This article is the first of a 5-part series on health. The other articles in the series can be accessed here:
It is fair to say; every person has had complications with health. The relentless struggle of everything material to continue existing. The innate desire of self-preservation. There are many ways to express the same idea.
In the post COVID-19 world, health has come to the forefront of the minds of everyone around the world. Almost like a broken record, the public conscious has now been hardwired to think about health. Although, even before the COVID-19 era health has always played a role in popular culture. From lifestyle blogs, fitness routines and diet regimes, people have always gone great lengths to stay healthy.
How did this come to be, or more importantly how has history shaped our individual understandings of health? By which means have these personal definitions then permeated the communal and social discourse to produce the health culture we know today?
The human experience with health is as old as the human condition. The history of health is the same as the history of illness. By understanding how previous peoples managed illness we can better understand their perspective on health.
The earliest texts relating to health and medicine date back to ancient Mesopotamia. Healers of the time would administer magical recitations as well as therapeutics to ease illness. Ancient Egypt saw a thriving public healthcare system, every physician was specialised to treat a certain illness utilising both therapeutics and rituals.
India and China also developed flourishing medical traditions during the early civilisational era. Both relied heavily on herbal remedies, and mystical solutions while making advances in surgery and invasive treatments. Much of these early civilisations shared the common trend being grounded in the supernatural even though material therapeutics were readily used.
The Greeks pioneered much of what is seen in modern medical fields. The likes of Hippocrates and Galen created a sound foundation on which later advances were built on. Hippocrates invented many medical terminologies still used in current science. In addition, his oath is almost held sacred amongst the medical field of today, with many variations of the original Hippocratic oath used in clinical practice.
The Hippocratic philosophy has essentially dominated all current medical sciences and practice. The idea of viewing the illness of a patient not just in isolation but as result of interactions of many factors within the patient’s environment was revolutionary.
A few centuries later, Galen adopted this philosophy and made great strides within medical science with his experimentation and theories. During the classical period of history, the concept of health was finally seen as a nuanced subject.
Although classical health still incorporated spiritual elements, it was a far cry from the early civilizational period where the supernatural dominated perceptions of health. This marriage of the biomedical sciences and the patient’s environment created the much-needed balance health required. With this outlook on health, the medical tradition of the classical period was able to prosper much further than the early civilisational period could have.
The Middle Ages treasured much of what had been built in the classical world, but further advanced in its theory and application. Both Byzantine and Sassanid empires took after the Greeks, compiling vast records of information.
The Islamic world then inherited torch of medical tradition from its two predecessors after many of these records were translated into Arabic. During the Islamic golden age there was an enormous acceleration of advances within the biomedical sciences as well as the appearance of many prominent physicians. The most prominent being polymath Ibn Sina, whose work The Canon of Medicine was used as standard textbook in European universities until the 18th century.
The medieval era of history although having much greater scientific knowledge in both medicine and biology, the outlook of health remained largely like the Hippocratic view. For the Byzantines and Persians did not abandon the wholistic view of health that Hippocrates had pioneered. Neither did the Islamic world, all three civilisations nurtured this tradition. This allowed the balance on the scales of health to remain, allowing physicians and hospitals to continue effectively treating patients.
The final arc of the history of health before the modern era is that of renaissance Europe and the age of enlightenment. Medieval Europe was often referred to as the ‘Dark Ages’, due to rapid cultural, intellectual, and economic decline.
This changed after the fall of Constantinople in 1453, causing eminent Byzantian scholars and intellectuals to flee towards broader Europe. As they fled, they took with them their knowledge and eventually fostered an intense scholarly tradition within greater Europe. Much of the great works in health that had been written throughout the pervious ages were translated into Latin by the Byzantian scholars. Along with this, there were rapid advances made in anatomy, therapeutics, and general biomedical sciences due to and increased amount of scientific inquiry and experimentation.
The invention of the first microscope in 1676 only exacerbated this movement, leading to the advent of microbiology. This subsequently set of a chain reaction of better disease control, clinical practice and eventually an explosion of intellectual activity within the health fields.
With this euphoria of free inquiry and advancement, there was a slow shift away from the balanced view of health. As the age progressed into the late enlightenment period and the early modern era, a patient’s illness was suddenly more important than the patient themselves.
The idea that absence of disease alone is the cause of health became prevalent. This mindset although incredibly effective at treating disease was not sufficient at improving the overall conditions of the patient.
It was the roman emperor Marcus Aurelius that said, ‘Everything we see is a perspective, not the truth.’ Through our senses we perceive the world, and through our perception we begin to understand it. If this is the case, then it is through our definitions that we understand an idea, and how we implement it.
As seen in the section above, the idea of health has changed drastically over the ages. Different eras had differing definitions of what they believed ‘health’ was. This subsequently impacted how each previous peoples implemented healthcare.
If the changing definitions of health over time periods were a graph it would look something like the image above. A sinusoid representing the oscillating definition of health on the biopsychosocial gradient over time.
As time marched on, the modern era entered centre stage. In the modern era health has shifted from away from the pure ‘biomedical model’ which was accepted and practiced for much of the enlightenment period.
There was a good reason for why the ideological shift occurred during the enlightenment into this ‘biomedical model’. Principle being infectious disease. Recalling the first line of the history section of this article, ‘The history of health is the same as the history of illness’, much of the illness that persisted throughout the pre-modern world was infectious in nature.
Between the years of 1817 and 2022, there were 19 pandemics for infectious diseases, including the likes of cholera, polio, tuberculosis and finally COVID-19. Some of which have been eradicated (such as polio) and others which remain (tuberculosis and COVID-19).
The biomedical model of health was very effective at treating and inhibiting infectious disease at a societal level, because it sets the disease as the focus which requires treatment. It considers only the disease and all its aetiological factors. Then one by one the model tries to address the factors associated with the disease.
However, throughout the 19th century, as standards of living rose across the world, a different group of diseases began proliferating. These being the non-communicable diseases, such as diabetes, heart disease, cancer, and kidney disease just to name a few.
Many of these conditions have complex aetiology, having links to many life-style factors of the patient. For example, a condition like heart disease (which is broad category of conditions), can be influenced by diet, exercise, smoking, drinking, stress, and many more patient specific factors.
Health practitioners and academics were unable to effectively deal with this change in challenge. The biomedical model could not manage these lifestyle influences. Thus, the medical professionals of the world were forced to reframe, their point of reference.
Faced with this mounting problem, these professionals held the International Health Conference in New York, 1946. In this conference the constitution of the World Health Organisation was written.
The first line of this constitution reads ‘Health is a state of complete physical, mental and social-wellbeing and not merely the absence of disease or infirmity.’ This definition became an inflection point for health in the modern world. Health once again took on a holistic meaning, and the sinusoid began to move back towards a balanced position (refer to the graph above).
Considering this history, it is no coincidence that so many other changes in society had occurred parallel to this definition change. Social justice, women’s suffrage and civil rights just to name a few. People began to recognise the intersectionality between health and other social factors.
This served as the spark for many new avenues of research such as the social determinants of health. This research then informed policy decisions. Which in turn impacts society in many positive ways.
So, what is health? Health depends on its definition. The definitions changed throughout the ages. These definitions then impacted how the health was implemented. These implementations then effected society. Well then, how does this impact you? Your personal definition of health informs you on how you should stay healthy. Therefore, whatever definition of health you may have. Make it a balanced and holistic one.