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By Alec Burton
Health is an ordinary language word, not a medical term. A paradox implies contradiction, inconsistency, incongruity, a puzzle, enigma, ambiguity, confusion, a riddle, absurdity, dilemma, something that cannot be but is. Indeed these epithets are befitting of the nature of health.

What is health? Can only individuals be healthy? Can we speak about a healthy marriage, a healthy family, a healthy society, meaning by these references more than just a healthy individual or a collection of healthy individuals? I think not. Such uses of the term health are inappropriate. Health, I think, in the strict sense, refers to the individual person, plant, animal or human, and only metaphorically, can we speak of it in relation to larger groups.

Health, it must be argued, is a matter of degree. There are standards of health and they are relative. Health is a relative concept and it also pertains to the time of life of each person. It is true to say that almost everyone’s state of health could be better. Many of us can remember when we were healthier than we are now. The famous Greek philosopher, Aristotle, pointed out 2,000 years ago health admits of degrees without being indeterminate. That means then, that health is like pleasure, strength and justice. It is unlike being pregnant or being dead. Health is a positive quality of living tissue. It is not a condition. It is however the absence of negative qualities. Is one necessarily healthy if one is not ill or diseased? Is one necessarily unhealthy if one is not ill or diseased? One might infer from modern medical practice that health is simply the absence of all known diseases.

The modern medical textbook,” Harrison’s Textbook Principles of Internal Medicine,” contains no discussion about health, gaining health, regaining health, maintaining health, in fact the term ‘health’ does not even appear in the index. Medicines’ pre-occupation with disease, the emphasis of disease and its cure, is understandable because, after all, it is the sick and not the well who consult the doctors. Therefore, they have become distanced from the promotion and maintenance of health. Health and health care were the responsibilities of gymnastics and dietetics in Greek times, they have never been the province of the medical practitioner. As one eminent doctor said “Doctors are too busy fighting disease to be bothered much about health.” There must be something of a paradox there.

Who is the best judge of health? The doctor or the patient? Recently, a friend of mine was admitted to hospital. He was bleeding internally. He told the surgeon and his other medical advisors “the source of my trouble is here – I can feel it.” The surgeon, a professor at the University, and the other doctors refused to accept this. They said “No – you have an ulcer in the stomach and its haemorrhaging.” After 27 litres of blood my friend had surgery. They operated. They cut him from here to here and they found a lesion here. The patient knew where the problem was but the doctors refused to believe him. Subsequently they apologised but instead of the incision that was necessary over a small area, the whole of the abdomen was separated.

It is true that in certain situations the doctor may discover a condition of the body of which you are not aware. A condition that may ultimately kill you, but this situation is indeed rare. Generally you know, yourself, whether you are well or sick. It is your pain not the doctor’s. It is your incapacity not his and you alone should take the responsibility for it. The responsibility is not something that you can transfer to somebody else. Whilst it is commonly believed that if you have a disease you can give it to somebody else, they don’t say if you have health you can give it to somebody else. The paradox here is that it is common for people to look upon disease as an entity, but not health. Therefore, their concept of disease is not in the same class as their concept of health. Whilst they talk of health and disease as though they are antagonistic opposites, when we analyse the concepts we find that, not only are they not considered as differences in degree (of health), but they are in fact entirely different in kind.

Health is both subjective and objective. A person must not only feel well they must also look well and be well. He or she must be capable of performing certain functions within certain parameters which we consider the normal range.

Should we consider the health of an organism apart from the environment which supports it. The environment provides the needs, the raw materials; or the facility for the expression of the need, whether it be food or activity, sunlight or relationships. Health is dependant upon environment, but not solely upon it. Heredity, what we inherit from our forebears, formulates the fundamental limits or constraints of the human race. Our self-determined, self-generated actions make their contribution to our functional efficiency. We can present the triad schematically as:
USE
HEREDITY ENVIRONMENT

These individual features are far reaching in their implicit potential. Heredity imposes determinism, environment increases flexibility but without the constraints of heredity would lead to chaos. Use provides us with the capacity to step outside the limits of determinism and, with our self-generated action, modify, alter, change and control our environment and ourselves.

We must also consider the importance of cause and effect. Disease has causes – health does not. I would like expand that thought a little. Health is the normal condition of the body, it is autonomous, that providing the environment supplies the needs and the organism is used within its limitations, health is the natural, normal outcome, given an intact organism in the first place of course. Disease, on the other hand, has to be caused and removing that cause, providing it is done before irreversible damage ensues, will allow health to be re-established. I will comment further on that subject when discussing the nature of disease.

I am not seeking here a precise definition of health. I am inclined to believe that it is not possible to define health so accurately any more than it is possible to define knowledge, wealth, livingness. I am more concerned with creating a clearer understanding of health, eliminating many of the misconceptions about health. In ordinary speech we use the terms health and healthy as if we really knew what we were talking about. Now, I do believe, in fact it’s a conviction, that most people, when they talk about health, and this includes the professionals, really do not know what they are talking about. Etymologically health is derived from an old Anglo Saxon word ‘hou’ meaning ‘wholeness’ and ‘to heal’ means ‘to make whole’. The German word ‘heil’ also means ‘whole’. In Greek, Ancient Greek, there are two etymologically distinct words translatable as health – ‘hygieia’ and ‘uixia’. ‘Hygieia’ the source of the word ‘hygiene’ of course, stands for living well or more precisely ‘a well way of living’. ‘Uixia’ means literally “well habitedness’ or in our present context “good habits of body.”

Certain linguistic points are worth noting. The Greek and the English words for ‘health’ are totally unrelated to all words for disease, illness or sickness. This fact is also true of German, Latin and Hebrew. The Greek words for health, unlike the English, are also completely unrelated to all verbs of healing. Health is an action or function unrelated to, and prior to, both illness and physicians. The English emphasis on ‘wholeness’ or ‘completeness’ is comparatively static in structure and the nature of a whole, distinct from all else and complete in itself, carries connotations of self-contained-ness, self-sufficiency, independence, responsibility. In contrast, the Greek terms stress the function and activity of the whole body, not only working but working well.

The Greek term suggests that health is connected with the way we live and perhaps implies that health has largely an inner cause. The Greek also seems to imply that to stay healthy requires effort and care, that however much nature makes health possible, human attention and habit are required to maintain and preserve it. Health is neither given or, usually, taken away from the outside, nor is it the gratuitous expected state of affairs.

Health is a natural norm. It is not a value as opposed to a fact. It is a state of being that reveals itself in activity as a standard of bodily excellence or fitness and, it must be related to the environment that supports it. Health and disease are not incompatible. They can co-exist in a sense and herein lies the paradox. The healthy person swallows a virulent poison. They immediately become sick. They have a disease. They get rigors fever, nausea, vomiting, symptoms of disease. The vigour and effectiveness of which are directly related to health. If the person is healthy they will defend themselves against the poison efficiently and completely, restoring normality rapidly. On the other hand, if the person does not vomit on imbibing the virulent poison, it is absorbed into the blood and more serious consequences are inevitable, with possible death.

As I have mentioned on occasions in the past, when I have departed from Australia, in the middle of winter, to arrive in Los Angeles half a day later, in the middle of summer, the adaptive requirements imposed upon the organism are enormous. A few hours in Los Angeles, with the smog, my eyes are sore, nostrils irritated, mucous in the throat, signs of disease, yes, but also indications of health because my body is defending itself against an environmental irritant which it cannot escape, overcome or destroy.

Health is not a static condition; it is a fluctuating quality. It is not the opposite of disease, it is inextricably associated with disease in an ever changing continuance, but to understand health, we need to understand disease. We need to understand the relationship that exists between the organism and its environment. If a person consults me and I learn they smoke tobacco, they take drugs, they imbibe tea and coffee, they drink alcohol and do the usual conventional things that are accepted as quite normal, I can state unequivocally that they are not healthy because they are not supplying needs. They are daily poisoning themselves and this is inevitable that health cannot withstand such an incessant and continual onslaught. If we are prepared to accept health on an average basis; if we are content to consider ourselves healthy when we suffer from frequent headaches, repeated gastro-intestinal upsets, recurrent constipation and obscure aches and pains then it is time we revise our values.

Hygiene argues that to be healthy we must supply the conditions of health – that health is not a matter of chance or accident but that the organism functions according to known and demonstrable laws, that the physiologists, biologists know only too well if we are to have health we can have it only on nature’s terms. An organism cannot act contrarily to its nature. The nature of the organism is, and it does not change. Its requirements a thousand years ago, a thousand years ahead and to- day are similar.

The body does not use food one day and poison the next. It does not utilise oxygen one week and carbon dioxide the next. The needs of the organism do not change in kind. Your needs are basically the same as your next door neighbour i.e. in the fundamental sense. Their appropriation, their quantitative application may vary but there is never a time when the organism acts contrary to its nature.

The needs of health are many and complex but broadly they fall into the major categories of food, air, water, sunshine, rest, sleep, activity and mental and emotional factors. The precise qualitative and quantitative application is highly individual and becomes more so as health is impaired because limitations become greater.

Health then, is a fluctuating quality of living tissue. It is a concept which represents an ideal. It is not an opposite of disease but the optimum on the same continuum.