Health and Well-Being

Abstract

The concepts of health and well-being are deeply intertwined and interdependent. Situating both health and well-being within a unified framework is important to ensure their inclusion in the full spectrum of health research and to achieve the crucial task of building a body of basic, translational, and clinical studies to guide the implementation of whole-person health care. This commentary proposes such a framework where an individual’s own assessment of their physical, emotional, and spiritual well-being complements objective measures of their physical and psychological function and where social, environmental, economic, educational, and vocational well-being are located within positive determinants of health.

“Health” and “well-being” are often mentioned in the same breath as 2 concepts joined at the hip—distinct and somehow related, but with a relationship that can be hard to pin down. Is well-being a part of health, health a part of well-being, or are they part of one another? And why does the distinction matter, if at all? This commentary will examine the relationship of health and well-being and propose a framework that can accommodate both to further refine our understanding of whole-person health.

The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” This definition emphasizes that an understanding of health based exclusively on the absence of disease would be missing something important. This important component of health (well-being) is based on a person’s own subjective assessment, in addition to the “lack of disease” component, which would be based on objective evaluation, including a medical history, physical examination, and laboratory tests.

This definition of health, created by the WHO in 1946, reflected a desire to prevent or correct an overemphasis on disease-focused diagnostic tests and a relative lack of attention to the patient. In the ensuing decades, growing use of the biopsychosocial model of care and patient-centered research has helped address this concern. More recently, the National Academies of Sciences, Engineering, and Medicine published a report in 2023, Achieving Whole Health: A New Approach for Veterans and the Nation, in which whole health is described as “physical, behavioral, spiritual, and socioeconomic well-being as defined by individuals, families, and communities.”¹ This exclusively subjective definition of whole health is in line with the US Department of Veterans Affairs emphasis on “what matters to the patient, not what is the matter with the patient,” which focuses on patient-reported factors, as opposed to objective measurements such as lab results and diagnostic imaging.²

To be sure, health care systems and providers will miss the mark in optimizing health if complex human beings are reduced to a list of numbers and indicators like blood pressure, cholesterol and genetic variants. However, something else may be lost when a person’s picture of health is informed only by their own assessment of their physical, emotional, and spiritual status. Objective measures provide critical signals of faltering health or individual risk, which can manifest silently while a patient may feel “fine.” Objective measures (eg, blood pressure, HgbA1c) can function as indicators of whether an individual is moving from a healthier to a less healthy state or vice versa. Underemphasizing such measurements that are important not just for guiding ongoing health care decisions but also for preventing serious long-term complications (eg, stroke, diabetic retinopathy) will lead to missed opportunities to improve health over the lifespan.

At an even more fundamental level, including objective measures of function (physiological and psychological) as an integral component of health, in addition to well-being, is necessary to link clinical research with basic mechanisms of health and disease. The current trend emphasizing the patient is laudable, as it focuses on the end result of what we want to achieve in health care—what is experienced by the patient. However, in doing this, we risk creating obstacles to the very integration that whole-person health aims to promote—one of these risks being disconnecting clinical from basic and translational research. Human beings are increasingly understood as being part of a complex multiscale ecosystem, within which an individual’s physiology is connected, via their behavior, to their social and physical environment. A striking example of these interconnections is our microbiome, which we now understand is intertwined with that of our family members, as well as the soil in which the plants we eat are grown. Basic physiological processes, such as the ability to absorb and metabolize food constituents, grow, and repair injured tissues, are part of health itself, not “determinants” of health. Current efforts to develop methods to study mechanisms of health restoration (salutogenesis) in multiscale networks require that the bidirectional health-disease continuum be examined within the entire network as a system. For example, blood pressure is the manifestation of a complex process involving cardiac output, extracellular fluid volume, renal, and endothelial function, as well as stress responses and physical activity. In this context, “lab results” are not only measurements that we act upon to direct patient care. They also measure the health of the system.

Figure 1 illustrates a framework built by starting with components of health and well-being that relate to an individual’s body, mind, and spirit, and then placing these components in the individual’s wider social and environmental context. This framework includes (1) an individual’s own assessment of their physical, emotional, and spiritual well-being, which complements objective measures of their physical and psychological function; (2) social, environmental, economic, educational, and vocational well-being, located within positive determinants of health³; (3) health-related behaviors, at the interface between the health of the individual and the social and environmental factors that affect health.

FIGURE 1.

Framework situating the various components of well-being in relation to health.

Situating well-being within such a comprehensive framework is important to ensure its inclusion in the full spectrum of health research and to achieve the crucial task of building a body of basic, translational, and clinical studies to guide the implementation of whole-person health care. Achieving this goal will require the development of whole-person health measures that capture an individual’s health trajectory over time, including patient-reported measures of well-being, as well as objective measures of function. The Center for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) are currently working together to create an integrated patient-centered self-report measure with broad applicability across the research and clinical spectrum. In addition, the National Center for Complementary and Integrative Health is leading a trans-NIH effort to facilitate the organization of “big data” into a comprehensive whole-person knowledge network and associated common data elements that aim to provide an integrated measurement of how the whole “physiome” can change over time, either toward or away from health.^4,5 This network will initially begin at the physiological level and, once established, will be able to grow to include a “full stack” of measures spanning biological, behavioral, social, and environmental domains. Together, these efforts will ensure that biomedical research is fully aligned with clinical efforts to support the care of the whole person.

CONCLUSIONS

As health care increasingly moves beyond treating diseases to encompass promoting health and well-being of the whole person, a clear understanding of how health and well-being relate to one another is essential. The schema presented in this paper and illustrated in Figure 1 will hopefully assist in this important task.