The outstanding challenge to the architects of a modern health care system is the change in patterns of disease and disability that has taken place over the last fifty years or so.

In all except the least developed societies, people are living longer (largely due to a decreased likelihood of premature death from acute, infectious disease, accidents or violence) and modernising their lifestyles to include a higher energy intake - primarily from animal fats, oils and simple carbohydrates; less physical exertion - especially less walking and less manual work, and more stress - rooted in rapid rates of change in the social environment.

Modern patterns of morbidity are directly related to these changes and are manifested in a high - and growing - prevalence of obesity, type II diabetes mellitus, certain types of cancer, hypertension, cardiovascular diseases, venereal diseases, substance abuse, domestic violence, accidents and social displacement.

Why "wellness"?

Lifestyle has become the main determinant of the health of the people. Social and economic progress has lead to greater freedom of choice for communities, families and individuals, and ultimately, it is decisions about the environment, the food supply and opportunities for exercise and relaxation that will determine the standard of health that the population enjoys.

The challenge for modern health care professionals is to influence lifestyle decisions in a positive direction. Ways must be found to induce people to strive for a higher standard of health at the personal and community level. In other words, to replace what could perhaps be called “survival” values with “growth” values.

A higher standard of health requires efforts that incorporate, but go well beyond preventative measures such as hygiene and immunisation; protective measures such as public health and safety regulations, and medical measures such as early detection and better treatment of disease. It requires that individuals, whether or not they are free from disease and disability, seek to be physically leaner and stronger, better balanced socially and emotionally, and personally happier and more productive.

An appropriate health system is centred on health promotion for all rather than on medical treatment for the sick or social support for the displaced or welfare for the indigent.  It is predicated on personal responsibility, and considers “care” of any kind to be a means to an end rather than an end in itself.  Success is measured with indices of wellness, and the measurements take place, not in institutions or health care centres but in communities, which is where people make the choices that ultimately determine their quality of life and their longevity.