What is health?

                                                       Some ancient answers

What would people in the ancient world consider when thinking about whether they were healthy or not?
As it is now, health was a matter of everyday conversation and, like us, the ancient Greeks would drink to each other’s health. Furthermore, Roman letters often began with ‘I hope you are well’ or ended with ‘Take care of your health, as best you can’.



'Sollemnis to Paris his brother, very many greetings. I want you to know that I am in very good health, as I hope you are in turn, you neglectful man, who have sent me not even one letter...'

Left: Extract from a letter discovered at Vindolanda

http://vindolanda.csad.ox.ac.uk/exhibition/army-8.shtml
                                                                               
                                                                          
The Good Old Days?

                                                              Celsus, a Roman from the 1st century CE
Celsus wrote, in the introduction to his ‘On Medicine’

'It is probable that with no aids against bad health, none the less health was generally good because of good habits, which neither indolence nor luxury had vitiated: since it is these two which have afflicted the bodies of men, first in Greece, and later amongst us; and hence this complex Art of Medicine, not needed in former times, nor among other nations even now, scarcely protracts the lives of a few of us to the verge of old age.' (Prooemium, 4-5).

In other words, health in the past must have been good because lifestyles were better. This is still the opinion of many.

Scholars disagree about whether Celsus was a doctor or a wealthy amateur but, as the head of a Roman household, he would in any case have been responsible for the health of his own family, slaves and animals.
The first book of his section on medicine opens with:
 ‘A man in health, who is both vigorous and his own master, should be under no obligatory rules, and have no need, either for a medical attendant [medicus], or for a rubber and anointer [iatrolipta].’

Above: A 1756 copy of Celsus's book
httpsopenlibrary.org

This, Celsus explains, is because such a man should have enough variety in his life to have a balanced body. Balance was a key concept in ancient health, whether this was in terms of the different constituents of the body, the relationship between food and activity, or between the body and its environment.

Celsus said that a healthy person should move between town and country*, and between exercise and rest, and will eat twice a day rather than once a day.
* There was some discussion in the group about moving between town and country. Was Celsus talking about variety, or did he consider one better than the other? Was town more stimulating than the country, or more unhealthy?

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                                                                                               Galen
         
The ancient doctor Galen, the most famous of all ancient medical writers because of the amount he wrote and its later influence, worked in the 2nd century CE.
He wrote:
I see all men using the nouns hygieia and nosos thus … For they consider the person in whom no activity of any part is impaired ‘to be healthy’, but someone in whom one of them is impaired ‘to be sick’ (On the Therapeutic Method, tr. Hankinson 1991: 22).

Nosos is the ancient Greek word for ‘disease’.

 If the activity of a leg is to walk, then a person can’t be healthy if the leg can’t walk. But a leg is also used for balance; if you can stand up, but your walking is slightly impaired, are you then ‘healthy’?
Above right: Galen
Courtesy of the US National Library of Medicine

                                                                            
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                                                                                 Xenophon of Athens
Above: Xenophon
Image courtesy https://www.thefamouspeople.com/profiles/xenophon-4212.php
In a book on how to manage your household, Xenophon of Athens has a man called Ischomachus explain:

I begin by worshipping the gods, and try to conduct myself in such a way that in answer to my prayers I may have health and physical strength, esteem in the city, the affection of my friends, safety with honour in war, and wealth increased by honest means (Oikonomikos, 11.8).

Later he gives his opinion on how to stay healthy:
For if a man has plenty to eat, and works it off properly, I think he both insures his health and adds to his strength (Oikonomikos, 10.12).
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                                                                                            Socrates

In another work attributed to Xenophon, the philosopher Socrates asks Euthydemus whether he knows the difference between good things and evil things.
Euthydemus concentrates on diet, answering:
Euthydemus: ‘Well, that’s a simple matter. First health in itself is, I suppose, a good, sickness an evil. Next the various causes of these two conditions—meat, drink, habits—are good or evil according as they promote health or sickness.’

Socrates: ‘Then health and sickness too must be good when their effect is good, and evil when it is evil.’

Euthydemus: ‘But when can health possibly be the cause of evil, or sickness of good?’

Socrates: ‘In many cases. For instance, a disastrous campaign or a fatal voyage: the able-bodied who go are lost, the weaklings who stay behind are saved.’ (Memorabilia, 4.2.31-32)

                                                                                                
Above: Physician treating a patient (Attic red-figure aryballos 480–470 BC)
This file is licensed under the Creative Commons Attribution 3.0 Unported license.
                                                                       Health in Victorian Times
Above: London slums, an engraving by Gustav Dore
Image courtesy of the Wellcome Library, London
                                                                  
In an article in the BBC History Magazine, Rosalind Crone, a senior lecturer in history at the Open University, asks if life was really so grim for the urban poor in the 19th century. Examining aspects of life such as working conditions in factories, surviving poverty, standards of cleanliness, crime statistics and health, she argues that modern assumptions, media sensationalism of the time, and concentration on the worst aspects of Vicotrian society all conspire to give an unbalanced picture of the period.  In addition, some of the undoubted ills were addressed throughout the century. For instance, life expectancy in towns such as Manchester, Liverpool and Glasgow, calculated to be as low in the 1830s and 1840s as in the time of the Black Death, improved through the better understanding of disease, and sanitary measures concerning the supply and disposal of water.
Overcrowding in towns and cities undoubtedly made disease easier to take hold and rapidly spread. Measles, scarlet fever, smallpox and typhus had always existed, but were made worse by poor living conditions. In 1840 40% of urban deaths were due to infectious disease - by 1900 it was 20%
Research suggests that nutrition was good in the middle of the century, with many eating fruit, vegetables, oily fish and grains - the quality of this diet may have deteriorated with the advent of tinned produce and cheap sugar. There was also the problem of adulteration of food, for instance chalk or alum in white bread, and plaster of Paris in boiled sweets.* Regulation of the food industry from the 1860s helped curb some of these practices.
BBC History Magazine, Christmas 2015. For the whole article see http://www.historyextra.com/article/premium/was-victorian-life-really-so-grim

* 1849 Five hundred people in Stourbridge had to receive treatment after consuming bread made with flour adulterated with lead acetate. 'The greatest excitement prevails in this town'.
North Devon Journal 12 April 1849, p8 col3

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                                                       The Peckham Experiment


Above: The new building from 1935, designed by Owen Williams
By Frontrow (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
In 1926 George Scott Williamson and Innes Hope Pearse began a project with the aim of examining positive health as opposed to absence of illness. A social centre - The Pioneer Health Centre - was set up in Peckham, South London, where in addition to participating in sports and recreational activities families also had access to health checks and consultations with the doctors on how the family was functioning.
Demand was so great that the original centre could not cope with the numbers - the centre closed for some years, money was raised and a new purpose-built centre was opened in 1935.
Oakley Farm, Bromley Common was leased to provide the families with organic produce.

This centre incorporated a lot of glass so that doctors could observe the families using it, and because of this the building had to close during the war years because of the danger of bombing. It was re-opened in 1946.
There was wide interest in the project, and it secured money from sources such as the Rockefeller Foundation, but policy-makers focused on the new NHS, which had a different approach to the nation's health*.  The centre closed in 1950.
http://blog.wellcomelibrary.org/2015/04/the-pioneer-health-centre-and-positive-health/


*'The payment of subscriptions, a focus on family rather than the individual and the absence of treatment facilities meant the Pioneer Health Centre did not tally with Beveridge's vision of state-run healthcare. So Williamson and Pearse's utopian creation was simply dismissed.'
http://peckhampeculiar.tumblr.com/post/90054272234/the-peckham-experiment

The study has never been repeated, but had a worldwide impact on people involved in everything from architecture and sport to education and nutrition.
'The experiment concluded that health is more than just absence of disease.' Other conclusions were that health has to be nurtured; that information encourages people to make good choices; and that giving resources to a community both stimulates individual growth, but also leads to people becoming involved with, and in turn aiding that community.
http://thephf.org/peckhamexperiment

In 1947 the documentarist Paul Rotha made a film about the Pioneer Health Centre, which can be viewed here: https://s3-eu-west-1.amazonaws.com/wdl-video-open/mp4/d89dba62-e6b3-4547-9711-e382740fd71a.mp4

After viewing it our group made the following observations:
The film was obviously staged.
To attend the centre people had to be married, and live within one mile of it; they were overwhelmingly (perhaps entirely) middle class. This was probably intentional, to restrict the variables of the experiment - it may also have reflected the assumption that the family was the basic unit of society.**
The film showed one family in particular, and the woman's medical condition was discussed in front of her husband.
The basis of the experiment was observation, not coercion, but the only time people were shown as being unhappy was when for various reasons they were not attending.

** See Peckham and Architecture section 3, Basic Technique, for how the families were chosen
https://www.sochealth.co.uk/1949/09/21/peckham/


See also:
https://www.youtube.com/watch?v=SbIvc-6v8Fo

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                                                                     Modern Health Definitions

 World Health Organization (WHO) in 1948:

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
This was offered as an alternative to an earlier definition: ‘health is the absence of disease’.
Key features of the 1948 version are:
Health is not simply ‘not being ill’.
Health is defined by positive, not negative, aspects.
Health is not merely physical.
No ideal body weight, body mass index, blood pressure or cholesterol level is given

When this definition was written, things were very different from today. The main health issue then was acute illness – a disease with an abrupt onset and, usually, a short course – but since then, standards of diet and hygiene have improved, and so have medical interventions.

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 In 2011 an international group of health experts proposed that the WHO definition was ‘no longer fit for purpose given the rise of chronic disease’.
They didn’t like the word ‘complete’ – who is ever completely healthy?
Furthermore, just because test results show some abnormality, this doesn’t mean it will ever make you ill.
They questioned how health is measured:
what is important, how many years you live, or how fully you can take part in society until you die?

Their suggested definition of health was ‘the ability to adapt and to self manage’.


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