WHY MEN DIE YOUNG

The extra longevity of women in our society is well established.  In fact, the difference in life expectancy for male and female infants born today is projected to be 80 years for females, but only 75 for males.  This five-year difference has commonly been attributed to genetic factors.  However, new evidence demonstrates that this discrepancy may be affected more by male behavior rather than genetic traits.

Men outrank women in all of the top fifteen causes of death except for Alzheimer’s disease.  Men’s death rates are twice as high for suicide, homicide, and cirrhosis of the liver.  In every age group, American males have poorer health and higher risk of mortality than do females.  Common increased risks include:

·         More men smoke than women.

·         Men are twice as likely to be heavy drinkers, or to engage in other risky behaviors such as abusing drugs and driving without a seatbelt.

·         More men work in dangerous settings than women, and men account for 90% of on the-job fatalities.

·         More men drive SUVs that are rollover prone, and suffer fatalities in motorcycle accidents.

Perhaps some of these increased risks are associated with deep-seated cultural beliefs about men’s bravely and machismo, which reward them for taking risks and facing danger head-on.  This “macho” attitude seems to extend to the care that men take of their own physical and mental health.  Women are twice as likely to visit their doctor on an annual basis and explore preventive medical treatments as are men.  Men are more likely to ignore symptoms and less likely to schedule check-ups or seek follow-up treatment.  Psychologically, men tend to internalize their feelings or stress or even self-medicated to deal with stress, while women tend to seek psychological help.  Almost all stress-related diseases are more common in men.

In the final analysis, men and women alike must be responsible for their own health and well-being.  By making sound choices regarding diet, exercise, medical care, and high-risk behaviors, both genders can attempt to maximize the full potential of their life expectancy.

DEFINITIONS OF HEALTH

By the time they reach college age, most Americans are familiar with the many ways in which health care is provided.  Here are easily recognizable examples, all of which serve to reinforce our traditional definitions of health.  As you will learn, these definitions are centered in the cure or management of illness and the extension of life.  Note the concerns over morbidity (pertaining to illness and disease) and mortality (pertaining to death) present in the descriptions that follow.

Episodic Health Care

The vast majority of Americans use the service of professional health care providers during periods (episodes) of illness and injury, that is, when we are “unhealthy”.  We consult providers seeking a diagnosis that will explain why we are not feeling well.  Once a problem is identified, we expect to receive effective treatment from the practitioner that will lead to our recovery (the absence of illness) and a return to health.  If we are willing to be compliant with the care strategies prescribed by our practitioner, we should soon be able to define ourselves as “health” once again.

The familiarity of episodic health care is evident in the 823.5 million times that Americans visited physicians during 2000.  Although some of these visits were for preventive health care (see discussion on page 5), the vast majority were in conjunction with illness.  When viewed by racial groups, Whites averaged 3.2 visits, Asians 2.9, Blacks 2.1 and Native Americans 0.8 visits during that year.

KEYS TO LONGER LIVING

Experts generally agree on basic lifestyle characteristics that support greater longevity and, hopefully, a higher quality of life.  Small adjustments that promote this improvement include:
·         Testing your cholesterol level regularly and taking a 30-minute brisk walk every day.

·         Wearing a seat belt in the car and a helmet while riding a bicycle, motorcycle, or while skating.

·         Substituting olive oil instead of butter.

·         Quitting smoking or at least reducing the amount of tobacco used daily.  Lung cancer is the most frequent cause of cancer-related death in the United States.

·         Avoiding sun exposure from 11 am until 2 pm when UV radiation is most dangerous.  Stay inside during those peak hours and always wear sunscreen outdoors.

·         Asking questions of your doctor or pharmacist about concerns, test results, diagnosis, or treatments.  It is often helpful to take someone with you to important appointments.

Don’t worry! Even if everyone was overly cautious, we would still not live in a risk free world – unnecessary worry can stress the mind and body.

Preventive or Prospective Medicine

Simple logic suggests that it takes more sense to prevent illness than to deal with it through episodic health (medical) care.  This philosophy characterizes preventive or prospective medicine.  Unfortunately, however, many physicians say they have little time to practice preventive medicine because of the large number of episodically sick people who fill their offices every day.

When physicians do practice preventive or prospective medicine, they first attempt to determine their patient’s level of risk for developing particular conditions.  They make this assessment by identifying risk factors (and high-risk health behaviors) with a variety of observational techniques and screening tests, some of which may be invasive (taking tissues from the body such as a biopsy or blood draw).  Additionally, an important tool in assessing risk is an accurate family health history, something that over one-third of all adults cannot adequately provide to their health care providers.

Once they have identified levels of risk in patients, health practitioners try to lower those risk levels through patient education, lifestyle modification, and when necessary, medical intervention.  Continued compliance on the part of the patients will result in a lower level of risk that will continue over the years.  Note that preventive medicine is guided by practitioners, and patients are expected to be compliant with the direction they are given.

Although preventive medical care appears to be a much more sensible approach than episodic care in reducing morbidity and mortality, third-party payers (insurance plans) traditionally have not provided coverage for these services.  Managed health care plans that earn a profit by preventing sickness, such as health maintenance organizations, or HMOs should be much more receptive to the concept and practice of preventive medicine.

HEALTH PROMOTION

Throughout the United States, YMCA/YWCA – sponsored wellness programs, commercial fitness club, and corporate fitness centers offer risk-reduction programs under the direction of qualified instructors, many of whom are university graduates in disciplines such as exercise science, wellness management, and health promotion.  Using approaches similar to those employed in preventive medicine, these nonphysicians  health professionals attempt to guide their clients toward activities and behaviors that will  lower their risk of chronic illness.  Unlike preventive medicine, with its sometimes invasive assessment procedures and medicine, with its sometimes invasive assessment procedures and medication-based therapies, health promotion programs are not legally defined as medical practices and thus do not require the involvement of physicians.  In addition, the fitness focus, social interaction, and healthy lifestyle orientation these programs provide tend to mask the emphasis on preventing chronic illness that would be the selling point of such efforts if they were undertaken as preventive medicine.  In fact, it is likely that people receiving health promotion in these settings do not recognize it as such.  Rather, they are only submitting to assessments and listening to health – related information as incidental parts of personal goals, such as losing weight, preparing for their first marathon, or simply friends for lunch hour basketball.

COMMUNITY HEALTH PROMOTION

In addition to the practices just described, a group – oriented form of health promotion is offered in many communities.  This approach to improving health through risk reduction is directed at empowering community groups, such as church congregations or a neighborhood association, so they can develop, operate, and financially sustain their own programs with little direct involvement of health promotion specialists.

The key to successful community – based health promotion is empowerment.  In the context of health, empowerment refers to a process in which individuals or groups of people gain increasing control over their health.  To take control over health matters, individuals and groups must learn to “liberate” themselves from a variety of barriers that tend to restrict health enhancement.

Empowerment programs have produced positive health consequences for individuals and groups that traditionally have been underserved by the health care system, such as minority populations.  Once such people are given needed information, inroads into the political process, and skills for accessing funding sources, they become better able to plan, implement, and operate programs tailored to their unique health need.  In many communities, empowered people have organized grassroots campaigns to prevent neighborhood violence, improve childhood nutrition, promote healthy lifestyle, or prevent drug use among youth.  When successful, these programs stand as excellent examples of the reality that people can make a difference when they become empowered. 

Healthy People 2000 and Healthy People 2010

To identify all of the health-related concerns identified by members of the health community would be a monumental undertaking far.  However, in 2003, the institute of medicine released a list of priority health concerns that they believed need particular attention.  Among these priority concerns are:

·         Treatment of asthma

·         Coordination if care for the 60 million persons with chronic health conditions.

·         Reduction in the development of diabetes.

·         Development of evidence-based cancer screening.

·         Enhanced rates of immunization, particularly for flu and pneumonia.

·         Improved detection of depression, which is now inadequately diagnosed and treated.

·         Aggressive promoted prevention of cardiovascular disease, presently the leading killer of American adults.

·         Concerted efforts to reduce the rate of nosocomial infections (infections that occur as a result of medical care) that kill an estimated 100,000 Americans annually.

·         Reduction of tobacco dependence through cessation and prevention of smoking.

·         Widened availability of prenatal care.

While improvements in these areas are greatly needed, the Institutes of Medicine have no specific programs in place at this time to address them.  In comparison, a well-established and ongoing program, Healthy People 2000, has established specific goals and objectives to improve the health of Americans in many of these areas.  A brief description of this ongoing program follows.

In 1991 a U.S government document titled Healthy People 2000: National Health Promotion and Disease Prevention Objectives outlined a strategic public.  The plan included 300 health objectives in twenty-two priority areas.  Forty-seven of the 300 objectives were defined as “sentinel ones, that particularly significant goals that could be used to measure the progress of the 1990s health promotion objectives.

Progress toward achieving the objectives was assessed near the middle of the decade and reported in a document titled Healthy People 2000: Midcourse Review and 1995 Revisions.  Although process was reported in some areas, little or no progress was reported in many.  Subsequently, a new plan, called Healthy People 2010: Understanding and Improving Health, was formulated, refined, and is now being implemented.

Healthy People 2010:  Understanding and improving Health is a health promotion program intended to be implemented at all levels, ranging from individual involvement through multinational cooperative efforts, including Health for All in the 21^st Century, a World Health Organization health promotion initiative.  Although the goals of healthy people 2000:  National Health Promotion and Disease Prevention Objectives and Healthy People 2010:  Understanding and improving health are similar, the later focuses on the projected needs of the United States during the first decade of the new century.  Newly emerging demographics, such as the increasing number of older adults, and technologies, including new vaccines and HIV antiviral drugs, are better addressed in Healthy People 2010: Understanding and Improving Health.

Central to the design of Healthy People 2010: Understanding and Improving Health are two paramount goals: 
(1) increasing quality and years of life, and 
(2) eliminating health disparities in areas such as gender, race, and ethnicity, as well as income and education level.  These goals in turn provide twenty-eight more focused objectives.  Progress in accomplishing these objectives is anticipated through the manipulation of the behavioral, biological, and environmental determinants of health as they relate to ten of the leading health indicators: 
(1) physical activity, 
(2) weight management, 
(3) tobacco use, 
(4) substance abuse, 
(5) responsible sexual behavior, 
(6) mental health, 
(7) injury and violence, 
(8) environmental quality, 
(9) immunization, and 
(10) access to health care.

The success of Health People 2010:  Understanding and Improving Health will not be known until nearer the end of the decade.  However, if its goals are ultimately reached, Americans can anticipate an improved quantity and quality of life.

Changing Health- related behavior

Although some health concerns can be successfully addressed collectively though local, state, national, or international efforts such as those just outlined, most are ultimately based on the willingness and ability of persons to change aspects of their own behavior.

Why Behavior Change Is Often Difficult

Several factors can strongly influence a person’s desire to change high health-risk behaviors, including those listed below.

1.        A person must know that a particular behavioral pattern is clearly associated with (or even causes) a particular health problem.  For example: Cigarette smoking is the primary cause of lung cancer.

2.       A person must believe (accept) that their behavioral pattern will make (or has made) them susceptible to this particular health problem.  For example: My cigarette smoking will significantly increase my risk of developing lung cancer.

3.       A person must recognize that risk-reduction intervention strategies exist and that should they adopt these in a compliant manner they too will reduce their risk for a particular health condition.  For example: Smoking cessation programs exist, and following such a program could help me quit smoking.

4.       A person must believe that benefits of newly adopted health-enhancing behaviors will be more reinforcing than the behaviors being given up.  For example: The improved health, lowered risk, and freedom from dependence resulting from no longer smoking are better than the temporary pleasure provided by smoking.

5.       A person must feel that significant others in their lives truly want them to alter their high-risk health behaviors and will support their efforts.  For example: My friends who are cigarette smokers will make a concerted effort to not smoke in my presence and will help me avoid being around people who smoke.

When one or more of the conditions listed above is not in place, the likelihood that persons will be successful in reducing health-risk behaviors will be greatly diminished.

Stages of Change

The process of behavioral change unfolds over time and progresses through defined stages.  James Prochaska, John Norcross, and Carol DiClemente outlines six predictable stages of change.  They studied thousands of individuals who were changing long-standing problems such as alcohol abuse, smoking, and gambling.  While these people used different strategies to change their behavior, they all proceeded through six consistent stages of change in the process referred to as Prochaska’s Stages of Change

Precontemplation Stage

The first stage of change is called precontemplation, during which a person might think about making a change, but ultimately finds it too difficult and avoids doing it.  For example, during this phase a smoker might tell friends, “Eventually I will quit,” but have no real intention of stopping within the next 6 months.

Contemplation Stage

For many, however, progress toward change begins as they move into a contemplation stages, during which they might develop the desire to change but have little understanding of how to go about it.  Typically, they see themselves taking action within the next 6 months.

Preparation Stage

Following the contemplation stage, a preparation begins, during which change begins to appear to be not only desirable but possible as a well.  A smoker might begin making plans to quit during this stage, setting a quit date for the very near future (a few days to a month), and perhaps enrolling in a smoking cessation program.

Action Stage

Plans for change are implemented during the action stage, during which changes are made and sustained for a period of 6 months.

Maintenance stage

The fifth stage is the maintenance stage, during which new habits are consolidated and practices for an additional 6 months.

Termination Stage

The sixth and final stage is called termination, which refers to the point at which new habits are well established and so efforts to change are complete.

TODAY’S HEALTH CONCERNS

In spite of astonishing progress on many fronts, we continue to face a number of serious health challenges.  Heart disease, cancer, accidents, drug use, and mental illness all are important concerns for each of us, even if we are not directly affected by them.  Also becoming increasingly troublesome are the complex problems of environmental pollution, violence, healthcare costs, and the international scope of HIV/AIDS epidemic, as well as other sexually transmitted diseases.  World hunger, over-population, and the threat of domestic and international terrorism are other health-related issues that will affect us, as well as the generations that follow.

The health concerns just mentioned are by no means unmanageable.  Fortunately, we as individuals can reduce the likelihood of encountering many of these conditions by making choices in the way we live our lives.  On a personal level, we can decide to pursue a plan of healthful living to minimize the incidence of illness and disease and to extend life.

HEALTH: MORE THAN THE ABSENCE OF ILLNESS

What exactly is health?  Is it exactly the absence of disease and illness, as Western medicine has held for centuries or does health embrace other elements we ought to consider now that twenty-first century has begun?

Rather routinely national news magazines (and other media) feature articles describing advances in modern medicine.  These articles describe vividly in words and images the impressive progress being made in fields such as cancer treatment, gene manipulation, computer-aided surgery, and complementary medical care.  Because of articles like this that relate health to medical care, most of us continue to hold our traditional perception of health as 
(1) the virtual absence of disease and illness (low levels of morbidity) and 
(2) the ability to live a long life (reduced risk of mortality).  However, in striving to be fully “health educated” in the new century, perhaps we need to consider a broader definition that more accurately reflects the demands associated with becoming functional and satisfied persons as we transition through each adult stage of life-young adulthood, middle adulthood, and finally, older adulthood.  With this in mind, look forward to another definition of health-one that recognizes the importance of the more familiar definitions of health, but is focused on the demands of our own growth and development.

TODAY’S COLLEGE STUDENTS

For many students, college classes are sandwiched in between other obligations-for example a full-time job, parenting, community involvement, even the care of older parents.  Some might be the first members of their families to pursue higher education.  Many students come from economic, racial, or ethnic backgrounds quite different from that of the majority of their classmates.  Thus, today there is no one type of college student, but nevertheless, all of them are progressing through life in predictable, yet unique ways.

Traditional-Age Undergraduate College Students

Statistics indicate that more than 13.4 million students were enrolled in degree-granting U.S colleges and universities in 2001.  Nearly 60% of these students are women.  Minority students make up approximately 28% of American college students and foreign students total 10.1%.

Because two-third (66%) of all undergraduates are traditional-age students.  However, because of significant growth in the proportion of older students, we will also address  a variety of life experiences appropriate to these students.  Unquestionably, the nontraditional-age students in our classes help our traditional-age students understand the wide and varied role that health plays throughout the life cycle.

Nontraditional-Age Undergraduate College Students

In 1999, nearly 33% of American undergraduate college students were classified as nontraditional-age students.  Included in this vast overlapping group are part-time students, military veterans, students returning to college, single parents, older adults, and evening students.  These students enter the classroom with a wide assortment of life experiences and observations.  Most of these students are twenty-five to forty years old.  Read the Learning from Our Diversity box for a closer look at nontraditional-age students.

Many nontraditional-age students are trying to juggle an extremely demanding schedule.  The responsibilities of managing a job, a schedule of classes, and classes, and perhaps a family present formidable challenges.  Performing these tasks on a limited budget compounds the difficulty.  For undergraduate students, concern over paying next month’s rent, caring for aging parents, or finding affordable child care are as common as the challenges that confront students of traditional age.

We ask nontraditional-age students to do two things:  (1) reflect on your own young adult years, and (2) examine your current lifestyle to see how the decisions you made as a younger adult are affecting the quality of your life now.  As a nontraditional-age student, you may have young adult children whose lives you can observe in light of the information you will find.

Minority Students

Although enrollment patterns at colleges and universities vary, the overall number of minority students is increasing.  In 1999, slightly over 26% of all college students were minority students, with African Americans, Hispanic Americans, Asian Americans, and Native Americans representing the largest groups of minority students.  These students bring a rich variety of cultural influences and traditions to today’s college environment.

Students with Disabilities

People with reported disabilities are another rapidly growing student population, currently comprising 9.3% of all undergraduates.  Improved diagnostic, medical, and rehabilitation procedures coupled with improved educational accommodations have opened up opportunities for these students at an increasing rate.  In addition to students who have visible disabilities, such as blindness, deafness, or a physical disability requiring use of a wheelchair, a greater number of students with “hidden” disabilities are appearing in campuses.  Examples are students with learning disabilities (including attention deficit disorders), those with managed psychiatric and emotional problems, and those recovering from alcohol and substance abuse.  Interestingly, many students with reported “hidden disabilities” often do not consider themselves to be disabled.

DEVELOPMENTAL TASKS OF YOUNG ADULTHOOD

Because of most of today’s undergraduate college students range between the age of eighteen and perhaps forty, we will address several areas of growth and development (defined as developmental tasks) that characterize the life of people in this age group.  When people sense that they are making progress in some or all of this areas, they are likely to report a sense of life satisfaction or, as we describe it, a sense of well-being.

Forming an Initial Adult Identity

For most of childhood and adolescence, most young people are seen by adults in their neighborhood or community as someone’s son or daughter.  With the onset of young adulthood, that stage has almost passed; both young people and society are beginning to look at each other in new ways.

As emerging adults, most young people want to present a unique identity to society.  Internally they are constructing perceptions of themselves as the adults they wish to be; externally they are formulating the behavioral patterns that will project this identity to others.

Completion of this first developmental task is necessary for young adults to establish a foundation on which to nurture identity during later stages of adulthood.  As a result of their experiences in achieving an initial adult identity, they will become capable of answering the central question of young adulthood:  “Who am I?” Most likely, many nontraditional-age students are also asking themselves this question as they progress through college and anticipate the changes that will result from completing a high level of formal education.

Establishing Independence

In contemporary society the primary responsibility for socialization during childhood and adolescence is assigned to the family.  For nearly two decades the family is the primary contributor to a young person’s knowledge, values, and behaviors.  By young adulthood, however, students of traditional college age should be demonstrating the desire to move away from the dependent relationship that has existed between themselves and their families.

Travel, peer relationships, marriage, military service, and, of course, college have been traditional avenues for disengagement from the family, although most undergraduates return home during summers.  Generally the ability and willingness to follow one or more of these paths will help a young adult establish independence.  Success in these endeavors will depend on the willingness to use a variety of resources.

Assuming Responsibility

The third developmental task in which traditional-age college students are expected to progress is the assumption of increasing levels of responsibility.  Young adults have a variety of opportunities to assume responsibility.  College-age young adults may accept responsibility voluntarily, such as when they join a campus organization or establish a new friendship.  Other responsibilities are placed on them when professors assign term papers, when dating partners exert pressure on them to conform to their expectations, or when employers require consistently productive work.  In other situations they may accept responsibility for doing a particular task not for themselves but for benefit of others.  As important and demanding as these areas of responsibility are, a more fundamental responsibility awaits young adults: the responsibility of maintaining and improving their health and the health of others.

Broadening Social Skills

The fourth developmental task of the young adult years is broadening the range of appropriate and dependable social skills.  Adulthood ordinarily involves “membership” in a variety of groups that range in size from a marital pair to a national political party or international corporation.  These memberships will require the ability to function in many different social settings and with a wide variety of people.

The college experience traditionally has prepared students very effectively in this regard, but interactions in friendships, work relationships, or parenting may require that they make an effort to grow and develop beyond levels they achieved by belonging to a peer group.  Young adults will need to refine a variety of social skills, including communication, listening, and conflict management.

Nurturing Intimacy

The task of nurturing intimacy usually begins in young adulthood and continues through midlife.  During this time it is developmentally important to establish one or more intimate relationships.  Most people in this age group are reviewing intimacy in its broadest sense as a deeply close, sharing relationship.  Intimacy may unfold in the context of dating relationships, close friendships, and certainly mentoring relationships.

Involvement in intimate relationships varies, with some people having many relationships and others having only one or two.  The number does not matter.  From a developmental standpoint, what matters is that we have others with whom to share our most deeply held thoughts and feelings as we attempt to validate our own unique approach to living.

Related Developmental Tasks of Young Adulthood

In addition to the five developmental tasks of young adulthood just described, two additional areas of growth and development seem applicable to 18- to 24-year-olds.  These include obtaining entry-level employment and the developing of parenting skills.

For at least the last sixty years, students in increasing numbers have pursued a college education in large part to gain entry into many occupations and professions.  Students of today certainly anticipate that a college degree will open doors for their first substantial employment or entry-level employment.

In many respects employment needs go beyond those associated purely with money.  Employment provides the opportunity to assume new responsibilities in which the skills learned in college can be applied and expanded.  Employment also involves taking on new roles (such as colleague, mentor, mentee, or partner) that may play an important part in the way we define ourselves for the remainder of our lives.  In addition, employment provides a new, more independent arena in which friendships (intimacy) can be pursued.  By no means least important, entry-level employment provides the financial foundation on which we can establish independence.

For many people, young adulthood mark the entry to parenthood, one of the important responsibilities anyone can choose to assume.  The multitude of decisions associated with this commitment will, naturally, shape the remainder of one’s life.  Examples of these decisions are whether to parent or not, and, if so, when to begin, how many children to have, what interval between children, and role parenting will play in the context of overall adulthood.  The ability to make sound decisions and to develop the skills and insights necessary to parent effectively may be the most challenging aspect of growth and development that confronts young adults.

THE MULTIPLE DIMENSIONS OF HEALTH

Let us introduce a multidimensional concept of health (or holistic health –a requirement for any definition of health that moves beyond the cure/prevention of illness and the postponement of death.

Although our modern health care community too frequently acts as if the structure and function of the physical body is the sole basis of health, common experience supports the validity of a holistic nature to health.  In this section we will examine six component parts, or dimensions, of health, all interacting in a synergistic manner allowing us to engage in the wide array of life experiences.

Physical Dimension

Most of us have a number of psychological and structural characteristics we can call on to aid us in accomplishing the wide array of activities that characterize a typical day, and, on occasion, a not so typical day.  Among these physical characteristics are our body weight, visual ability, strength, coordination, level of endurance, level of susceptibility to disease, and powers of recuperation.  In certain situations the physical dimension of health may be the most important.  This almost certainly is why traditional medicine for centuries has equated health with the design and operation of the body.

Emotional Dimension

We also possess certain emotional characteristics that can help us through the demands of daily living.  The emotional dimension of health encompasses our ability to cope with stress, remain flexible, and compromise to resolve conflict.

For young adults, growth and development often give rise to emotional vulnerability, which may lead to feelings of rejection and failure that can reduce productivity and satisfaction.  To some extent we all affected by feeling states, such as anger, happiness, fear, empathy, guilt, love, and hate.  People who consistently try to improve their emotional health appear to enjoy life to a much greater extent than do those who let feelings of vulnerability overwhelm them or block their creativity.

Social Dimension

A third dimension of health encompasses social skills and insights.  Initially, family interactions, school experiences, and peer group interactions foster social skill development, but future social interactions will demand additional skill development and refinement of already existing skills and insights.  In adulthood, including young adulthood, the composition of the social world changes, principally because of our exposure to a wider array of people and the expanded roles associated with employment, parenting, and community involvement.

The social abilities of nontraditional-age students may already be firmly established.  Entering college may encourage them to develop new social skills that help them socialize with their traditional-age student colleagues.  After being on campus for a while, nontraditional-age students are often able to interact comfortably with traditional-age students in such diverse places as the library, the student center, and the bookstore.  This interaction enhances the social dimension of health for both types of students.

Intellectual Dimension

The ability to process and act on information, clarify values and beliefs, and exercise decision-making capacity ranks among the most important aspects of total health.  In fact, for many college-educated persons, this dimension of health may prove to be the most important and satisfying of the six.  In fact, for all of us, at least on certain occasions, this will hold true.  Our ability to analyze, synthesize, hypothesize, and then act upon new information enhances the quality of our lives in multiple ways.

Spiritual Dimension

The fifth dimension of health is the spiritual dimension.  Although certainly it includes religious beliefs and practices, many young adults would expand it to encompass more diverse belief systems, including relationships with other living things, the nature of human behavior, and the need and willingness to serve others.  All are important components of spiritual health.

Through nurturing the spiritual dimension of our health, we may develop an expanded perception of the universe and better define our relationship to all that it contains, including other people.  To achieve growth in the spiritual dimension of health, many people undertake a serious study of doctrine associated with established religious groups and will assume membership in a community of faith.  For others, however, spiritual growth is believed to occur, in the absence of a theist-based belief system, as they open themselves to new experiences that involve nature, art, body movement, or stewarding of the environment.

Interestingly, the role of the spiritual dimension of health was given an increased measure of credence when studies published in the scientific literature, including a statistical review of forty-two earlier studies, demonstrated consistently longer life for persons who regularly participated in religious practices, particularly for women.  This was true even factors such as smoking, alcohol use, and incomes were statistically eliminated.  Contradictory to these findings, however, was a report suggesting that the ability of prescriptive prayer (prayer of intercession) to enhance healing and extend life could not be supported by current research due to design flaws in the studies made to date.

Occupational Dimension

A significant contribution made by the current popular wellness movement is that it defines for many people the importance of the workplace to their sense of well being.  In today’s world, employment and productive efforts play an increasingly important role in how we perceive ourselves and how we see the “goodness” of the world in which we live.  In addition, the workplace serves as both a testing ground for and a source of life enhancing skills.  In our place of employment we gain not only financial resources to meet our demands for both necessities and luxuries, but also an array of useful skills like conflict resolution, experiences in shared responsibility, and intellectual growth that can be used to facilitate a wide range of nonemployment-related interactions.  In turn, the workplace is enhanced by the healthfulness of the individuals who contribute to its endeavors.

Wellness

Expanded perceptions of health are the basis for wellness.  Recall that episodic health care, preventive medicine, and community health promotion are directly aligned with concerns over morbidity and mortality, while health promotion at the individual level is focused on aspects of appearance, weight management, body composition, and physical performance capabilities.  Wellness differs from these kinds of health care because it virtually has no interest in morbidity and mortality.

Practitioners describe wellness as a process of extending information, counseling, assessment, and lifestyle modification strategies, leading to a desirable change in the recipients’ overall lifestyle, or the adoption of a wellness lifestyle.  Once adopted, the wellness lifestyle produces a sense of well-being (also called wellness) that in turn enable recipients to unlock their full potential

This explanation of how wellness differs from episodic health care, preventive medicine, and health promotion does, on first hearing, seem progressive and clearly devoid of interest in morbidity and mortality concerns.  But in practice, wellness programs are not all that different from other kinds of health care.  Your authors have consistently noted that wellness programs, as carried out on college campuses, in local hospital wellness centers, and in corporate settings, routinely transmit familiar health-related information and engage in the same risk reduction activities that characterize preventive medicine and health promotion.  It is in the final aspect of wellness, the “unlocking of full potential,” that wellness differs from other concepts of health.  More than the absence of chronic illness, it involves achieving optimal health across all six of the dimensions of health discussed in the previous section.

A NEW DEFINITION OF HEALTH

The definition that we propose takes into account the differences between what health is for (its role) and what health is (its composition).

The Role of Health

The role of health in our lives is very similar to the role of a car.  Much as a car (or other vehicle) takes us to places we need or want to be, health enables us to accomplish the activities that collectively transition us into and through developmental tasks associated with young adulthood.  Recall that process of moving through each stage of adulthood does not occur simply because of the passage of time, but rather because we actively participate, on a day-to-day basis, in demands of life appropriate to our life stage.

The Composition of Health

Now that you know the role of health is, its composition can be seen as being more than simply having a body free of illness and apparently destined for a long life.  Rather, the composition of health is that of a collection of resources, from each dimension of health, determine to be necessary for the successful accomplishment of activities that you need or want to do.  Some of these needed resources will already be within you (intrinsic), while others will need to come from outside (extrinsic).  However, regardless of their origin, once they are accessed and applied to activities, small forward growth steps will occur.  Obviously, to recognize what resources are needed, you must be a student of society’s expectations for persons of your age, as well as your own highly personalized developmental aspirations.

Our Definition of Health

By combining the role of health with the composition of health, we offer a new definition of health that we believe is unique.

v  Health is reflection of your ability to use the intrinsic and extrinsic resources related to each dimension of health to participate fully in the activities that contribute to your growth and development, with the goal of feeling a sense of well-being as you evaluate your progress through life.

In light of this definition, do not be surprised when your textbook asks whether you are resourceful (healthy) enough for the goals you wish to reach, or whether you are healthy enough to sustain a particular behavioral pattern that you have adopted, or whether you are experiencing the sense of well-being to which you aspire.