This paper seeks to feed a sophisticated conversation about how best to achieve the following outcomes:
- Adoption of the new concept of health
This will require careful deliberations about the economic and political measures that would be needed to reverse the heavy level of medicalization (or "pathologization") of our modern society. Such measures would need to include, among others, the creation of new incentives for practically every group of stakeholders except for patients and staunch proponents of health promotion, to propel society towards the creation of health. This will not be easy, given the extent to which most activities and careers are currently rewarded, while feeding a veritable, almighty medical-industrial complex (81).
- Repositioning of self-reported health as the main indicator
Making this happen will also be difficult, despite the ease, low cost, validity and predictive power of self-assessments of health. The conversation would need to focus on ways to overcome the ingrained "pathophillic" nature of practically all of the indicators in use, and creative efforts to align positive health with the interests of the powerful groups that are currently profiting from disease.
- Creation of new models to enable health-creating service provision
Genuine, health-focused models for service provision should incorporate a comprehensive menu of services designed to allow any person in the community to feel healthy. Such services would be supported by health-oriented insurance, management, financing, and evaluation modules, and would aim at preventing the preventable, curing the curable, relieving the relievable, controlling the controllable, and transcending the inevitable, while always accompanying people whenever and wherever they make efforts to achieve or maintain positive levels of health.
- Identification and exchange of knowledge about effective innovations
Most successful efforts showing that it is possible to create and maintain positive levels of health remain like islands in a global archipelago of innovation, often unknown beyond the limited geographic area in which they have been developed and implemented.
Digital technologies-particularly in the form of an ecosystem of global open source knowledge management resources-could enable the innovators behind such breakthroughs to make their work visible to interested people from around the world, and to engage in collaborative efforts, efficiently, across geographic and institutional boundaries. Such ecosystems should include, as a minimum, a powerful database to store the information about the innovations; tools for innovators to update their information directly and autonomously, and for system administrators to vet, approve, or blacklist services; multiple search capabilities; easy-to-share content, free of cost; and a strong set of easy-to-deploy measures to punish or deter those who misuse sensitive personal data.
- Scaling of sustainable successful initiatives
Today, adopting or adapting proven innovations in settings other than those in which they were developed originally is extraordinarily hard and time-consuming. Even if and when it occurs, scaling up any successful effort to a global level, and sustaining it over time, will be practically impossible. One of the main impediments is the lack of organizations with the mandate to promote, support, or fund the global implementation of disruptive health-creating initiatives. There is even less support, of any kind, to sustain such efforts over long periods of time. As a result, most effective innovations have very limited impact, both in time and space.
As this picture is unlikely to change in the foreseeable future, perhaps the only available way to multiply and sustain effective health-creating innovations is in the hands of existing large global digital data organizations, particularly those with an apparently altruistic nature, such as Wikipedia. More realistically, scaling and sustaining successful innovations might only happen through the creation of entirely new social business models that do not require the end users to pay for their services, which are immune to the chronic financial woes plaguing healthcare systems the world over, and which could be designed, deliberately, to activate and unleash millions of human and technological vectors to complete the pandemic of health.
- Nurturing a movement to usher in a culture of health promotion
In 1986, the Ottawa Health Charter called for international efforts to achieve "health for all" by the year 2000, through health promotion activities that were meant to enable people to gain control over their lives and to improve their health (82). Sadly, the Charter had little impact, ending up overshadowed by the relentless power of medicine.
The time has come to design a completely fresh strategy to turn into reality the large-scale transformative movement that was meant to follow the launch of the Charter. Perhaps the ubiquitous presence of digital technologies, and the deep penetration of social media platforms provide new opportunities to mobilize and motivate people to pay more attention to what causes health, as opposed to what causes disease(83).
- Cultivation of "Precision Health"
Precision Medicine promises to revolutionize healthcare through the recognition that each patient is unique from a biological perspective. This notion, which goes back thousands of years, now relies on breakthroughs from research on genomics, proteomics, metabolomics, and microbiomics to identify and correct the unique abnormalities affecting each individual patient (84). Analogously, there is an opportunity for the emergence of what could be called Precision Health. Such an approach would involve an explicit acknowledgement of the uniqueness of each person in terms of the capacity to adapt and self-manage when facing physical, mental, or social challenges, and effective means to mobilize the best available resources in the world to boost it.
For Precision Health to work, as it is the case with Precision Medicine, digital technologies will be essential to fuel the massive individualization required to make it part of day-to-day reality. Social networking tools, such as those offered by applications designed to help people access services to meet their needs (e.g. book a table at a restaurant, make a flight reservation, and find a date), could be easily adapted to allow people to make explicit their unique characteristics in terms of self-reported health, as well as their values, preferences, circumstances, incentives, and goals. Once individual profiles are created, they could be matched with the most compatible assets in their communities with which they could maintain or achieve good levels of health.
- Humanistic conceptualization of well-being
Just as it happened with the meaning of the word "health", the limitations that are created by the perception of well-being as a state or as something that can be evaluated from the outside, or that depends on the acquisition or provision of material goods, could probably be overcome by regarding well-being as an ability.
The most prominent connection between well-being and ability was made by Amartya Sen in 1979, when he introduced the concept of human capabilities. Sen suggested a little later that we should consider well-being as "the ability to do valuable acts" (85). The limitation of this approach is that it requires someone to judge what is "valuable", again running the risk of falling back into an economistic paradigm. An approach that might be even more appropriate was proposed by Sumner, who suggested that we consider well-being as: "The ability to judge that our life is going, or is, well" (86,87).
This conceptualization, which mirrors that of health, could be considered as our best option to recover the protagonic role we must have in our own lives. It could also lead to an analogous approach to self-rating well-being, through a question such as: "In general, how would you rate your well-being, understood as the ability to judge that your life is going well: poor, fair, good, very good or excellent?". In turn, the answers to this question would lead to judging the levels of well-being as positive or negative, enabling studies using them as dependent variables to determine what are its true determinants.
- Clarification of the relationship between health and well-being
Upon examination of the OECD effort to propose indicators of well-being, the largest effort to date, it is clear that the first indicator that is presented, within the component of quality of life is, precisely, the health status of the population. The only indicator apart from life expectancy that is included is self-reported health.
In sum, the two most ambitious efforts to clarify the meaning of health and well-being consider the alternative term to be part of the one being addressed. This invites deliberation as to whether well-being should be a component of health or vice versa, health a component of well-being.
It might help to examine the conceptualizations of health and well-being as abilities side by side, as a means to find insights that might help clarify the situation.
Thus, health could be considered reactive, as it requires an adaptive response to challenges. The concept of well-being, on the other hand, seems to be more proactive, since it calls for an assessment of our life to determine how well it is going.
Therefore, if a choice were necessary, it would appear more appropriate to consider health to be a component of well-being, as judging how well our life is going would involve an assessment of our capacity to adapt and manage challenges, in addition to other aspects that go beyond the reactive, such as having social connections or a satisfactory level of education or income, among many others.
Regardless of whether well-being is the overarching concept, its conceptualization could be used as the substrate for efforts focused on re-thinking it along the lines of what was proposed for health. Therefore, it would be possible to ponder and develop strategies to encourage the widespread adoption of such conceptualization, the use of self-reported well-being as the top indicator, the emergence of well-being-creating services and systems, the identification and scaling up of effective innovations, the creation of movements to promote well-being, and the cultivation of "precision well-being".
These ideas, which are intended to stimulate conversations and our imagination - both virtually and in person, might also act as signposts to guide us as we attempt to muster the unprecedented levels of leadership, clear vision, conviction, and willingness to engage in painstaking work that are needed to see the emergence of systems that are truly devoted to enabling humans to achieve optimal levels of health and well-being, as part of a flourishing planet.