Health or Disease: An Individual or Societal Norm?


The study of anatomy and physiology started in the Renaissance period, and since then, many researchers have regarded the body as a peculiar type of mechanism; the heart is a pump, blood vessels are pipes, joints and tendons are blocks and gears. “Health”, then, entails the correct functioning of this mechanism; in other words, the lack of disruptions and diseases. Hence, treatment means quickly fixing a malfunction so that the person in question can proceed with their usual lifestyle.

Is atherosclerotic plaque blocking an artery? You just need to place a stent that widens the arterial lumen, and the disease will be cured. Alas, the reality is much more complex. Largely, the “either healthy or ill” approach is still present today whenever patients’ complaints are devalued and multiple pre-existing diseases (or conditions that do not correspond to the criteria of an “illness”) are ignored. Essentially, you can turn to someone for help only when your disease is already fully developed, and before that, you are considered formally healthy.

Have you ever experienced this situation: you feel ill, go to a doctor, get yourself tested, receive results showing that you’re “fine,” and see the doctor’s expressive gaze clearly implying that a hospital is no place for fakers, but you definitely feel unwell!?

A biostatic model of health exists in which physical wellness is thought of as a range of multiple indicators within which an organism functions normally, and disease, therefore, is anything that falls outside the boundaries of that norm. According to this system, norms are universal and can be determined experimentally. The rub, of course, is that health is not a “norm”, and that seeing it as such leads to the formation of a dangerous misconception: why would I do anything right now? I’ll seek treatment when I get sick.

The thing is, most modern diseases start to develop long before they manifest — this applies to a variety of tumors, type 2 diabetes, and cardiovascular or neurodegenerative conditions. These processes last for years, and their early identification can slow down or even reverse the damage being done. Moreover, the modern state of science allows us to determine a range of markers that change many years before a disease emerges and thus to predict its occurrence. The earlier a disease is found, the more probable the success of its treatment, and the lower the cost of that treatment will be.

It is vital to identify predispositions and improve health even without any symptoms. Many, including me, are afraid not of aging in itself, but of dying as a person before physical death comes. But we can affect this problem too!

Fix the roof while the sun is shining! It is true both literally and figuratively — take care of your mind before dementia manifests! Neurodegenerative diseases are dangerous because they have a long period of hidden development (latent stage). During this time, even though neurons are dying, there are almost no manifestations of the illness, and the affected person feels as they usually would since the surviving neurons assume part of the functions of the dead ones. The disease develops asymptomatically.

The functionality of our brains has a great deal of flexibility, and most neurons can be irreversibly destroyed before the first symptoms appear. The more cells die, the less effective treatment will be. For example, in amyotrophic lateral sclerosis, symptoms only appear after half of the person’s motor neurons die, and in Parkinson’s disease — only when 70% of their dopamine neurons die.

There are 12 key risk factors for dementia: a low level of education, hypertension, hearing disorders, smoking, obesity, depression, a lack of physical activity, diabetes, little social contact, the excessive consumption of alcohol, craniocerebral traumas, and air pollution. They are responsible for 40% of all cases of dementia and are controllable. Eliminating these factors will markedly lower the risk of contracting neurodegenerative diseases.

The health continuum is another relevant perspective on the topic, emphasizing that health and illness are not mutually exclusive states or processes. You cannot limit pathology to absolutism by trying to draw strict contrasts between health (as an optimal state) and disease. Both disease and health can coexist, each having a number of transitional stages with a wide range of indicators.

One end of this continuum is occupied by death, the other by super-perfect health, and in between them, multiple stages reside, among which are good health, normal health, discomfort, minor symptoms, disease and lack of activity, and a noticeable decrease in abilities due to illness. A high health level can compensate for separate manifestations of diseases. Health and illness are very much a kind of spectrum. You may be 10% ill or 40% ill, 5% healthy or 60% healthy. This ratio determines your state.

The difference between “health improvement” and “disease treatment”. These notions have many differences and similarities. Health improvement includes measures and actions aimed at increasing your internal resources. However, sometimes it also involves curing diseases. Disease treatment, in contrast, implies taking specific approaches aimed at correcting disruptions caused by illness; for example, antibiotics for bacterial pneumonia or a cast for a bone fracture. If you break your leg, healthy nutrition and meditation won’t make the bone mend significantly faster, but for a number of maladies, both disease treatment and health improvement are used.

For example, in the case of diabetes, physical activity (which improves the patient’s health overall) helps to increase insulin sensitivity and lower blood glucose levels. Simultaneously, prescribing metformin — a medication with a similar effect — is a part of the (disease) treatment. Despite the fact that healthcare considers type 2 diabetes practically untreatable, a systemic lifestyle change can lead to full recovery in many cases.

Advice like “increase physical activity and lose weight” often sounds boring for patients who view such goals with pessimism, so experienced doctors wrap these recommendations into exciting challenges. Once, a merchant with diabetes and obesity asked for help from famous doctor and physiologist S.P. Botkin, ready to pay a substantial amount of money for “potions” that would fix his problems. However, Botkin told him that he would only provide a cure under one condition: if the merchant took a knapsack, and, without a penny or even shoes, went on foot to Odessa (a distance of 2000 km), where his treatment would begin. When the merchant finally reached the city, he had no symptoms of obesity and diabetes anymore.

More than the absence of disease. I want you to gradually expand your understanding of health while reading this book, as your motivation to improve it will grow too. The modern definition of health, offered by the World Health Organization, states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The WHO definition sounds like the Ancient one: “The highest good is based on complete physical and mental health” (Marcus Tullius Cicero — Roman politician, orator, and writer)

Multiple conditions and factors, including biological (anatomy, physiology, genetics), physical, and social ones play a role in the development of human health — they form a foundation for the biopsychosocial health model, and I agree with it as well as with WHO and Cicero.

Health as adaptation and opportunity. We can consider adaptation an analog to health, i.e. the ability of an organism’s internal forces to adapt to external influences, including social, physical, and emotional challenges. Notably, academician N.M. Amosov defined health as “the level of an organism’s functional abilities, the range of its compensatory-adaptive reactions to extreme conditions, i.e., the level of an organism’s reserve capabilities.”

Health was also considered a potential, i.e. the “state of an organism that gives it an opportunity to maximally realize its genetic program under the conditions of socio-cultural existence particular to it”. In this interpretation, health becomes a condition for self-realization, the ability to reach one’s life goals. The matching of life goals and desires to real possibilities is also important for health, and a restricted ability to resolve problems and tasks can be considered an accurate symptom of unhealthiness.

Health as a value and happiness. French writer and philosopher of the Renaissance era Michel de Montaigne thought that “Health is a precious thing, and the only one, in truth, meriting that a man should lay out not only his time, sweat, labor, and goods but also life itself to obtain it”. Health helps us to enjoy life and be happy. Happiness does not come by itself, it is a labor, but in contrast to hedonism, pleasure directly depends on a person’s virtues.

According to ancient philosopher Epicurus, the highest forms of pleasure are not of the base physical variety, but the sophisticated spiritual ones. The happy person is one who has reached a state of complete tranquility, or ataraxia, a kind of mental peace that ancient Greeks believed only sages were capable of achieving. Listen to yourself: how is your ataraxia doing

Questions and Assignments

1. Play with the metaphor of “my body — my car”. Car owners explore their vehicle’s basic structure, pay attention to the road signs and markings, maintain distance, and monitor the fuel sensors. Do you know your body’s signals and rules of use? Do you perform regular maintenance on time?

What illnesses do you have now? Are they treatable? How would a lifestyle change (i.e. health improvement) affect them? How big would the potential of this influence be?

3. Evaluate your health as a percentage (100% being super-perfect). How would you feel and what would you experience if you had perfect, 100% health?