A definition of health.

I was asked, indirectly, to respond to the question “Why do you think you’re healthy?” Definitions of health are important to me, as I’ve spent a lot of time in school and at my job considering what it means to be “healthy,” and watching how those definitions play out in real life. This is what I came up with.

I am professionally involved in nutrition, so I have a good understanding of food and exercise. I walk at least two miles a day, in all kinds of weather. I don’t drive or take public transit. I eat a varied diet that balances immediate pleasure with longer-term well-being. And all of that is really no one’s business but my own. It represents a mere drop in the bucket — you’d be surprised how many more determinants of health there are than just lifestyle.

What really makes me healthy is that I refuse to allow my health status to be dictated by my weight. I don’t regularly weigh myself. I don’t diet. I don’t engage in punitive or boring exercise. I don’t read women’s magazines. I try to avoid influences, like advertising, that tell me I am not good enough as is, and need to buy X product to be a complete person. I believe in my own beauty aesthetic, and dressing in the way I like.

I’m a feminist and a believer in social equality, so I stand up for myself, and for other people. I don’t believe in blaming people for their own health problems, because even in the rare cases where someone may be at fault, it is not a useful or compassionate response. I believe in kindness not because I am wimpy, but because it is right. And I don’t believe people have a responsibility to anyone but themselves to manage their lifestyle and physical health as they see fit.

I’m healthy because I say so. In school, we studied the various definitions of health, developed over years by the World Health Organization, and then came up with our own definitions. Having worked in health care, I can tell you that a diagnosis of disease and good health are not mutually exclusive. I believe someone’s health is determined by how well they are able to cope with whatever life throws at them, with whatever circumstances they happen to be in. By my definition, people who are physically well, but continually worried about death and disease, are not healthy. Someone who lives with a disease, managing it and maintaining a meaningful and enjoyable existence, is far more healthy.

For a midterm I once had to write on the definition of health, I explained it this way:

I would wager a bet that no one — no one now, and no one at any point in history — has ever enjoyed perfect health. Yet we persist in dividing the population into sick people and healthy people. At any given point in history, and in any given culture, what constitutes illness is at the mercy of subjective interpretation. In reality, we are all ‘sick’ to some degree. The difference exists only in that we decide whom to call ‘sick’ and whom to call ‘well.’ Because of this rather arbitrarily placed point on the seamless continuum of health, I propose that our definition of health should have less to do with how sick or well we are, and more to do with how we live inside and with our unique physical condition.”

I believe this because physical health itself is often just a crapshoot. And I believe it’s a crapshoot not because I’m fat and it’s convenient to think so, but because I learned it the hard way, by working at a cancer hospital filled to the brim with young, formerly healthy people. People, who by most definitions, did everything “right” — and were rewarded for that with an agonizing, deadly disease.

That said, I have no diseases that I’m aware of. I’m young, able-bodied, and I live in a fabulously wealthy country with medical care and a food supply that is the envy of much of the world. I’m part of a privileged social class. I have a strong social support network that includes family, friends, and my husband. Aside from being fat, I have no physical traits that mark me for social censure. Being aware of how undeservedly fortunate I am, and working to make human society more equitable, keeps me healthy.

I don’t think BMI is flawed only because it fails to measure muscle mass, or only because it is a population-based epidemiological tool that has been inappropriately co-opted as an individual diagnostic, or because it insults attractive people by calling them ‘overweight’ — but because it reinforces a very destructive belief: that you can make assumptions about a person based on their body size. That you can assume they are unhealthy, or that there is a ‘correct’ size/weight to be, and the subtextual conclusion that weight and health status define a person’s worth. That people on the fringes of the chart are freaks, not even entirely human. That it is okay to diagnose people as ‘diseased’ for not meeting an arbitrary beauty standard. And that traits associated with disease, whether causally or not, can be legitimately treated as diseases in their own right.

Whether or not someone is healthy, and however much they weigh, however fat or thin they appear, they are human. They have rights, and they deserve compassion, or at least basic dignity. Humans are naturally physically diverse — it is a strength of the species that helps protect us from total extinction should some natural catastrophe come calling. We should not dedicate our time and resources to eradicating a certain group of people, or trying to eliminate the natural variation of our population. Simply put, to do so is not healthy.

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