Richard Smith: What are the causes of health?

richard_smith_2014Ask doctors for the causes of heart failure or any disease, and answers will pour from them. Ask them about the causes of health or wellbeing, and they will go blank. Doctors are trained to think about disease not health.

Sir Harry Burns, formerly chief medical officer for Scotland, asks doctors about the causes of health or wellbeing to get them thinking. He shows a slide, compiled by others, of the many theories of salutogenesis, the opposite of the familiar pathogenesis. They boil down, he believes, to just six things. They are:

• An optimistic outlook
• A sense of control over your life
• A feeling that your life has purpose and meaning
• A capacity to overcome problems
• A supportive network
• A nurturing family

I suggest that you might have cancer and yet if you have these six assets then you’re healthy. This would make no sense to doctors who implicitly, and even explicitly, think of health as the absence of disease, but it’s also clear that doctors cannot “prescribe” the six assets of health.

So we might conclude that disease belongs to doctors and health to a much broader group, primarily people themselves. This will be fine to doctors, who feel comfortable with disease not health, but it’s a problem that doctors swallow up resources that at least some of which would be better devoted to helping people achieve health—or at least avoid circumstances in which achieving health is almost impossible.

Richard Smith was the editor of The BMJ until 2004. 

Competing interests: None declared.

  • MJHopeC

    Many decades ago when I trained as a vet we were told that the first thing we had to learn was what “good health” was on the grounds that if one did not know that, it would be difficult to identify “ill healthy”. This was then followed by a year concentrating on nutrition, hygiene and “materia medica” (yes that long ago).

    Seems to me that Dr Smith is definitely on the right track

  • Ravindra Ghooi

    I recall that Ivan Illich in his book Medical Nemesis (1976) made similar comment. He said health is the capacity to cope with the human reality of death, pain, and sickness. Smith by bringing the focus back on health, has suggested a course correction to our thinking.