What is ‘health’?
What does it mean to be healthy? If I’m not sick, am I healthy? As long as I’m not sick, does it matter?
Health is a complex concept, it means different things depending on the context. Our health care system seems like an obvious starting point as I try to think about health and being healthy. The health care system of course includes health insurance plans, doctors, hospitals, drug prescriptions, and more. In this system I pay insurance premiums and copays, go to the doctor, get a blood test, take prescribed medications, etc. Is this what it means to care for my health?
Is my doctor caring for my health? Or is she primarily there to help me feel better when I get sick? Is taking a pill something I do for my health or for my disease?
Our health care system seems to be primarily focused on healing or managing poor health.
But if health care is mostly about healing disease, then I’m still stuck trying to understand what health is. Is it really just the state of not having any disease? If I don’t currently have any disease does that mean I am healthy and don’t need health care right now?
If I am healthy then how do I go about staying healthy? What about this thing the health care system calls ‘prevention’?
With preventable chronic disease now consuming more than 3 of every 4 dollars spent on health care, there is a growing focus on prevention. New insurance claim codes, for example, allow health plans to pay for lifestyle change programs designed to help prevent pre-diabetes from developing into a full-blown type-2 diabetes diagnosis.
But health plans only spend about 3% on prevention. And while prevention seems like a logical solution to our growing chronic disease crisis, it doesn’t make much sense to expect a system that gets paid $3.3 trillion per year to treat disease to be responsible for implementing programs to prevent it. That’s kind of a ‘fox guarding the hen house’ problem.
And the reality is that prevention isn’t working anyway. Obesity rates are not going down. The total per capita cost of health care continues to increase. Type-2 diabetes is preventable, but the situation is getting worse not better. Some estimates suggest that 1 in 2 adults in the US are now either pre-diabetic or already have type-2 diabetes, many without even knowing it.
I believe that there is a an even more fundamental problem with the concept of prevention. Prevention is a life-long journey, not a 16-week billable health care encounter. But who wants to go through life ‘preventing’? That doesn’t sound like any fun.
OK, so our health care system exists primarily to help me get better when I’m sick, but health is not just the lack of disease and attempts at prevention don’t seem to be working. Back to my original question: What is health?
Health may not really be a thing, or state that I can ever achieve. I can never really declare victory and claim that I made it, that “I am healthy!” No matter how much weight I have lost, or how good my lab results look, I’m never done. This brings me to the conclusion that health is something I do, not something I have.
Disease is something I have but health… health is something I do.
Health is about behavior, habits, lifestyle. Health is a way of living, not a goal or a destination. It is a practice.
Practice is a funky word too. I grew up thinking of practice in the context of little league and basketball practice. We had to practice if we wanted to play in the game at the end of the week and have a shot at winning. But let’s face it, practice sucked!
I’m not talking about that kind of practice. When I think of health as a practice, I’m talking about practice as a regular, habitual component of my life – a part of my identity, of who I am. So when looked at this way, when I claim that I am healthy, what I am saying is that I purposely live ‘healthily’, I practice health – not that my lab results and weight have reached certain thresholds.
This concept of practicing health – as opposed to preventing disease – is actually very profound, not just a new semantic. It starts with understanding and accepting that your identity is both determined by and reflected in your habits, and that you have the ability to purposely carve these identity-defining habits into your life. Habits are. That is just the way the brain works. Habits are the autopilot that run about 40% of your show. So you are either running on an autopilot programmed by people and circumstances you didn’t purposely choose or you are running on an autopilot that has been programmed on purpose, by you.
So stop trying to prevent disease and instead begin practicing health. Don’t worry so much about the outcome, focus on the practice. Eat on purpose, sleep on purpose, exercise on purpose, every day, make it a habit – practice health.
Maybe some day we will have a health practice system to complement our health care system. Employee-sponsored heatlh wellness benefit programs may be where this health practice concept starts. But if it is going to last, we can’t make the mistake that many critics of employee wellness programs are currently making and give up if we don’t see health care costs going down before the next earnings report. The goal is the practice, not who win’s the game on Saturday.