Adding years to life and life to years
March 29, 2022 | Report
By Erica Coe, Martin Dewhurst, Lars Hartenstein, Anna Hextall, and Tom Latkovic
Historically, society has defined health in terms of the presence or absence of disease. Someone is deemed to be “in good health” if disease has no impact on their life expectancy or physical function. To add up to 45 billion years of higher-quality life, McKinsey Health Institute (MHI) proposes that we embrace a broader definition of health that better aligns with individual aspirations and the latest scientific research. The World Health Organization (WHO) proposed just such a broad definition of health, with a greater emphasis on well-being, back in 1948: health is a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” The subcomponents of spiritual health41 have also been recognized as relevant to health for decades.42 MHI uses the term “spiritual” because it is the most common way for other healthcare institutions and leaders to refer to these concepts. Strong spiritual health does not necessarily imply the adoption of religious beliefs. Unfortunately, a broad vision of health has not taken hold. MHI proposes that society fully embrace the proposed foundation and act on it.
MHI proposes an understanding of health with the following characteristics:
Holistic. It recognizes the relevance and interdependencies of physical, mental, social, and spiritual dimensions.
Uses a positive frame. The objective on each dimension is optimal health given an individual’s physiological capacity, not simply the absence of disease.
Anchored in function. Health is relevant only to the extent it enables people to live fully—to build relationships, work or volunteer, and contribute to society while also enjoying pursuits.
Affected by a multitude of influences. This understanding of health recognizes the vast set of factors that affect health, including personal attributes, personal behaviors, interventions, and environmental attributes.
Objective. It is measurable across time, geographies, health systems, and cultures.
Physical health is the extent to which an individual can competently perform physical tasks and activities without substantial discomfort. It includes the capacity to move through the environment in which one lives with confidence and independence and to control one’s interactions with the physical world via fine motor control. People with good physical health have sharp sensory capacities with keen senses of touch, vision, hearing, taste, and smell. Physically healthy individuals are full of energy and vitality, free from the twin scourges of debilitating pain or fatigue.
Mental health is an individual’s cognitive, behavioral, and emotional state of being. Mental health is needed for an individual to understand and interact with the world through memory and language. Mental health allows us to experience joy, direct anger, limit harmful impulsive behavior, and avoid serious depressive episodes. Mentally healthy individuals have the resilience to cope with normal stresses and adverse events while maintaining a positive and realistic sense of self. 
Social health represents an individual’s ability to build healthy, nurturing, genuine, and supportive relationships. People in good social health have the capacity to form meaningful connections with others, to both receive and provide social support. Social health gives people a strong sense of belonging to a community. 
Spiritual health enables people to integrate meaning in their lives. Spiritually healthy people have a strong sense of purpose, belonging or identity. They feel a broad sense of connection to something larger than themselves, whether to a community, a calling, or a form of divinity. Spiritual health helps people feel rooted and mindful in the present moment.   
Strong anecdotal and empirical evidence suggests that these four health dimensions collectively contribute to both longevity and quality of life. Individuals often suffer harm when their health fails along even one of these dimensions. For example, global data indicate that severe mental health disorders can reduce life expectancy anywhere from 10 to 25 years.52 On the social health dimension, loneliness and social isolation are associated with higher risks of heart attack and strokes.53 In fact, research shows that loneliness and social isolation can be as damaging to an individual’s health as smoking 15 cigarettes per day,54 which is especially concerning when we note that up to 29 percent of elderly people report feeling lonely.55 A lack of social connections has been associated with an increase in inflammation at the same magnitude as physical inactivity in adolescence, and in old age, the effect of social isolation on hypertension exceeded that of clinical risk factors such as diabetes.56 On a more hopeful note, for older American adults, greater purpose in life has been linked with a lower risk of stroke.57
A more complete understanding of human health also includes acknowledging the extensive set of factors that affect it. These influencing factors fall into four groups: personal attributes, personal behaviors, environmental attributes, and interventions. Personal behaviors refer to individual actions such as sleep, diet, exercise, and adherence to treatment regimens. Personal attributes are individual characteristics such as genetics, education, and relationships that typically cannot be modified, at least in the short term. Environmental attributes are factors that shape the health of all individuals within a given context and include the context’s political and economic system as well as global threats such as climate change. Interventions refer to deliberate actions intended to bring about change, such as clinical interventions, financial support, or incentives.
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