The Need for Redefining Health
Preamble to the Constitution of the World Health Organization (WHO) as adopted by the International Health Conference held in New York in 1946 and entered into force on April 7th, 1948 (celebrated as the World Health Day) defined ‘health’ as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. However, this conceptualization of health is not holistic, both in nature and scope. Thus, the WHO Constitution extended this definition to include the socioecological determinants of health (Source: Glanz K, Rimer BK, Viswanath K. Health Behavior: Theory, Research, and Practice. John Wiley & Sons; 2015. 512 p.) such as internal and external environmental factors and the State’s responsibility to ensure health promotion of their respective citizenry, among other factors.
The Ottawa Charter of Health Promotion also emphasized this notion via provision of adequate social, economic, political, and environmental measures to maximize the overall well-being of society (Source: Judd CM, James-hawkins L, Yzerbyt V, Kashima Y. Fundamental dimensions of social judgment: Understanding the relations between judgments of competence and warmth. Journal of Personality and Social Psychology. 2005;899–913). As a result, in general, global public health has shifted from a pathogenic health approach towards a salutogenic perspective to health of individuals, communities, and populations, especially in the recent decades (Source: Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, et al. How should we define health? BMJ. 2011 Jul 26;343:d4163). This enhanced focus on external elements related to global public health promotion is inextricably linked to the concepts of attainment of peace and prosperity.
Perhaps, an alternative definition of health could entail critical elements of creating enabling health systems and conducive social environments that allow individuals, families, and communities to not only survive but thrive in an ecosystem that affords individual and societal empowerment via health equity, equality, justice, and access to socioeconomic capital (Source: Venkatapuram SS. Health Justice: An Argument from the Capabilities Approach. John Wiley & Sons; 2013. 236 p.) pertaining to food, housing, education, employment, income, and freedoms from fear, conflict, disease, and poverty (Source: Shilton T, Sparks M, McQueen D, Lamarre M-C, Jackson S, executive committee of the International Union for Health Promotion and Education-IUHPE. Proposal for new definition of health. BMJ. 2011 Aug 23;343:d5359), regardless of age, sex, and gender.
Determinants of Health and Peace Promotion
The Ottawa Charter of Health Promotion identified peace as the foundation for good health. Johan Galtung (Source: Galtung J. A Synthetic Approach to Peace Thinking. :238.), the principal founder of the discipline of peace and conflict studies, noted that individuals require both internal and external peace emanating from individual, political, cultural, and societal harmony. Internal peace is a prerequisite for extending into the external environment, that is, family, friends, and community (Source: Galtung J. Peace by peaceful means: Peace and conflict, development and civilization. Thousand Oaks, CA, US: Sage Publications, Inc; 1996. viii, 280. (Peace by peaceful means: Peace and conflict, development and civilization)).
Further, Pathways to Peace, a United Nations (UN) designated peace messenger organization developed the peace wheel model for peacebuilding constituting eight pathways – governance, education, economics, health, science and technology, religion and spirituality, environment, and culture. These interrelated peace pathways identify and engage all stakeholders as peacebuilders, transcending national, ethnic, racial, religious, age, identity, or gender differences. These pathways are interlinked and interdependent with the health promotion principles and socioecological frameworks (Source: Glanz K, Rimer BK, Viswanath K. Health Behavior: Theory, Research, and Practice. John Wiley & Sons; 2015. 512 p.).
Furthermore, health, peace, and prosperity (economic as well as social) are critical elements for ensuring human dignity and self actualization. Goals related to peace promotion are like health promotion (Source: Middleton JD. Health promotion is peace promotion. Health Promot. 1987;2(4):341–5.), with peace promotion acting as a catalyst for achieving health promotion and vice-versa. Health promotion is a bridge to peace promotion and peace promotion leads to health promotion.
Thus, global peace and global health promotion is dependent on both intrinsic and extrinsic structural factors, that is, sociopolitical peace, sociocultural harmony, and socioeconomic prosperity.
Happiness and the idea of ‘balanced’ abundance
An implicit component to achieving worldwide health, peace, and prosperity is happiness – most importantly at individual, familial, and community levels for better physical, social, and mental health outcomes for entire populations across various stages of the human life cycle. Happiness is an equally essential component at the systemic and/or structural level of the socioecological framework, that is, environmental, policy, and societal levels. Although it is difficult to evaluate peace and happiness at any level, The Institute for Economics and Peace measures the average level of global peacefulness via The Global Peace Index. Further, The UN Sustainable Development Solutions Network measures global happiness via the annual World Happiness Report and reports the Global Happiness Index based on six variables such as income, freedom, trust, healthy life expectancy, social support, and generosity. These index measures and key indicators provide some interesting insights to analyze peace and happiness in conjunction and ascertain the enablers and barriers to global peace and happiness.
However, before delving into the analysis, it is critical to understand why happiness is the most vital performance indicator for humans. Humans are distinct from other species for having rationality, which governs thought processes. Aristotle’s Nicomachean Ethics argues that happiness is the greatest good and the end at which all human activities and efforts aim. Most of the ends are means toward other ends, however, only happiness is an end in itself – the all-encompassing primary goal of life. This makes understanding and interpreting happiness in all visions, missions, policies, and programs related to health, peace, and prosperity especially important in the current day and age.
Based on these indices, an international comparison suggests that the Scandinavian countries such as Finland, Denmark, Norway, Iceland, among others, consistently rank better than other countries year after year. These countries tend to rank higher in all the six variables, as well as emotional measures related to overall health and well-being.
On the other hand, The United States, a global economic superpower, and a country where pursuit of happiness is embedded in the deepest layers of society, is also the country with one of the highest rates of antidepressant use in the world. Although the United States ranks higher in terms of economic indicators such as capital and income, it does not even come close to the international leader board on the list of measures that make up a happy country such as generosity, social support, freedom, and corruption.
This is the biggest valuable lesson for countries vying to be the next superpowers of the world, especially emerging economies and developing countries such as India. India was ranked at 140th place in 2019 on the Global Happiness Index, dropping seven spots since 2018 on the back of an increase in negative emotions, including higher levels of worry, sadness, and anger, especially over the past few years. Compared to this, India’s neighbour, the small country of Bhutan came in at 95th place.
Both these indices depict one thing clearly – the country that grows (both economically and socially) together equally and equitably, stays together peacefully and happily. This simplistic idea and a generic thumb rule are quite straightforward, both in theory and practice. A general trend with respect to the top ranked happy and peaceful countries is that all these nations have a sense of community and shared responsibility (although immigrant inclusivity, social diversity, and race and ethnic heterogeneity might be questionable in some of the Nordic countries) and thus are much more peaceful, happier, healthier, and overall prosperous. Canada, for instance, is the only country in the Americas to make it to the top ten in both health and peace indices, respectively. Perhaps, the biggest contributing factor is Canada’s ‘multiculturalism’ (Source: Brosseau L, Dewing M. Canadian Multiculturalism. (2009):32.) – officially adopted by the government during the 1970s and 1980s. Based on these insights, it can very well be argued that a Canadian dream and/or a Nordic dream (not only in terms of economic migration but all other relative factors that determine the quality of life and standard of living) seems far more rewarding than an American dream in order to pursue a happier and fulfilling life in every sense of the word. However, this beyond the scope of this article!
Conclusion and Way Forward
In conclusion, the way forward to ensure and sustain good health, overall well-being, greater internal and external peace, enhanced socioeconomic prosperity, and universal happiness is to replace the vicious cycle of violence (of all forms) and poor health outcomes with the virtuous cycle of higher levels of peace, prosperity, and health. This can be made possible only if the world transitions towards the idea of sustainable and ‘balanced’ abundance – an intricate balance between excess and deficiency, as noted by Aristotle almost two millennia ago and Mahatma Gandhi a century ago (Source: Dalton D. Mahatma Gandhi: Nonviolent Power in Action. Columbia University Press; 2012. 353 p.). The path to stable and sustainable prosperity requires the non-tangible and dynamic concept of happiness to be embedded in all policies, inherent at all governance levels, and amongst all individuals to transition towards a healthier and peaceful world in the future.
Ankur Chhabra 