Introduction and Context
‘But no time or nation will produce genius if there is a steady decline away from the integral unity of man and the earth. The break in this unity is swiftly apparent in the lack of “wholeness” in the individual person. Divorced from his roots, man loses his psychic stability.’
-- Elyne Mitchell, Soil and Civilization (1946)
There is now considerable research interest in the topic of 'wellbeing’ and its relationship to 'health', yet there has also been much debate and
criticism. The Oxford English Dictionary (OED) defines ‘wellbeing’ as ‘the state of being comfortable, healthy, and happy’, suggesting that the term relates to aspects of emotions and feelings, as well as 'health'. By contrast, the OED defines ‘health’ as ‘the state
of being free from illness or injury’, a definition that does not
fully capture the meaning of 'health' as understood by researchers in population health: 'there is no health without mental health' \cite{Prince_2007}. We further note that absence of illness is not necessarily 'healthy'. It is possible for instance, to be unhealthy without having illness, as one can be on course for an illness through having poor diet, lack of sleep, being overweight and physically inactive. Similarly, 'not being depressed' is not the same thing as 'being happy'. The World Health Organisation \cite{constitutionconstitution} defines ‘health’
as complete mental, physical and social wellbeing, thus - according to
this definition - wellbeing is subsumed by an overarching concept of
‘health’, which differs from the OED definition. Although superficially appealing, the WHO definition has been criticised as being unrealistic. Petr Skrabanek, a Professor of Medicine and sceptic reportedly
joked that according to this definition, health is only achievable at
‘the moment of mutual orgasm’ \cite{bmj}. A critical
observer might even query whether it is possible for people living with
long-term disabling conditions such as common mental disorders, diabetes, obesity and cardiovascular disease to have opportunities for experiencing wellbeing. We suggest that they do have such opportunity, and that enhancing wellbeing in such people may also improve physical health. This is an important consideration as chronic conditions and disease now outstrip the societal burden imposed by acute conditions \cite{2015}. In 2017, as much as 79% percent of the years lived with disability (YLDs) globally are attribtuable to chronic conditions \cite{hub}. Prominent conditions including depression and anxiety are associated with 5.05% and 3.18% of total global YLDs in 2017, respectively (Fig \ref{535015}). Critically, our work is now focused on building wellbeing in people living with chronic conditions (see section \ref{223145} for further discussion).