strategies that can both apply evidence-based processes to healthcare improvement as well as implementing evidence-based practices into care, moving beyond research as an endpoint, to research as an enabler, underpinning delivery of better healthcare.

Availability of data and materials

Not applicable

Abbreviations

Australian Stroke Clinical Registry

Confidence interval

• Learning Health System

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Acknowledgements

The following authors hold National Health and Medical Research Council Research Fellowships: HT (#2009326), DAC (#1154273), SM (#1196352), MFK Future Leader Research Fellowship (National Heart Foundation #105737). The Funders of this work did not have any direct role in the design of the study, its execution, analyses, interpretation of the data, or decision to submit results for publication.

Author information

Helena Teede and Dominique A. Cadilhac contributed equally.

Authors and Affiliations

Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, VIC, Australia

Helena Teede, Emily Callander & Joanne Enticott

Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, Australia

Helena Teede & Alison Johnson

Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 2 Monash University Research, Victorian Heart Hospital, 631 Blackburn Rd, Clayton, VIC, Australia

Dominique A. Cadilhac, Tara Purvis & Monique F. Kilkenny

Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia

Dominique A. Cadilhac, Monique F. Kilkenny & Bruce C.V. Campbell

Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, VIC, Australia

Bruce C.V. Campbell

Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia

School of Health Sciences, Heart and Stroke Program, University of Newcastle, Hunter Medical Research Institute, University Drive, Callaghan, NSW, Australia

Coralie English

School of Medicine and Dentistry, Griffith University, Birtinya, QLD, Australia

Rohan S. Grimley

Clinical Excellence Division, Queensland Health, Brisbane, Australia

John Hunter Hospital, Hunter New England Local Health District and University of Newcastle, Sydney, NSW, Australia

Christopher Levi

School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia

Sandy Middleton

Nursing Research Institute, St Vincent’s Health Network Sydney and and Australian Catholic University, Sydney, NSW, Australia

Stroke Foundation, Level 7, 461 Bourke St, Melbourne, VIC, Australia

Kelvin Hill

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Contributions

HT: conception, design and initial draft, developed the theoretical formalism for learning health system framework, approved the submitted version. DAC: conception, design and initial draft, provided essential literature and case study examples, approved the submitted version. TP: revised the manuscript critically for important intellectual content, approved the submitted version. MFK: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. BC: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. CE: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. AJ: conception, design and initial draft, developed the theoretical formalism for learning health system framework, approved the submitted version. EC: revised the manuscript critically for important intellectual content, approved the submitted version. RSG: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. CL: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. SM: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. KH: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. JE: conception, design and initial draft, developed the theoretical formalism for learning health system framework, approved the submitted version. All authors read and approved the final manuscript.

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Teede, H., Cadilhac, D.A., Purvis, T. et al. Learning together for better health using an evidence-based Learning Health System framework: a case study in stroke. BMC Med 22 , 198 (2024). https://doi.org/10.1186/s12916-024-03416-w

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Health and Fitness Essay for Students and Children

500+ words essay on health and fitness.

We have always heard the word ‘health’ and ‘fitness’. We use it ourselves when we say phrases like ‘health is wealth’ and ‘fitness is the key’. What does the word health really mean? It implies the idea of ‘being well’. We call a person healthy and fit when he/she function well physically as well as mentally.

Factors Affecting our Health and Fitness

Good health and fitness is not something which one can achieve entirely on our own. It depends on their physical environment and the quality of food intake. We live in villages, towns, and cities.

In such places, even our physical environment affects our health. Therefore, our social responsibility of pollution-free environment directly affects our health. Our day-to-day habits also determine our fitness level. The quality of food, air, water all helps in building our fitness level.

Role of Nutritious Diet on our Health and Fitness

The first thing about where fitness starts is food. We should take nutritious food. Food rich in protein, vitamins, minerals, and carbohydrates is very essential. Protein is necessary for body growth. Carbohydrates provide the required energy in performing various tasks. Vitamin and minerals help in building bones and boosting our immune system.

However, taking food in uneven quantity is not good for the body. Taking essential nutrients in adequate amount is called a balanced diet. Taking a balanced diet keep body and mind strong and healthy. Good food helps in better sleep, proper brain functioning and healthy body weight.

Include vegetables, fruits, and pulses in daily diet. One must have a three-course meal. Having roughage helps in cleaning inner body organs. Healthy food habit prevents various diseases. Reducing the amount of fat in the diet prevents cholesterol and heart diseases.

Get the huge list of more than 500 Essay Topics and Ideas

Impact of Exercise on our Health

Routine exercise helps improve our muscle power. Exercise helps in good oxygen supply and blood flow throughout the body. Heart and lungs work efficiently. Our bones get strong and joints have the pain free movement.

We should daily spend at least twenty minutes in our exercise. Daily morning walk improves our fitness level. We should avoid strenuous Gym activities. Exercise burns our fat and controls the cholesterol level in the body. Various outdoor games like cricket, football, volleyball, etc keeps our body fit. Regular exercise maintains our body shape.

Meditation, Yoga, and Health

Meditation and yoga are part of our life from ancient time. They not only make us physically fit but mentally strong as well. Meditation improves our concentration level. Our mind gets relaxed and thinking becomes positive.

A healthy mind is key for a healthy body. Yoga makes us stressfree and improves the endurance power of the mind. Yoga controls our blood pressure. With yoga, a strong bond with nature is established. Meditation is considered the best way to fight depression.

A person stays happier when he/she is fit and healthy. A fit and healthy person is less prone to chronic diseases. The healthy mind reacts better in a pressure situation. The self-confidence of a person is increased. Risk of heart failure is reduced drastically. With the increased immunity power body could fight cancerous cells. The intensity of the fracture is decreased with regular exercise.

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Guest Essay

The End of Polio Is in Sight. What Have We Learned?

By Richard Conniff

Mr. Conniff is the author of “ Ending Epidemics: A History of Escape From Contagion .”

The fight to eradicate polio has been long and difficult. It’s been nearly 50 years since vaccines eliminated the disease in the United States. But polio continues to this day disabling or killing children in some harder to reach parts of the world. The good news is that we are now on the cusp of eradicating this terrible disease everywhere and forever.

The Global Polio Eradication Initiative is a consortium of major players in the fight — the Gates Foundation, Rotary International, the World Health Organization, the Centers for Disease Control and Prevention and Gavi, the Vaccine Alliance. The group has the ambitious aim to end transmission of the virus that causes the disease, wild poliovirus, by the end of the year in Afghanistan and Pakistan, the two countries where it is still actively infecting humans. If the initiative succeeds, it will be the culmination of a campaign that has reduced the incidence of paralytic wild poliovirus from an estimated 350,000 cases in 1988 to just 12 known cases last year.

It will also be a result of what may seem like a counterintuitive strategy: Knowledge about the disease flows not just from medical experts in great research centers to people in developing nations, but the other way as well, with workers on the front lines providing crucial information to stop the disease in their own areas and beyond. The lesson here: The medical tools needed to detect and contain any disease work best in the hands of the people most directly affected by it. Having used this strategy to stop polio, people in developing nations are already looking to apply those same tools against other diseases, both familiar and emerging.

Along the remote, mountainous Afghanistan-Pakistan border, the people on the front lines of the polio eradication effort are mostly women, and mostly members of the communities they serve. Each team is responsible for up to 75 houses, going door to door (or sometimes mosque to mosque), providing a dose of oral polio vaccine to every child in every five-day campaign. Because the communities are poor, and because families can lose patience with repeated visits focused only on polio, the workers also bring nutritional supplements, health information and other resources. Their job is to build trust in villages where people are prone to distrust, and to keep parents engaged in the fight. (In 2011, the fake vaccination campaign reportedly staged by the Central Intelligence Agency in its hunt for Osama bin Laden served only to deepen that distrust.)

The intensity of the national programs — with about 400,000 workers in Pakistan and 86,000 in Afghanistan — has recently reduced 12 genetic clusters of the wild poliovirus in the region to just two, and one of the two hasn’t been seen since November. “From a medical perspective, the virus is gasping in these last corridors,” says Dr. Ananda Bandyopadhyay of the Gates Foundation.

The virus could, of course, spread outside these regions, as it did in 2022, when international air travel carried polio to a handful of other countries, including the United States. But frontline workers in Pakistan and Afghanistan serve as a network for tracking its possible escape routes, as families move back and forth across the border.

Sheeba Afghani, a communication specialist for UNICEF’s polio program, said that when local health workers make a home visit, for instance, and find a family member absent, they ask questions, such as: “If the child is not at home, where are they? Are they out of the district? If out of the district, is it in the same city or another city?” These are questions outsiders could never ask. If the family member has crossed the border, the information gets relayed to polio workers at the reported destination, to locate newcomers in their own 75-house networks.

New tools also help track the virus as it moves in these areas. When India was struggling to eliminate polio in 2010, it had fewer than 10 sites routinely monitoring for the virus in sewage and surface water, said Dr. Hamid Jafari, the World Health Organization’s director of polio eradication in the Eastern Mediterranean region. Back then, to spot an outbreak, health officials had to wait for children to turn up with paralysis. Now, Pakistan has monitoring sites in 84 districts.

Over nine months last year, that monitoring alerted the city of Peshawar to 30 separate introductions of the virus. But the Peshawar district’s 4.7 million people did not suffer a single case of polio, said Dr. Jafari. Knowing where to look for the virus and maintaining a high level of vaccination among permanent residents kept them safe.

A big part of this success is due to the use of the Sabin oral vaccine rather than the Salk injectable vaccine. The oral vaccine, containing a weakened live virus, is easier to deliver and has the critical advantage of inducing immunity not just in recipients’ bloodstream, as the Salk vaccine does, but also in their intestines. That means it stops transmission of the virus in the unsanitary conditions that are common in affected areas (and universal in children). Instead, the live vaccine itself spreads and protects children who might otherwise go unvaccinated.

According to the Global Polio Eradication Initiative, the Sabin vaccine has protected more than three billion children in the past 10 years. But using it involves a trade off: In places with very low levels of polio immunity the vaccine-derived virus can evolve as it spreads, and in rare instances it can revert to a paralytic form. Over the five years through 2023, about 3,600 people, mostly unvaccinated children, have suffered vaccine-derived poliovirus. But the number of cases has already begun to decline thanks to a novel version of the oral vaccine, genetically modified to sharply reduce the risk of reverting.

In Pakistan and Afghanistan, the women on the front lines see the end of polio in sight. This fight has given them the opportunity to work outside the home, earn money and make a lifesaving difference to their villages. When the government of Pakistan recently surveyed them about their experience, one big question they asked was: What can we work on next?

Public health workers everywhere already have the answer. Give them the tools, and developing nations will apply the lessons learned in this fight against infectious diseases like tuberculosis, malaria, measles, typhoid fever and others yet unknown. The end result will be a world that’s safer for all of us.

Richard Conniff is the author of “ Ending Epidemics: A History of Escape From Contagion .”

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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Zinc is a trace mineral, meaning that the body only needs small amounts, and yet it is necessary for almost 100 enzymes to carry out vital chemical reactions. It is a major player in the creation of DNA, growth of cells, building proteins, healing damaged tissue, and supporting a healthy immune system . [1] Because it helps cells to grow and multiply, adequate zinc is required during times of rapid growth, such as childhood, adolescence, and pregnancy. Zinc is also involved with the senses of taste and smell.

Recommended Amounts  

RDA:  The Recommended Dietary Allowance (RDA) for adults 19+ years is 11 mg a day for men and 8 mg for women. Pregnancy and lactation requires slightly more at 11 mg and 12 mg, respectively.

UL:   The Tolerable Upper Intake Level is the maximum daily intake unlikely to cause harmful effects on health. The UL for zinc is 40 mg daily for all males and females ages 19+ years.

Zinc and Health

Because zinc supports the growth and normal functioning of immune cells, even a mild or moderate deficiency can slow down the activity of lymphocytes, neutrophils, and macrophages that protect the body from viruses and bacteria. Zinc deficiency is a common health problem in children from low and middle-income countries that contributes to stunting of growth, diarrhea, pneumonia, and malaria. [2] The elderly who may have low zinc intakes from a poor appetite due to multiple diseases and medications are at risk for infections, such as pneumonia and skin ulcers, as reviewed in the next section.

Adequate zinc is needed to create new cells, particularly collagen and fiber-like tissues, a necessary function in repairing damaged cells. Zinc also supports immune cell activity that combats inflammation from a wound. Therefore the greatest benefit of zinc appears to be in people who are deficient in the mineral and who have severe wounds such as decubitus ulcers or extensive burns. Because people with these conditions have higher zinc needs and may have poor appetites, supplements or topical creams are used rather than relying on food intake alone. In these cases, zinc is often combined with other nutrients like protein, vitamin C, and L-arginine that also promote wound healing such as in a nutritional shake. [3] However, a benefit of zinc supplementation has not been shown in people with skin ulcers who have normal blood levels of zinc. [4]

Food Sources

Meats, poultry, and seafood are rich in zinc. Some plant foods like legumes and whole grains are also good sources of zinc, but they also contain phytates that can bind to the mineral, lowering its absorption.

• Shellfish: oysters, crab, lobster
• Nuts , seeds
• Whole grains
• Fortified breakfast cereals

Supplements

Zinc is available in supplement form as pills and lozenges. Excess zinc can interfere with the absorption of iron and copper. High doses can also cause nausea and even vomiting. Therefore it is important not to take supplemental zinc unless it is known that the diet is low in foods containing zinc or a zinc deficiency is confirmed. A registered dietitian can help to evaluate one’s diet and determine if zinc intake is low.

What about the use of zinc lozenges for colds?

Zinc is believed to prevent cold viruses from spreading and by reducing inflammation, which may shorten the duration of a cold. Research has shown mixed results of their effectiveness due to differences in the form of zinc, the dosage, and how long it was used. Yet some clinical trials support its effectiveness. A Cochrane review of clinical trials found that zinc lozenges did not prevent colds, but if taken within a day of the onset of cold symptoms (sore throat, sniffles), the lozenges could tame its severity. [5] However, it is noted that some of the trials were funded by pharmaceutical companies who may have had financial interest in or produced zinc lozenges.

Zinc lozenges can carry a few unpleasant side effects like having a metallic flavor and causing nausea, but some people would gladly trade these symptoms for a bout with a nasty cold.

Signs of Deficiency and Toxicity

A zinc deficiency is rare and is seen most commonly in people who do not absorb zinc well due to digestive disorders such as inflammatory bowel diseases or who have undergone gastrointestinal surgery. Those with chronic liver or kidney disease are also at risk. Excessive or prolonged diarrhea can lead to a zinc deficiency, as well as severe conditions with increased zinc needs like burns and sepsis (an infection caused by harmful bacteria entering the blood). Zinc is more efficiently absorbed when taken in smaller doses and in people who are deficient in the mineral.

Other groups at risk for zinc deficiency:

• Pregnant women. Increased zinc needs for the fetus and during lactation.
• Low amounts of zinc in human breast milk. High amounts of calcium and phosphorus in cow’s milk can lower zinc absorption.
• Vegetarians/vegans. Zinc intake is limited to plant foods like whole grains that have lower bioavailability than from animal foods.
• Decreased absorption and increased loss of zinc through the urine.

Signs of deficiency include:

• Loss of taste or smell
• Poor appetite
• Depressed mood
• Decreased immunity
• Delayed wound healing

Toxicity occurs almost exclusively from zinc supplements rather than food. There have been no reports of eating too much zinc from the diet alone. [1]

Signs of toxicity include:

• Nausea, vomiting
• Abdominal pain or cramping

Did You Know?

Zinc oxide was used in ointments to treat wounds, as noted in ancient Greek medical texts. Today, zinc oxide is still a popular over-the-counter treatment skin treatment. It can defend against sunburns by reflecting and scattering ultraviolet rays so they do not penetrate the skin. It is also used to treat inflamed skin conditions like burns, eczema, bedsores, and diaper rash. The compound forms a protective barrier on the skin’s surface, repelling away moisture and allowing the skin to heal. It may also aid enzymes to break down damaged collagen tissue so that new tissue can be formed. No negative side effects have been reported.

Vitamins and Minerals

• Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc: a Report of the Panel on Micronutrients. Washington, DC: National Academy Press; 2001. https://www.ncbi.nlm.nih.gov/books/NBK222317/ Accessed 10/17/2019.
• Mayo‐Wilson E, Junior JA, Imdad A, Dean S, Chan XH, Chan ES, Jaswal A, Bhutta ZA. Zinc supplementation for preventing mortality, morbidity, and growth failure in children aged 6 months to 12 years of age. Cochrane Database of Systematic Reviews . 2014(5).
• Ellinger S, Stehle P. Efficacy of vitamin supplementation in situations with wound healing disorders: results from clinical intervention studies. Current Opinion in Clinical Nutrition & Metabolic Care . 2009 Nov 1;12(6):588-95.
• Wilkinson EA. Oral zinc for arterial and venous leg ulcers. Cochrane Database of Systematic Reviews . 2014(9).
• Singh M, Das RR. Zinc for the common cold. Cochrane Database Syst Rev . 2011 Feb 16;(2):CD001364.

Last reviewed March 2023

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Health Effects of Vaping

At a glance.

Learn more about the health effects of vaping.

• No tobacco products, including e-cigarettes, are safe.
• Most e-cigarettes contain nicotine, which is highly addictive and is a health danger for pregnant people, developing fetuses, and youth. 1
• Aerosol from e-cigarettes can also contain harmful and potentially harmful substances. These include cancer-causing chemicals and tiny particles that can be inhaled deep into lungs. 1
• E-cigarettes should not be used by youth, young adults, or people who are pregnant. E-cigarettes may have the potential to benefit adults who smoke and are not pregnant if used as a complete substitute for all smoked tobacco products. 2 3 4
• Scientists still have a lot to learn about the short- and long-term health effects of using e-cigarettes.

Most e-cigarettes, or vapes, contain nicotine, which has known adverse health effects. 1

• Nicotine is highly addictive. 1
• Nicotine is toxic to developing fetuses and is a health danger for pregnant people. 1
• Acute nicotine exposure can be toxic. Children and adults have been poisoned by swallowing, breathing, or absorbing vaping liquid through their skin or eyes. More than 80% of calls to U.S. poison control centers for e-cigarettes are for children less than 5 years old. 5

Nicotine poses unique dangers to youth because their brains are still developing.

• Nicotine can harm brain development which continues until about age 25. 1
• Youth can start showing signs of nicotine addiction quickly, sometimes before the start of regular or daily use. 1
• Using nicotine during adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control. 1
• Adolescents who use nicotine may be at increased risk for future addiction to other drugs. 1 6
• Youth who vape may also be more likely to smoke cigarettes in the future. 7 8 9 10 11 12

Other potential harms of e-cigarettes

E-cigarette aerosol can contain substances that can be harmful or potentially harmful to the body. These include: 1

• Nicotine, a highly addictive chemical that can harm adolescent brain development
• Cancer-causing chemicals
• Heavy metals such as nickel, tin, and lead
• Tiny particles that can be inhaled deep into the lungs
• Volatile organic compounds
• Flavorings such as diacetyl, a chemical linked to a serious lung disease. Some flavorings used in e-cigarettes may be safe to eat but not to inhale because the lungs process substances differently than the gut.

E-cigarette aerosol generally contains fewer harmful chemicals than the deadly mix of 7,000 chemicals in smoke from cigarettes. 7 13 14 However, this does not make e-cigarettes safe. Scientists are still learning about the immediate and long-term health effects of using e-cigarettes.

Dual use refers to the use of both e-cigarettes and regular cigarettes. Dual use is not an effective way to safeguard health. It may result in greater exposure to toxins and worse respiratory health outcomes than using either product alone. 2 3 4 15

Some people who use e-cigarettes have experienced seizures. Most reports to the Food and Drug Administration (FDA ) have involved youth or young adults. 16 17

E-cigarettes can cause unintended injuries. Defective e-cigarette batteries have caused fires and explosions, some of which have resulted in serious injuries. Most explosions happened when the batteries were being charged.

Anyone can report health or safety issues with tobacco products, including e-cigarettes, through the FDA Safety Reporting Portal .

Health effects of vaping for pregnant people

The use of any tobacco product, including e-cigarettes, is not safe during pregnancy. 1 14 Scientists are still learning about the health effects of vaping on pregnancy and pregnancy outcomes. Here's what we know now:

• Most e-cigarettes, or vapes, contain nicotine—the addictive substance in cigarettes, cigars, and other tobacco products. 18
• Nicotine is a health danger for pregnant people and is toxic to developing fetuses. 1 14
• Nicotine can damage a fetus's developing brain and lungs. 13
• E-cigarette use during pregnancy has been associated with low birth weight and pre-term birth. 19 20

Nicotine addiction and withdrawal

Nicotine is the main addictive substance in tobacco products, including e-cigarettes. With repeated use, a person's brain gets used to having nicotine. This can make them think they need nicotine just to feel okay. This is part of nicotine addiction.

Signs of nicotine addiction include craving nicotine, being unable to stop using it, and developing a tolerance (needing to use more to feel the same). Nicotine addiction can also affect relationships with family and friends and performance in school, at work, or other activities.

When someone addicted to nicotine stops using it, their body and brain have to adjust. This can result in temporary symptoms of nicotine withdrawal which may include:

• Feeling irritable, jumpy, restless, or anxious
• Feeling sad or down
• Having trouble sleeping
• Having a hard time concentrating
• Feeling hungry
• Craving nicotine

Withdrawal symptoms fade over time as the brain gets used to not having nicotine.

Nicotine addiction and mental health

Nicotine addiction can harm mental health and be a source of stress. 21 22 23 24 More research is needed to understand the connection between vaping and mental health, but studies show people who quit smoking cigarettes experience: 25

• Lower levels of anxiety, depression, and stress
• Improved positive mood and quality of life

Mental health is a growing concern among youth. 26 27 Youth vaping and cigarette use are associated with mental health symptoms such as depression. 22 28

The most common reason middle and high school students give for currently using e-cigarettes is, "I am feeling anxious, stressed, or depressed." 29 Nicotine addiction or withdrawal can contribute to these feelings or make them worse. Youth may use tobacco products to relieve their symptoms, which can lead to a cycle of nicotine addiction.

• U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General . Centers for Disease Control and Prevention; 2016. Accessed Feb 14, 2024.
• Goniewicz ML, Smith DM, Edwards KC, et al. Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes . JAMA Netw Open. 2018;1(8):e185937.
• Reddy KP, Schwamm E, Kalkhoran S, et al. Respiratory symptom incidence among people using electronic cigarettes, combustible tobacco, or both . Am J Respir Crit Care Med. 2021;204(2):231–234.
• Smith DM, Christensen C, van Bemmel D, et al. Exposure to nicotine and toxicants among dual users of tobacco cigarettes and e-cigarettes: Population Assessment of Tobacco and Health (PATH) Study, 2013-2014 . Nicotine Tob Res. 2021;23(5):790–797.
• Tashakkori NA, Rostron BL, Christensen CH, Cullen KA. Notes from the field: e-cigarette–associated cases reported to poison centers — United States, April 1, 2022–March 31, 2023 . MMWR Morb Mortal Wkly Rep. 2023;72:694–695.
• Yuan M, Cross SJ, Loughlin SE, Leslie FM. Nicotine and the adolescent brain . J Physiol. 2015;593(16):3397–3412.
• National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes . The National Academies Press; 2018.
• Barrington-Trimis JL, Kong G, Leventhal AM, et al. E-cigarette use and subsequent smoking frequency among adolescents . Pediatrics. 2018;142(6):e20180486.
• Barrington-Trimis JL, Urman R, Berhane K, et al. E-cigarettes and future cigarette use . Pediatrics. 2016;138(1):e20160379.
• Bunnell RE, Agaku IT, Arrazola RA, et al. Intentions to smoke cigarettes among never-smoking US middle and high school electronic cigarette users: National Youth Tobacco Survey, 2011-2013 . Nicotine Tob Res. 2015;17(2):228–235.
• Soneji S, Barrington-Trimis JL, Wills TA, et al. Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis . JAMA Pediatr. 2017;171(8):788–797.
• Sun R, Méndez D, Warner KE. Association of electronic cigarette use by U.S. adolescents with subsequent persistent cigarette smoking . JAMA Netw Open. 2023;6(3):e234885.
• U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease . Centers for Disease Control and Prevention; 2010. Accessed Feb 13, 2024.
• U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General . Centers for Disease Control and Prevention; 2014. Accessed Feb 12, 2024.
• Mukerjee R, Hirschtick JL, LZ Arciniega, et al. ENDS, cigarettes, and respiratory illness: longitudinal associations among U.S. youth . AJPM. Published online Dec 2023.
• Faulcon LM, Rudy S, Limpert J, Wang B, Murphy I. Adverse experience reports of seizures in youth and young adult electronic nicotine delivery systems users . J Adolesc Health . 2020;66(1):15–17.
• U.S. Food and Drug Administration. E-cigarette: Safety Communication - Related to Seizures Reported Following E-cigarette Use, Particularly in Youth and Young Adults . U.S. Department of Health and Human Services; 2019. Accessed Feb 14, 2024.
• Marynak KL, Gammon DG, Rogers T, et al. Sales of nicotine-containing electronic cigarette products: United States, 2015 . Am J Public Health . 2017;107(5):702-705.
• Regan AK, Bombard JM, O'Hegarty MM, Smith RA, Tong VT. Adverse birth outcomes associated with prepregnancy and prenatal electronic cigarette use . Obstet Gynecol. 2021;138(1):85–94.
• Regan AK, Pereira G. Patterns of combustible and electronic cigarette use during pregnancy and associated pregnancy outcomes . Sci Rep. 2021;11(1):13508.
• Kutlu MG, Parikh V, Gould TJ. Nicotine addiction and psychiatric disorders . Int Rev Neurobiol. 2015;124:171–208.
• Obisesan OH, Mirbolouk M, Osei AD, et al. Association between e-cigarette use and depression in the Behavioral Risk Factor Surveillance System, 2016-2017 . JAMA Netw Open. 2019;2(12):e1916800.
• Prochaska JJ, Das S, Young-Wolff KC. Smoking, mental illness, and public health . Annu Rev Public Health. 2017;38:165–185.
• Wootton RE, Richmond RC, Stuijfzand BG, et al. Evidence for causal effects of lifetime smoking on risk for depression and schizophrenia: a Mendelian randomisation study . Psychol Med. 2020;50(14):2435–2443.
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Smoking and Tobacco Use

Commercial tobacco use is the leading cause of preventable disease, disability, and death in the United States.

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Australian Government Department of Health and Aged Care

Budget 2024–25

Fact sheets and other health, aged care and sport information from the 2024–25 Budget.

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Ministers' media releases

Budget 2024–⁠25: Cheaper medicines, new Medicare Urgent Care Clinics and more free mental health services in a stronger Medicare

Budget 2024–⁠25: Investing in quality aged care

Portfolio Budget Statements

Budget 2024–25: Health and Aged Care Portfolio Budget Statements

Stakeholder pack

Budget 2024–⁠25: Stakeholder pack

Budget 2024–25: Budget overview

Budget 2024–25: Ensuring all Australians get the health care they need

Fact sheets

Budget 2024–⁠25: Strengthening Medicare

Budget 2024–⁠25: Cheaper medicines

Budget 2024–⁠25: Quality aged care

Budget 2024–25: A fit and healthy Australia

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