Definitions of Health
As previously mentioned, the traditional view of health has come from epidemiological studies conducted in laboratory settings. In terms of homeostasis and allostasis, epidemiology is more concerned in the process of homeostasis and its biomarkers to define a baseline for human health.
Nevertheless, it fails to account for the effects and biomarkers of allostasis and the resulting allostasic load condition. Overall, health is studied and normalised equally across individuals and settings, considering the human body outside of its environment and daily demands.
This has led to the development of standardised diagnoses and therapies in clinical settings, that are only somewhat effective in treating patients suffering from non-communicable diseases - for eg. in the US, more than two-thirds of patients suffering from mental health receive inadequate therapies and fail to recover.
Health and social care services are currently among the largest public expenses in the western world, with the EU spending more than 7% of its annual GDP on healthcare for non-communicable diseases.
Apart from the direct costs of healthcare, mortality and long-term disabilities mean added costs to public funds.
Given that climate change and pandemics are posing an immediate threat to health and are disproportionately affecting deprived communities, healthcare costs are projected to increase significantly. Thus now, more than ever, it is necessary to review our definition of health and how we apply it.
We propose an ecological definition of health that is based on the stress response and its ramifications. Health is not static nor restrained to the human body, but is the result of a constant and dynamic interaction between the person and the environment.
Healthcare in Western society is often simplified to a checklist of common symptoms to diagnose disease and standard treatments (often involving drugs) as cures. These overlook the differences in lived experience of individuals, and have a negative impact on deprived and ethnic minority communities.
Inadvertently, current healthcare models are exacerbating social divides by not acknowledging the disproportionate levels of stressors in certain communities.
Our new definition of health is in line with the WHO: they initially defined health as a state of well-being with absence of illness, later introducing a link to the HPA-axis, by framing health as the ability to restore homeostasis after stress. Although these definitions have long existed, they have been disregarded in favour of more biomedical approaches that use quantitative measures of disease biomarkers.
We offer a revisitation of this interpretation of health, and offer further possibilities on how to apply it. Even though the WHO’s official definition is one that incorporates notions of allostasis, our health definition expands to ideas of equity.We propose that health services assess a patient’s exposure to stressors on an individual basis and work to prevent allostasic load/allostasic overload, and therefore disease, rather than focus on reactive therapies after disease onset.
This should be achieved by communicating with local authorities and governmental bodies and developing plans for improving air quality, promoting healthy lifestyles and social cohesion and supporting communities, for example by reducing deprivation and creating better and more accessible urban spaces.
Importantly, these regeneration and public awareness plans should be fairly distributed based on needs: by this we do not simply mean equality, but equity. Taken together, these measures would not only prevent communities from being subjected to biological inequity, but would also increase community resilience, meaning the ability to strengthen and adapt to external challenges.
Overall, acting on preventative measures rather than reactive ones, will reduce the incidence of non-communicable diseases and thus the burden on health and social services.
Centric Lab will focus on an ecological view of health through systems biology, neuroendocrinology and neuroscience. We term this umbrella of biology disciplines as ‘systems neurohealth’
Resources
Giddens 7th Edition. https://politybooks.com/giddens7/studentresource/summaries/Student_Summary_11.asp.
Mehta, N. Mind-body Dualism: A critique from a Health Perspective. Mens Sana Monogr. 9, 202–209 (2011).
Gendle, M. H. The Problem of Dualism in Modern Western Medicine. Mens Sana Monogr. 14, 141–151 (2016).
Lake, J. & Turner, M. S. Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care. Perm. J. 21, 17–024 (2017).
Maragkoudakis, P. Cost of Non-Communicable Diseases in the EU. https://ec.europa.eu/jrc/en/health-knowledge-gateway/societal-impacts/costs (2020).
World Health Organization. The First ten years of the World Health Organization. (World Health Organization, 1958).
World Health Organization. Regional Office for Europe. Health promotion : a discussion document on the concept and principles : summary report of the Working Group on Concept and Principles of Health Promotion, Copenhagen, 9-13 July 1984. https://apps.who.int/iris/handle/10665/107835 (1984).
PHE. Community Resilience. https://www.phe.gov/Preparedness/planning/abc/Pages/community-resilience.aspx (2015).
Ozbay, F. et al. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry 4, 35–40 (2007).
McEwen, B. S. The untapped power of allostasis promoted by healthy lifestyles. World Psychiatry19, 57–58 (2020).