2.1 Defining wellbeing
Wellbeing has become popular among policy makers as a generic term that embraces physical, mental and emotional health. Is this simply a matter of changing fashions in terminology or does it reflect particular assumptions about what it means to be healthy? Moreover, does the term have particular meanings when used in relation to young people? In this section you will analyse current ideas about what constitutes wellbeing for young people, and work towards producing a critical framework for understanding young people's health.
An early use of the term wellbeing as a synonym for health can be found in the definition adopted by the World Health Organization (WHO) in the years following the Second World War:
Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.
What work is the word ‘wellbeing’ doing in this definition? First, it signals an attempt to bring together different aspects of health – principally the physical and the mental – and to demonstrate the connections between them. This is an implicit criticism of earlier, medical models of health which had viewed these areas as discrete and unconnected. Second, the use of the word wellbeing reinforces the sense of health as a positive concept – a state of ‘wellness’ – rather than the mere absence of illness. Once again, there is an implicit criticism of a negative, medical focus on health ‘problems’. Third, the use of the word wellbeing represents an attempt to broaden the scope of what is meant by health, so that it includes not only physical and mental health but also what is here called ‘social’ wellbeing. Presumably, this means a sense of ‘wellness’ not only within the person but also in their social environment. This reflects an assumption that the causes of health, and of ill health, are not only located within the individual (as in the medical model) but also depend crucially on social factors, such as material resources (e.g. money) and social relationships. There is an implicit recognition here of the part played by social disadvantages such as poverty in many people's experience of poor mental and physical health.
Writing in support of using the notion of wellbeing in public policy, Hetan Shah has argued that ‘an incredible amount is spent on our “health” service, but most of it focuses on dealing with physical symptoms of sickness’ and that ‘we need to reconfigure the purpose of the system in order to promote wellbeing’ (Shah, 2005, p. 39). Other writers have argued that the holistic concept of wellbeing is more in keeping with the way in which health is seen in the majority of societies and cultures in the world, than is the Westernised medical model (Svalastog et al., 2017).
However, some commentators have been more cautious about adopting the positive model of health implied by the term wellbeing. Drawing attention to the emphasis on ‘complete … wellbeing’ in the WHO definition, at least one writer criticised this model at the start of the millennium for presenting an idealistic counsel of perfection that ‘puts health beyond everyone's reach’ (Lewis, 2001, p. 59). How many people can claim to have experienced a ‘state of complete physical, mental and social wellbeing’, and is such a state desirable? Arguably, promoting this ideal as a standard puts pressure on individuals to constantly strive for its vision of perfection, and to be forever dissatisfied with their current state of health. Thus, a holistic model of wellbeing, while appearing to present a more social vision, may paradoxically promote an individualised approach in which good health is not only every person's right, but also their personal responsibility.
Certainly, it can be argued that much recent health related policy, with its promotion of healthy lifestyles and ‘taking control’ of your own health, seeks to shift responsibility for health on to individuals and away from society as a whole. Some critics have seen this as part of more general attempts to ‘responsibilise’ individual citizens in a number of areas (Buyx and Prainscak, 2012), a notion you will return to later in the course.
How does this movement away from a medical model of health and towards a positive and holistic model of wellbeing relate to the experience of young people, and to the ways in which their health has been discussed and promoted?