What is health, really? Is health itself a state of being? A set of behaviors? A performance? Is health a delicate balance between an individual, genetics, and environment? What we do know, is that if you ask 10 people what health means, you’ll get 10 different answers. There are multiple realms of health - physical, emotional, social, spiritual, mental - any of which may be more important to you than another. There may even be aspects of life that are more important to you than health, like personal goals or values. And that’s the point - whatever it means, health is personal!
Now, what is healthism? The term healthism was first coined by Richard Crawford in 1980. He defined healthism as the increased pervasiveness of health to all areas of life, and the promotion of health to a super-value that allows moral judgment. He argued that health was inherently political and due to healthism, the definition of health has become so strict that risk factors for disease are now viewed as almost equivalent to disease itself, as they threaten risk of future disease.
Today, you’ll more often see healthism masquerading as diet culture, or even more recently – wellness culture.
Healthism makes many assumptions. It assumes that weight loss or organic produce or the latest influencer craze is healthy. It assumes that everyone has the same definition of health and should obviously be striving for that. It assumes that people have nutritious and affordable food available, the time to engage in enjoyable movement, the finances to support their food, exercise and time choices, and the social landscape that provides access to health resources. This leads to oppression of marginalized groups who can’t fit those assumptions.
A key part of healthism is the moralization of behaviors as right or wrong, and foods are good or bad. Do these lies sound familiar? We’re looking at you, diet culture! But even more pervasive in its costume of wellness culture, healthism demonizes practices like processing food, preservatives, or sugar as “toxic”.
Above all, healthism is the moral responsibility to seem healthy to others.
Healthism has seriously negative effects, on both a societal and individual level. Healthism directly leads to stigmatization, misplaced responsibility, barriers to true health, oversimplification, and marginalization.
Healthism creates stigma because it increases shame and reduces access to care, as well as causing psychological distress, social exclusion, and less employment opportunities. This stigma leads to marginalization. There are negative inferences made about fat people in the workplace, that they are lazy or less competent (so untrue, ugh!). Fat individuals are also less likely to access healthcare due to shame, and less likely to receive bias-free care, which is a true detriment to health.
Placing too much responsibility on an individual frees politicians or healthcare specialists from their accountability, potentially blocking necessary reforms. Healthism blocks empowering, shame-free, and truly holistic health promotion.
This creates an opportunity cost of the missed methods to increase health for all. Healthism is deceptive, it misdirects the public about appropriate healthcare interventions or behaviors. This is accomplished through social marketing imbued with oversimplified and moralistic messages that lead to perfectionist thinking. Think about those posts that say, “eat this, not that”. And at the end of the day, commitment to an overly strict health practice characterized by self-discipline could be just as mentally stressful or physically demanding as any perceived benefit.
So let’s recap. What is health again? Well, it’s personal! What does a healthy life look and feel like to you? Your own answer to this question is more likely to point you in the right direction than moralistic health messages or the latest wellness trend. Use your own values and the dimensions of health to create a vision of health that feels intrinsic and sustainable to you.
It’s not that there are no health truths, but rather that these truths are more complex than moralizing public health messages. Public health nutrition information is designed to be extremely simple and easy to digest. This definitely has its place, but is not very helpful when you're trying to make a personal health decision. Incorporating more fruits and vegetables, variety, fiber, hydration, and joyful movement in your life all have proven health benefits, but just saying those facts doesn’t include the personal context that is necessary to integrate any health behaviors. If you’re struggling to implement the health promoting behaviors you care about, it may be time to seek the help of a dietitian!
If you only take away one thing from this article, let it be this – the definition of health is, and should be, personal. Health is defined by your values and the context of your personal life. There definitely are some helpful health behaviors, but that doesn’t mean everyone should always, or ever, be pursuing all of those things. A health behavior must fit within your values and context in order to be important and possible for you to implement. What health is not? Weight loss, blanket statements, black and white, assumptions, or a responsibility. And allowing health to be defined by these constricting and unhelpful boundaries creates stigma, marginalization, and the opportunity cost of true health.
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