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"Improving Health"

"We need to gain a better understanding of what creates good health in the face of the rigours of modern life: a ‘salutogenesis’ (as distinct from pathogenesis) approach. We need a wider epidemiology, an epidemiology of health." There is great wisdom in these statements by the Chief Executive of the Health Education Board for Scotland, Andrew Tannahill, in a commentary in the Journal of Public Health.

The world is engrossed in trying to deal with diseases and lifestyle issues as causes of ill health. No doubt that these two areas of action are important, but they are not enough. We need go a level beyond these to "life circumstances". The intertwining of diseases and lifestyle issues will then become clearer. Many apparently discrete diseases and behaviours have common roots in adverse life circumstances.

While tackling the risks to health we must also ensure that we pay enough attention to positive health. While discouraging unhealthful pleasures we must also encourage awareness and provision of healthful pleasures. When we acknowledge the positive dimension of health we lift a veil to gain understanding: we see that grim life circumstances cause harm to our health by impairing our well-being, whatever their effects are on ill-health; that social deprivation and mental anguish in themselves constitute ill-health, irrespective of their links to physical illnesses.

A local study on lower income group people by Myrna Blake et al found that such people can cope until they run into trouble due to certain life circumstances, like increasing financial demands when their children reach school going age, when illness strikes or when the family breaks up through divorce or desertion. We need to pay attention to such life circumstances. Indeed, a response to the study was the setting up of family service centres all over Singapore to take care of people under such circumstances. Not all people are made poor by their own doing, some are made so by life circumstances.

The Scottish Green Paper "Working together for a healthier Scotland", calls for such a paradigm shift in thinking. In the words of Andrew Tannahill: "In essence, the Green Paper helps us to add to Juvenal’s ‘mens sana in corpore sano’ the dimension ‘in civitate sana’. Let our motto for the new millennium be ‘A Healthy Mind In A Healthy Body - In A Healthy Society.’" Well said. General George Marshall arrived at the same answer 50 years ago.



1. Andrew Tannahill. Commentary: the Scottish Green Paper: beyond a healthy mind in a healthy body. J Public Health Medicine 1998; 20:3:249-252. K