There is now considerable research interest in the topics of ‘health’
and ‘wellbeing’, yet these have been the focus of much debate and
criticism. The Oxford English Dictionary defines ‘health’ as ‘the state
of being free from illness or injury’, and ‘wellbeing’ as ‘the state of
being comfortable, healthy, and happy’, yet these definitions do not
fully capture the meanings of these terms, nor their overlap or
distinguishing features. For instance, researchers have argued that
wellbeing is not simply health and happiness, and by treating it as such
will compromise the concept, as well as the wellbeing of future
generations \cite{Dooris_2017}. 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’, spanning multiple domains of functioning. While ambitious in
scope, this definition has also been criticised as being an unrealistic
outcome. Petr Skrabanek, a Professor of Medicine and sceptic reportedly
joked that according to WHO’s definition, health is only achievable at
‘the moment of mutual orgasm’ \cite{bmj}. Considering that chronic conditions and
disease now outstrip the burden of acute conditions \cite{2015}, a critical
observer might query whether it is possible for people living with
long-term disabling conditions such as common mental disorders, diabetes
and cardiovascular disease will have opportunities to experience
wellbeing once again. Positive psychology has approached the construct
of wellbeing from a different perspective, emphasising life satisfaction
\cite{Pavot_2008,Diener_1984}, psychological wellbeing \cite{Ryff_1995,Ryff_2014} and flourishing \cite{Diener_2009,seligman2011,Seligman_2018}. In contrast to the study of
‘pathogenesis’, others have proposed the need to study ‘salutogenesis’ \cite{ANTONOVSKY_1996},
a word based on the Latin term ‘salus’ (health, well-being) and the
Greek word ‘genesis’ meaning emergence or creation. This salutogenic
concept emphasises a role for a ‘sense of coherence’ for managing and
overcoming stress reflecting feelings of confidence that the environment
is comprehensible, manageable and meaningful. Others have focused on the
relevance of ‘resilience’, which the
\citet{association} uses to describe the process of adapting well in the face of
adversity or tragedy, and ‘bouncing back’ from difficult experiences.
However, it is interesting to observe that this psychological definition
conflicts with those from other disciplines (e.g. engineering), which
highlight ‘stability’ and ‘efficiency’ \cite{Quinlan_2015}. Psychological theories of
wellbeing has been criticised for their individualistic focus, ignoring
wider systemic issues such as loneliness, inequality, environmental
degradation and climate change \cite{Carlisle_2009,b2010,Frawley_2015}. However, these criticisms are somewhat
disingenuous, ignoring developments in conservation and environmental
psychology, which explicitly link psychological science to some of these
challenges. These developments include the positive psychology of
sustainability \cite{Corral_Verdugo_2015,Corral_Verdugo_2012}, sustainable happiness \cite{2010,O_Brien_2012,obrien2016} and sustainable wellbeing \cite{Kjell_2011}. Given
the considerable research interest in the constructs of ‘health’ and
‘wellbeing’, and associated criticism, it is perhaps time to take stock,
to reconsider what is meant by these terms and to determine whether it
might be possible to develop a model of wellbeing that spans the
individual, community and environmental wellbeing (Fig \ref{881013}). This is the
job of the present paper. The aims of the present paper are threefold: 1) to briefly review our
previously proposed GENIAL (genomics, environment, vagus nerve, social interaction, allostatic regulation, and longevity) model of wellbeing , a life-course model that
lays a theoretical framework within which pathways to
premature mortality versus health and wellbeing may be better understood, 2) to expand the focus
of our GENIAL model to explicitly encompass individual, community and
environmental wellbeing, highlighting a key role for individual
wellbeing as a foundation to build community and environmental
wellbeing, and their respective bidirectional impacts on the wellbeing
of individuals, 3) to consider the implications of our updated model
(GENIAL 2.0) for people living with chronic conditions, the burden of
which has now outstripped acute conditions, placing excessive demands on
a healthcare sector that remains driven by the acute medical model,
which is focused on returning patients to full health, rather than
supporting patients to manage their condition.