CHAPTER 1
Basic Concepts: Health, Wellness, and Lifestyle

Day by day, what you choose, what you think and what you do is who you become.

Heraclitus (Ancient Greek, pre‐Socratic, Ionian philosopher)

Health is considered the most valuable asset of our lives and central to human happiness. According to Hippocrates (Ancient Greek physician, also known as the Father of Medicine), “A wise man should consider that health is the greatest of human blessings, and learn how, by his own thought, to derive benefit from his illnesses.” Defining health is not as straightforward as it may seem; various definitions have been given through the years, gradually incorporating many aspects of human life.

Early definitions conceptualized health primarily as the absence of disease. The World Health Organization (WHODay by day, what you choose, what you think and what you do is who you become.Heraclitus (Ancient Greek, pre‐Socratic, Ionian philosopher)Health is considered the most valuable asset of our lives and central to human happiness. According to Hippocrates (Ancient Greek physician, also known as the Father of Medicine), “A wise man should consider that health is the greatest of human blessings, and learn how, by his own thought, to derive benefit from his illnesses.” Defining health is not as straightforward as it may seem; various definitions have been given through the years, gradually incorporating many aspects of human life.Early definitions conceptualized health primarily as the absence of disease. The World Health Organization (WHO) was the first to introduce a more holistic definition of health in 1948: “Health is a state of complete physical, mental and social well‐being and not merely the absence of disease or infirmity.” This more inclusive concept of health, which encompasses the multifaceted nature of human beings, has recently gained ground. The suggestion that health has a positive component, instead of just the absence of a negative one, i.e., illness, gradually led to the use of other terms, such as wellness and well‐being.

Key Point

“Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” WHO

Wellness can be described as optimal health in all three dimensions – body, mind, and spirit – within the limits of one's hereditary and personal traits. The term wellness was added in the WHO Health Promotion Glossary in 2006 to describe “the optimal state of health of individuals and groups, with two focal concerns: the realization of the individual's fullest potential physically, socially, spiritually, and economically, and the fulfilment of one's role expectations in the family, community, place of worship, workplace, and other settings.” Figure 1.1 illustrates the Illness‐Wellness Continuum proposed by John W. Travis According to this view, wellness is not just the absence of disease, but it incorporates the individual's mental and emotional health. The right side of the Continuum reflects degrees of wellness. Individuals can move further to the right, toward health and wellness, through awareness, education, and growth. The left side of the Continuum reflects degrees of illness or worsening states of health, reflected by signs, symptoms, and disability. This approach underlined that traditional Western medicine typically treats injuries, disabilities, and symptoms, to bring the individual to a “neutral point” but not to achieve a high level of wellness.

FIGURE 1.1 The Illness‐Wellness Continuum.

Source: Travis (1977). Reprinted with permission from the Wellness Association.

The National Wellness Institute (NWI) introduced the “Six Dimensions of Wellness” model that includes physical, occupational, social, intellectual, spiritual, and emotional parameters (Figure 1.2). According to this model, the feature of consciousness is critical in achieving and maintaining wellness. It gives the impetus to opt for choices, which will enhance a person’s maximal capabilities. In addition, wellness is characterized by positiveness – a complex condition that incorporates balance and harmony in lifestyle, environmental, mental, and spiritual features. According to the NWI, “Wellness is an active process through which people become aware of, and make choices toward a more successful existence.”

Key Point

“Wellness is an active process through which people become aware of, and make choices toward, a more successful existence.” NWI

FIGURE 1.2 Six Dimensions of Wellness Model. ©1976 Bill Hettler, MD.

Source: Reprinted with permission from the National Wellness Institute, Inc. (2020).

The holistic character of wellness integrates the effects of frequent physical activity, sound dietary habits, self‐reliance, and determination but also self‐confidence, assertiveness, mental creativity, and inventiveness, along with the eagerness to share one's virtues with others. For optimal health, a person is expected to be physically able to fulfill everyday activities without disproportionate tiredness or stress. To this end, physical wellness can be achieved by the adaption of health‐promoting practices, such as regular physical activity, healthy dietary and sleeping habits, and the rejection of the detrimental ones (e.g., undue stress, excessive alcohol intake, and use of tobacco or other substances).

Occupational (or vocational) wellness pertains to the satisfaction gained in the workplace, in balance with personal life. Employment is associated with personal satisfaction and life enrichment comparable with someone's goals, values, and lifestyle, offering unique skills and talents that are meaningful and rewarding. Furthermore, being socially involved (i.e., social wellness) means being harmoniously related to other people and efficiently sustaining positive intimate bonds with family, friends, and colleagues. Emotional wellness refers to the trait of self‐consciousness and the state of being in harmony with oneself, as well as coping with life’s adversities and expressing one's feelings in a constructive way. Spiritual wellness delineates the state of living peacefully by achieving concordance between ethical principles and course of action in combination with creativity. In a similar way, intellectual wellness refers to the adeptness of being receptive to different views and perspectives, and constructively encompassing them in future decision‐making, not only on a personal level but also while interacting with the social environment in an attempt to improve it. In addition, the environmental dimension refers to the acknowledgment of the effect that people exert on their environmental surroundings (i.e., air, water, and land) and the adoption of such practices that sustain and preserve the environment. Finally, the term financial wellness refers to the sense of satisfaction when people manage to live within their means. This involves making the appropriate financial decisions, setting realistic goals, and preparing to meet their short‐ and long‐term needs.

The assessment of the various aspects of well‐being is subjective. It depends on the perceived views a person holds, rather than his or her actual abilities. For example, a person might have a very important job, but the perception and satisfaction might be negative, whereas another person with a less important job might be more satisfied with his or her work. Therefore, healthy thinking and positive outlook are essential features to ensure overall wellness.

Key Point

Healthy thinking and positive outlook are essential features to ensure overall wellness.

Given the important role of health throughout life, scientific research has, from very early on, been focused on factors that could affect health. The genetic background has been acknowledged to be crucial to an individual's health. For example, heritability estimates for type 2 diabetes mellitus (T2DM) range from 20% to 80%. High estimates for the heritability of obesity have also been proposed (typically >70%). However, the exposure to an obesogenic environment is necessary for the development of T2DM and obesity, suggesting that the genetic background is important, but several other environmental/lifestyle factors may also exert a cumulative effect on human health.

Key Point

The genetic background is important, but several other environmental/lifestyle factors may also exert a cumulative effect on human health.

Lifestyle choices and the way the individuals conduct their lives have recently received great attention, since these factors are modifiable and, therefore, may be subject to intervention and improvement. Lifestyle factors that may affect health include habits, attitudes, tastes, moral standards, economic level, activities, interests, opinions, and values. It is a constellation of motivations, needs, and wants, influenced by factors such as culture, family, reference groups, and social class. Many unhealthy lifestyle choices, such as poor diet, physical inactivity, tobacco use,...