Health Illness Continuum
If you are not sick, you must be healthy, right? Not exactly. Health and sickness run on a continuum.
The Health Illness Continuum depicted below was developed by John Travis, MD in the 1970s. I first discovered it during my very first month in medical practice back in 1990. I have found it to be an extremely useful concept to share with patients interested in improving their health.
I ask patients to identify where along the Health Illness Continuum they fall with respect to their health, and where on the Continuum they would like to see their health. We then develop a plan to help them go from point A to point B.
What is Wellness?
Defining illness typically presents no problem, and we know it when we see it. But, defining wellness is more challenging. Most often, we define wellness as the absence of disease. “I don’t have high blood pressure. I am not a diabetic. I don’t have cancer. Therefore I must be healthy.” But, being free of disease doesn’t mean you’re healthy.
I see many patients who are not sick. Yet, they have low energy. They are not as focused as they once were. They are gaining weight despite maintaining the same diet and activity level. They experience mood swings. Some are depressed and not happy with their career or personal life. They lack purpose in their lives. Basically, they don’t feel like themselves or as good as they should.
Wellness is more than the absence of disease. It’s living life with a high level of energy. It’s having the physical and mental endurance to achieve your goals. It’s looking forward to the day and approaching it with vigor and vitality.
Being in a state of wellness enables us to take advantage of the gifts we each have and applying them fully. Wellness isn’t about getting through the day. It’s about making the day. In short, high-level wellness is “being all you can be.”
Where would you place yourself on this continuum and why? And, what can you do to move further to the right on the Continuum? I suspect if we could plot where every individual would fall on the Continuum we would see a bell-shaped curve slightly shifted to the right of the neutral point. In other words, most individuals are only in fair health and are hovering around the neutral point.
The Health Continuum Explains How Healthcare Operates
There’s much more to the Health Illness Continuum than is apparent. It explains much of our current approach to healthcare. Traditional medicine encompasses the “treatment paradigm” to the left of the neutral point. Typically this is what health insurance covers. There’s not much that traditional medicine offers on the right side of the neutral point – may be an annual preventive exam.
As Bill Maher said. “You see, there’s no money in healthy people, and there’s no money in dead people. The money is in the middle – people who are alive sort of, but with one or more chronic conditions.” Perhaps that is why traditional medicine focuses on the left-hand side of the Continuum – that’s where the money is. However, if you rely only on traditional medicine you cannot achieve optimal health. Traditional medicine only gets you back to a neutral point in most cases.
In recent years we have seen a better effort emphasizing prevention and wellness but this has largely been motivated by the escalating costs of healthcare. It’s a step in the right direction – pun intended.
Great Health Requires Great Effort
On the left side of the continuum, we find passive patients and active health care providers. On the right side of the continuum, we find active patients and passive healthcare providers. Here’s what we mean by that.
As we go further to the left on the Health Illness Continuum the patient takes on an increasingly passive role while the healthcare team takes on an increasingly active role. The classic example is the patient in the intensive care unit—a ventilator is breathing for the patient, and they are being hydrated with an IV and being fed through a G-tube. If their heart stops, the medical team will shock it back to work…and so on. The individual is doing very little to actually get better.
As we go further to the right along the Health Illness Continuum, the patient or individual assumes more responsibility and takes on an increasingly active role in his or her overall health. The doctor takes on a more passive role, as he becomes more of a teacher or coach – the very definition of a doctor.
On the left side of the Health Illness Continuum, the doctor-patient relationship is very much one-sided. However, on the right side the doctor-patient relationship is more of a partnership or teacher-student relationship.
Health Illness Continuum: Real Life Examples
Let’s take a professional football player who is currently functioning at the far right of the Continuum, but he tears his ACL. In a fraction of a second (the time it takes to get injured) he goes from being extraordinarily functional to be disabled. He then has his ACL reconstructed. Where does the surgery move him? Back to the far right? Nope. The surgery only moves him back to the neutral point. The surgery removed his symptoms of the instability of the knee. In and of itself the surgery does not get him playing football again. That comes through hard work by the athlete in conjunction with help from the physical therapists and athletic trainers.
Now let’s take a second case – that of a 55-year-old male who was slightly to the right of the neutral point, sedentary, and then has a heart attack. He gets a couple of stents to open his blocked coronary arteries that improve the blood flow to his heart. He becomes chest pain-free.
The revascularization of his coronary arteries only moves him back to the neutral point as the stents remove his angina (chest pain) symptoms. He then goes through cardiac rehabilitation and changes his diet and in doing so is able to move somewhere to the right of the neutral point.
Likewise, giving antibiotics to someone with pneumonia or a urinary tract infection also only gets a patient back to the neutral point – it removes their symptoms. It does not get them to a high level of wellness.
The point is: to get to the right of the neutral point takes patient effort. To enjoy wellness YOU must take action – take charge.
Take Charge of Your Health
When you stop and think about it, how far can conventional medicine get you? If you want to get to the right of the neutral point you have to take charge of your health and find people who can help teach you how to accomplish that. But, in the end, it’s ultimately up to you.
Your goal should be to get to right on the continuum as far as possible as you approach middle age. This will give you the “reserve” to weather the declines, some of which are inevitable, that come with aging. If you do that before those age-related declines occur you will find yourself still to the right of the neutral point as you age and not dependent on the healthcare system like so many experiences.
Your goal is to die healthy. Healthy aging is dying at the slowest rate possible. Eat too much sugar, put on weight, don’t exercise and you are taking time off your longevity clock.
Your goal is to get and stay right of the neutral point. You also want to die right of the neutral point. How do you get to the right of the neutral point?
Exercise and nutrition
Better exercise and better nutrition are the keys. Consider working with a personal trainer and nutritionist to fine tune your exercise and nutrition program as much as possible.
Exercise and nutrition require discipline. Of the two, though, eating well is more challenging because it is a 24/7/365 endeavor. Most can discipline themselves to exercise 2-4 hours a week. Eating healthy is far more challenging as you have to make nutrition decisions much of the 168 hours in a week.
Hormones
Don’t forget hormones—optimal wellness also requires optimal hormone levels. However, optimal health and wellness are not possible without optimal hormone levels. Many can achieve high levels of wellness during their 30s and even 40s through exercise and nutrition (when their hormone levels are naturally healthy), but there comes a point for a majority where exercise and nutrition are not enough as their hormone levels decline.
Each year these individuals become increasingly frustrated as their ongoing efforts just are not enough to keep them at a high level of wellness. That’s where the help of a doctor is necessary to restore levels to healthy levels.
Newer developments to keep us on the right side of the Wellness-Illness Continuum are being developed, too. This includes stem cell treatments and products that activate stem cells to repair and regenerate the body, and products to increase telomere length.
It’s your life. It’s your health. Take charge!
Final Thoughts On The Health Illness Continuum
It’s safe to say, the Health Illness Continuum is a vital part of helping patients understand their level of health. It’s nice to know there are tools in place to ensure optimum health and wellness for patients. Now that you’ve learned more about it, where you think you are on the continuum?
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*Updated 3/17/19
