Health can be defined as ‘the ability of an individual to mobilise his resources, physical, mental and spiritual, to the preservation and advantage of himself, his dependants and the society to which he belongs’. Health is thus a state of preparedness for activity to ensure personal survival and achievement while at the same time safeguarding human relationships, especially in the family.
The way in which a person uses this ability is not necessarily one which will be beneficial and is of course influenced by many personal and environmental factors. However, such is man’s ‘make up’ that continuing misuse of resources will result in their deterioration with failing health and ultimate destruction.
The ability to mobilise resources advantageously is therefore dependent upon the extent and quality of those resources which accordingly reflect the degree of ‘health’. Where resources are inadequate they cannot be successfully mobilised and ill-health results.
Resources are either inherited or acquired. At conception the fertilised ovum is provided with a genetic blueprint for its development embodying characteristic trends from both parents and their ancestors. The fertilised ovum is thus the investment for the survival of the species and a manifestation of the immortality of protoplasm.
The genetic blueprint, it must be emphasised, is designed for living in a wholly natural environment in which survival is largely dependent on physical strength and swift reactions. Physical resources, providing adequate nutrition is available, are programmed for activity. Without activity atrophy is inevitable. Thus, in an affluent society, where there is a lessening demand for physical effort, the built-in drive, designed to maintain an adequate muscular growth, must, unless met by satisfying planned activity such as sport, lead to aggression and violence. Life itself is the ongoing manifestation of the continuing inflow of energy from the sun to the earth in biological evolution. Man absorbs an almost measurable amount of energy from food and oxygen whose intake is somewhat automatic. His metabolism demands the expenditure in positive activity of sufficient energy to balance the equation. Man’s physical resources thus provide an extensive and highly efficient locomotor system with groups of muscles in a highly mobile skeletal system crying out for regular and coordinated usage under the strict control of an equally advanced nervous system both reflex and conscious. Much activity is provided in everyday contact with the environment though this may be less demanding with mechanical alternatives to human effort. Thus if the physical resources are to be maintained at an optimal standard their continuing exercise must be assured.
Unfortunately, health has been regarded as synonymous with physical or muscular development; ‘physical fitness’ being the key to good health. Equally important, however, are the sensory organs of the body whose care and exercise is essential to ensure the smooth and continuing acceptance of a summated sensory intake from the environment. Such a sensory input is necessary for the efficient working of both the mental and spiritual resources.
Similarly, mental resources are programmed in the genetic blueprint for survival of the individual, to assess the promises and threats of the sensory intake, to secure food and shelter, to find a mate and to provide for children. Experience from generations of trial and error and an ability to cooperate with other members of the species have produced exceptional development of mental resources. This has enabled man to exploit for his advantage the extensive potential of the natural environment. Storage and re-call of information, memory, is one of man’s greatest assets enabling him to accumulate knowledge and use it in coordinating incoming data with outgoing motor activity. Muscular response, vocal communication, the use of equipment and technology are the direct results of mobilising his advanced mental resources.
Mental resources are today becoming of greater personal importance than the physical ones. If the human race is to survive it must ensure that a reasoned use of motor energy is maintained by controlled activity to avoid outbursts of violence. Mental and physical resources are entirely complementary and must be exercised together. To maintain health each must be exposed to a minimum standard of usage.
Finally the third resource, ‘spiritual’, is the most difficult to define and yet the most important. However much mental resources may develop, each person maintains a unique individuality. To what extent spiritual resources are influenced by the genetic blueprint is not known but curiosity most certainly is an inherited human trait.
The spiritual aspect of life is found in attachment to a creed or code of practice, in beliefs which are stepping stones to truth, and a faith that there is some finite purpose in living. It is manifest in motivation and maturity, in affectionate regard for others, and an appreciation of the responsibility to use the more tangible resources not only for self-preservation but for the advantage ofdependants and fellow human beings. It is a commitment to competitive and abundant living sometimes described by sportsmen as ‘heart’.
In an age where man is caught up in the turbulent wake of advancing technology he becomes increasingly dependent on the strength and integrity of his spiritual resources.
The assessment of health
Medicine has been more concerned with the treatment of the sick than the care of the healthy and the assessment of health has been more concerned with physical examination for fitness for specific activities, e.g. service in the Forces, strenuous games, hazardous occupations, routine examinations for life insurance. More recently regular screening for specific illness such as cancer and heart disease has gained popularity with executive personnel in industry and others with specific responsibility.
In the field of sport, particularly the professional, assessment is important both in the maintenance of an ongoing standard of health and as a check on fitness immediately before competition. Boxing provides us with a good example.
Today, there is an increasing need for a wide acceptance and availability of health assessment, a need to divert some proportion of medical expertise away from the sick to the healthy as a more positive approach to preventive medicine. Any examination however will only reveal the health at the moment of investigation and follow-up is essential, I.e. assessment followed by regular monitoring. Screening, if presented as the sole object, may produce hypochondriacs. It should be no more than a bonus of the assessment and monitoring programme ensuring that where necessary a small proportion of those examined would be referred to conven- tional medicine for investigation and any necessary treatment.
Full health evaluation must include a wide range of physical tests for all systems, motor, sensory, metabolic and coordination with considerable aptitude testing, I.e. practical tests of the ability to mobilise resources for a variety of realistic tasks. Biochemical, haematological, radiological and other laboratory procedures are available to assist the examiner. Complete examination of the nervous system must be supplemented with investigations of mental aptitude, memory and decision making. Psychological probing can be valuable and revealing, particularly with a confident and confidential person-to-person session.
Finally, the spiritual resources must be considered with a frank assessment of the quality of life; affectionate regard for others; status, wealth, possessions and achievement; skill and knowledge, motivation and morale; attitudes to work, rest and recreation, and above all faith and philosophy. A simple scoring system could be adopted for the whole investigation and all the results used to form a basic profile for subsequent monitoring. Correlation can frequently be found and maintained between the profile and the continuing life style.
When resources cannot be mobilised to maintain survival and they themselves deteriorate or are damaged, ill-health is assumed. Without therapeutic intervention this state will progressively worsen.
The resources are, however, interdependent and failure in one area can be compensated by increased support from elsewhere. For example, gross physical deformities can be overcome by mental re-adjustment and spiritual strength so that a handicapped person can maintain good health. Man’s diseases can similarly be compensated for, and life enjoyed with advantage.
The maintenance of health throughout the normal life span can only be impaired by birth deformities, malnutrition, ageing, illness and injury. In the developing and productive years of life it is illness and injury which are largely responsible for ill-health and death. Prevention is therefore closely associated with health assessment and medical services might well re-orientate their activities to health maintenance with facilities for active intervention when things go wrong, I.e. a new and positive dimension in health care.
For practical purposes illness and injury can be considered together. Each may produce distress, pain, disability and tissue damage. Each involves the whole person and each demands assessment, therapeutic intervention and appropriate rehabilitation. Each involves personal and environmental factors and the influence of chance. Each invites an epidemiological approach to control and elimination.
If man is to enjoy the health which gives him, his dependants and society continuing advantage he must find a compromise to his dual role. On the one hand he is a very private and unique individual with innate urges of aggressive selfishness seeking advantage for himself. On the other hand he is a member of a constantly changing and often hazardous environment of which his fellow men are also active participants. His health thus depends on the sympathetic interplay of three forces . This gives the pattern for epidemiological investigation, with the maintenance of health in mind, of illness or injury.
Similarly, taking the individual as the starting point for management of illness or injury, I.e. ill-health, a similar pattern emerges .
THE ACCIDENT (INJURY OR ILLNESS) EQUATION The use of the word ‘accident’ (’an untoward event without apparent cause’) is perhaps unfortunate but it is nevertheless generally accepted as involving injury. In the sporting world ‘injury’ is a more formal and acceptable term as indeed it would be in any epidemiological investigation. The formula, equally applicable to injury and illness is: where T represents the incident, injury, illness or even accident; ‘C’ represents chance and ‘E’ the environment, both of which may be favourable or unfavourable as far as the cause of the incident is concerned.
Factors which are known to be contributory are p, r and f which respectively represent accident proneness, risk acceptance and personal failings which are usually temporary.
Lessening the impact of the situation and helping towards prevention are t, m and s, signifying training, maturity and safety precautions.
This equation is more symbolic than mathematical but it can be modified to allow a scoring procedure for an incident research programme. The interpretation is made on the following lines and is particularly applicable to sporting activities.
Chance is the random coincidence of time and place. It plays a vital part in both physical and biological evolution and adds much to the interest and excitement of sport and recreation. Experience can help estimate the probability of events but the purely random factors cannot be forecast. If they could, life and evolution would come to a grinding halt!
As far as injury is concerned in the United Kingdom the average person has, in any week, an 8000 to 1 chance against being seriously injured. Injury however gives no protection as far as chance is concerned and the odds remain the same for the survivor in subsequent weeks.
The environment is natural or man made. The former includes all the hazards of land, sea, air and outer space. Some areas may not even sustain life. Animal and vegetable life is also an essential part of the natural environment and includes man himself.
The man-made environment is of great significance including shelter, work place, sports arena and the many agents associated with modern life, weapons, vehicles, machines, clothing and so on. Man may come to terms with his environment and use its properties for safety and survival or on the other hand he may be caught by its hazards and succumb to injury or disaster. He may create a personal environment or ‘with-around’ ofprotective clothing and life-support systems to improve his chances of survival. In sport the breathing apparatus and suit of the underwater swimmer is a good example.
Accident proneness (p) is currently a reality. Increased vulnerability to accident and injury (and indeed illness) is common in a society where the pace of life leads to frustration, anxiety, and instability.
The normal reaction of a healthy man to an emergency, sudden threat or crisis is a natural call on reserves with adrenaline output, increase in heart rate and respiration, improved muscle tone and sensory awareness, I.e. an increased state of readiness with anxious-ness and anticipation, which returns to normal after the crisis has passed. However, in conditions of continuing stress and harassment the reserves are already in demand. When the further crisis occurs there is little left to call upon and in extreme cases the result is panic, a common prelude to accident and injury.
The acceptance of risk (r) is a natural human character. In the crudest situation, risks are taken for survival, to obtain food, and for mating. In a more rational society they are taken for personal gain, for praise and adulation or simply for the thrill and enjoyment of the experience, I.e. for fortune, fame or fun.
Risk taking is a very personal factor influenced largely by local opportunities and responsibilities. In sport it is available at all levels from gentle activities to dangerous highly competitive events such as car and motor-bike racing. High risk sports attract high rewards, glamour and real excitement. The dangers are accepted but with codes of practice offering some protection.
Many other human factors or personal failings (f) increase vulnerability to injury. Most of these are temporary, such as illness, the incubation or post-febrile state of an infection, alcohol, drugs, hangover, hunger, fatigue, anger and the day-to-day physical and emotional upsets which are so common. The performance of a sportsman can be greatly reduced by such occurrences and the likelihood of injury increased.
Training (t) is fundamental to any human activity and is possibly the most important single factor. It is closely associated with health. A person in good health is able to be trained for almost any activity. In the wide variety of sports, training may demand attention to selected muscle groups and reflexes but at all times this must be supported by a high standard of efficiency in all physical, mental and spiritual systems to achieve the best results.
Maturity (m) is not just the experience gained with age but a state of high motivation and understanding which ensures a coordinated and productive use of resources. Economy of effort aids endurance and emotional stability ensures success. Skills are more flexible and adapt with ease to changing circumstances and demands. In sport, maturity may follow the physical triumphs of youthful endeavour to give help and example to the less experienced.
Finally, the safety precautions (s) or codes of practice are at the end of the list. Though essential for the protection of learners, the young and the elderly, they must be applied with care lest they interfere with production and enjoyment. All too often in a highly competitive commercial world they are used in place of training. Employers may also be pressed to take excessive precautions for fear of litigation. In sport a compromise is needed and usually achieved by introducing rules which give equal opportunity to all competitors, fair play and a degree of personal safety to encourage adequate participation.
Safety precautions are but one area in a wide range of personal, environmental and chance factors. In the investigation of injuries in sport and elsewhere there is invariably evidence of the summation of many predisposing factors with one being responsible for the final nudge into catastrophe. Unfortunately many investigations seek to apportion blame and fail to look beyond the immediate cause to the background of events which gradually build up to the final critical pattern.
A FORMULA FOR HEALTH
Life is an ongoing positive experience and too much attention to illness, injury and prevention may detract from enjoyment and achievement. In seeking better health and quality of life it is possible to apply the same factors with advantage. Only the simplest change in the formula is needed thus- with *H’ for health substituted for T:
H = CE^ prf
The formula is applicable to any human activity and ideal for sporting and recreational occupations. If man’s genetic blueprint demands a continuing state ofgood health, all systems-physical, mental and adventure activities will be increasingly necessary to spiritual – must be exercised in harmony. Where much ensure the well-being and quality of life for the human of the physical activity associated with productive work race. is being replaced by machines and technology, reward- The maintenance of health is essential. It can and ing alternatives must be found. Sport, recreation and must be given absolute priority.