Harald Renner

In 1994 the German GEO magazine published a representative survey topic: "What keeps us healthy, what harms our health? Where are the dangers?"

Most answers to these questions surprised at the time and have remained so to this day.

The population at large when interviewed chose the hazards they believed could harm our health. They list them in descending order: toxic waste, asbestos, side effects of strong medicines, car exhaust fumes, drinking water pollution, AIDS and nuclear power stations.

Experts from science and technology, who are also interviewed, differently assess the risks.

At 81 percent, the tar and nicotine vapour from cigarettes poses the greatest health risk for them. 71 percent pointed out that people do not get enough exercise. 58 percent reminded people that alcohol is poison. At 42 percent, "fat" and "it also classifies too much" food as far more dangerous than asbestos, toxic waste or the dangers of nuclear energy.

It seems to be difficult to agree on "health risks". Do we at least know what keeps us healthy?

Karin Felix could help us answer the question. She has written a bestseller called "Fitness and Beauty". It reads like this in the opening credits:

"The book wants to inspire women to do something for themselves - for a healthy, beautiful body, for serenity and self-confidence, it wants to stimulate them to an active, relaxed life. Every woman can choose what she likes from the variety of possibilities offered. Because an all-round good self-esteem is not a question of age or fitness."

Today, choose this language to attract many readers. Self-confidence, fun, an all-round  sense of self-worth - such concepts capture zeitgeist: Health as a central part of the quality of life. This message sounds good and is clear. It is right to answer health questions in this way.

With all the fundamental approval of this book and its positive outlook on life, I would like to add two reflective questions.

First question.

The "healthy, beautiful body" - does this catchy and superficial equation exhaust our concept of health? Is that what keeps us healthy?

Second question.

Can I call my goal "health for me"? Health for me alone, for my beloved self? Or do I get to the World Health Organization's more humane demand: "Health for all?"

The WHO names seven basic health conditions:

1. a stable self-esteem

2. a positive relationship to one's own body

3. friendship and social relationships

4. an intact environment

5. meaningful work and healthy working conditions

6. health knowledge and access to health care

7. a present worth living in and a well-founded hope for a future worth living in.

What threatens our health today, endangers our body, mind and soul, overtaxes us?

Our lives are often determined by overstimulation, haste and restlessness, anger and aggression, lack of movement and noise, mass traffic and spatial narrowness. We like to see ourselves in the role of the maker who masters technology and uses the new media with confidence. But far more often we are subject to the apparatus we have created ourselves. Pressure to perform is everywhere. It has a firm grip on students and athletes, drivers and professionals, self-used persons and employees. Even leisure time, vacation and pleasure are determined by stress, which tugs at our strength and nerves.

Where can we start if we want to build up a counterbalance to the "syndrome of the overburdened human being" in us? Maybe, by trying to stabilize our self-esteem.

Siegrist states: "According to current knowledge, a stable self-esteem is a very important prerequisite for coping well with burdens, conflicts and emotional tensions. If the social environment prevents or hampers the development or stabilization of self-esteem, it limits the tolerance for stress. Crises then unfold their shocking power to the full extent, and the susceptibility to disease increases."

We should take countermeasures. With modern relaxation techniques we have the chance to counteract the inevitable and homemade stress to a large extent. For me, however, this means easing symptoms rather than solving the problem at its root.

It seems to be more crucial that we ask ourselves in a calm minute what our life plan is like. If we recognize what makes us ill, it is possible to recognize what keeps us healthy. Aren't corrections overdue? Where should we start when the pressure of suffering takes over? Above all, we should no longer take part in everything that others - contrary to our inner conviction - expect from us. We should learn to say "no" in a friendly but definite way to things we perceive as unreasonable. Even to things we put ourselves through without need. We should develop into "tolerant egoists" in an acceptable sense. It is possible that our family, our friends and acquaintances, even our superiors and career colleagues may find such a change in values even more attractive in the longer term than the deliberate and well-adapted participation. If not, we should keep telling them about our changed attitudes.

We should also face up to the question of what keeps us healthy.

We are all subject to the constant balancing act between success and failure - no one is immune to it. But even if it looks like a contradiction: We need this game like the air to breathe. It's not so much because we're thrilled by the thrill, but rather because every risk offers tangible opportunities.

The more difficult the challenges we face, the more satisfying it becomes to have overcome fear and insecurity. Proud of an accomplishment that one did not dare to do before, means a valuable gain in mental health. Prevention does not wrap people and their problems in cotton wool, but rather encourages them to lead a conscious life "here and now".

Our best protection of health seems to be that we learn to deal with conflicts and tensions in such a way we do not become paralyzed by them, but rather grow on them. Part of this is that we feel at home somewhere, recognize a sense of purpose in life and personal perspectives. We have confidence, cultivate relationships and can feel joy. We dare to do something and are grateful for the full range of our emotions - anger and envy and fear and sadness and love, lust and sensual joy. It's all part of being human, and more.

Let us also remember that it is not only our fellow human beings who cause us stress. We ourselves may cause stress for others daily, without even realising it. Recognising we can this enables us to change our attitude from egoistic to empathetic. Thus improving our own health care and enabling promote health care of others too.

Health promotion means assuming responsibility in three respects. It is about responsibility for one's own health, responsibility for the health of fellow human beings and responsibility for the living conditions in this world and thus for the life chances of future generations.

The first aim - responsibility for one's own health - is obvious. Here we will find the classical topics that aim at a healthy lifestyle, such as healthy nutrition, prevention of cardiovascular diseases through health sports, moderate use of stimulants.

The individuals are able to recognise life circumstances they perceive as hazardous to health, and to change them. They learn to perceive and understand the interaction between body, mind and soul. They gain decision-making authority for their health.

By the second aim of health promotion, we mean responsibility for the health of our fellow human beings.

How does this stand in practice? No one wants to endanger or harm the fellow citizen through reckless behaviour on the roads - which one of us would not have done it already?

No one wants the stronger to harm the weaker one, to overreach him and put physical or psychological pressure on the weaker one - yet we know many examples of where it happens and we do not intervene.

We react appalled and stunned to reports of violence against the defenceless, in all terrible varieties. But are we fighting with all our might to ensure that this kind of thing cannot happen again? We must also ask ourselves the following question: Do we help our fellow human beings to cope with their problems in life, do we give them social support? Do we sympathize with the old, disabled and ill?

How do we deal with the incurable cancer patients in our neighbourhood? Do we support and stabilize the addicted young people in our circle of acquaintances? Do we make our own personal contribution to freeing people from a vicious circle that makes suicide appear as the only way out?

Who would deny that all these issues have anything to do with health? Who would deny that we can and must do more than just worry about our own health?

A third goal of health promotion is to take responsibility for the living conditions in this world and thus for the life chances of future generations. This topic will occupy us in the coming years whether we perceive this or want to hide it from our consciousness.

On "global" issues such as environmental or peace policy or a just world order, we should refrain from using purpose-optimistic whitewashing just as much as from discouragement and resignation. Let us put our faith in the principle of hope without losing touch with reality. Let us trust in a hope that is active and impatient, looking for every opportunity to to act within our means. This applies above all to the manageable area familiar to us and for which we are responsible.

According to a study by the University of Bielefeld, 61 percent of young people in our country consider their future to be threatened by environmental degradation. The number proves it is possible to change attitudes and arouse a concern with patience and persuasiveness. But the consequences of correct knowledge and good intention alone are insufficient. Knowledge is not synonymous with action, acting is not synonymous with stabilized behavioral change.

Every one of us has to deal with this problem when we try to influence our own health behaviour and that of our fellow human beings.

In recent years, it has become clear it makes little sense to define a certain - sensible - preventive message and to spread it all over the world with the aid of well-known advertising media such as: Smoking Kills! With this procedure we can convince ourselves that we have done something. However, we achieve nothing and no one with it - at least not if we only use this method. Things are more complex.

We know from behavioural research and our own experience that the strongest motivation in human behaviour does not come from rational considerations, but from emotional impulses. Let us draw the conclusions from this insight.

We should say goodbye to the attempt which has failed a thousand times over, to achieve stabilised, changed health behaviour by conveying information. We must also say goodbye to the trying to achieve something positive by describing the darker consequences of a wrong lifestyle.

If we therefore focus less on distributed print media and more on the means of discussion and working in groups, we will try to convince through our personality, our openness and - if available - our own positive health behaviour.  Let us motivate others to take part, let's do it ourselves! Disappointment and failures in health promotion are also inevitable when we see our counterpart as an object, but not as an equal, self-determined, mature partner who has as much to give us as we give them.

Those who have committed themselves to the good task of promoting their own health and the health of their fellow human beings live in the constant danger of being disappointed and resigned. It reduces danger if we assume a realistic image of humanity and attainable goals.

So let us take a self-critical look over our shoulders from time to time. Our own enthusiasm, our own ability to perform, our own health successes can tempt us to overtax our partners looking for advice. We must offer achievable milestones and thus a real personalised help. Let us not make our partners in health promotion a victim of our own broad objectives and expectations. We make the sacrifice ourselves. It may lead to disappointment, resignation and abandonment. We must protect ourselves from this. Reality becomes our protection.

Today there are people in the medical and health professions, in the educational and social sectors, in the political and journalistic field who interpret the signs of the times and act in the sense of health promotion. People who look for and need partners. Teamwork and multisectoral approaches are indispensable for illuminating social and psychological backgrounds of behaviours that impact health. Let us not forget the importance we attach to dealing with conflicts, our personal and social anxiety, our fear of exclusion and discrimination. We must not underestimate the impact of prestige and peer pressure on our health behaviour. So let us be mindful of the power of the media and advertising.

Health promotion is only effective if it influences behavior and circumstances if it considers the social environment and if they tailor it to the individual person and his/her living conditions.

Anyone who has recognised that health promotion means teamwork also understands that no professional group holds the "Philosopher's Stone" in their hands. Openness, diversity of opinion and tolerance are in demand in the discussion about the goals and contents of the joint work. We need a responsibility for health, which includes everyone. That's what keeps us healthy.