Over the decades there have been numerous attempts to define the term “health”. Perhaps the most common has been the negative definition,”the afsence of disease”. Yet health is cleary more than that. In the 5th century B.C. pericles defined healt as the state of moral,mental and physical weel being which enables aperson to face any crisis in life with utmost gracen facility. In the “magic bullet”(1976) boyden and Diesendrof defined optimal health as that physiological and mental state most likely to ensure the survival of the individual in the natural or evolutionary environment of the species.
The Evolutionary Background
The human species,homo sapiens,evolved tens of thousands of years ago as hunter-gatherers in a primitive environment very different from modern urban civilization. Gradually man developed agriculture and domesticated animals,and for another ten thousand years his environment changed very little. Even until the 19th century the majority of the population still lived rural life. Today in the 20th century however,as industrialization and urbanization increase,major environmental changes are occurring whitin each of our own lifetimes at a rate unprecendented in history. Never before has man been faced with the need to adapt so quickly to such an exponentially changing environment.
In 1972 Stephen Boyden proposed the Principle of Phylogenetic Maladjustment as a corollary to the Darwinian Theory of Evolution. He suggested that a species shows physiological and behavioural signs of maladjustment when the environmental conditions in which it lives have deviated from those which prevailed when the species evolved. This particurally applies to man,for the rapid rate of social,cultural,chemical and physical maladjustment is evidenced by the dramatic rise in the so called “diseases of modern civilization”.
So far,however,the human species has not become extinct,because man has at his disposal a set of cultural mechanisms adapting to environmental change. Merely treaning symptoms and neglecting the underlying environmental disorder allows further degeneration of conditions,and set up a self perpetuating cycle of snowballing deterioration of both health and environment. And yet these same antidotes are the basis of modern medicine.
Insidius Maladjusment
Another important cultural phenomenon contribitong to the survival and prolifelation of the human species in the face of extensive environmental change is that of pseudoadaption ,in which considerable levels of maladjustment may persist in a population whitout significantly interfering with survivar or reproductive success. In this way modern civilization provides biological protection for and individual in ill health and for his off spring.
Historycal Facts
From the pre-industrial era until today,the changing patterns of mortality and morbidity inthe commnunity reflect changes in the quality and quality of living,and are a strong indication of the signs of biological maladjustment in western technological man. in the hunter-gathere era,probably the main factors contributing to ill health and death were attacks by predators,hunting wounds and subsequent infection. With poor urban living conditions after the industrial revolution,epidemics of infectious diseases became the major causes of ill health. These resulted in eitjer death or complete recovery and the sequalae of chronic illness or disability were relatively infrequent.
Since the turn of the century illness patterns have changed considerably,and today thet are of three main types. First,there are the irreversible chronic diseases,such as heart disease,cerebrovascular disorder,chronic bronchitis,obesity,arthritis,chronic aloholism and pyschiatric illness,for which medical managemen is at nest supportive ratjer than curative.
Who Will Provide health Education?
Responbility tiwards one's own health will be brougth about not by legislation but by education. The W.H.O. definition of "health education" is "to help people achieve health by their own efforts aiming to develo a sense of responbility for their own health betterment as individuals,and as members of families,communities and goverments". Greater goverment utilisation of the mass media for health education and support for community groups such as Weight Watchhers will do much to enciurage an attitude of self help. However health education is most succesfull when directe at the level of the individual.
Health education at the personal and family level should be the responsibility of every doctor,and as much a part of his clinical approach as diagnosis and treatment. The family G.P. has a particulary important role to play in this regard. He has the privilege of being welcome in the homes of his patiens and thus is able o gain insight into their mode of living and perhaps seek out potential problems.
