The Concise Oxford defines "health" as: "1. the state of being well in body or mind. 2. a person's mental or physical condition (has poor health)", and revealingly, goes on to define a "health centre" as the headquarters of a group of local medical services; "health service" as a public service providing medical care, and "health visitor" as a trained nurse who visits those in need of medical attention in their homes.

We beg to differ with the learned scholars who have put together these dictionaries. We suggest that wellness is not so much a state of being as a process of becoming. It implies movement - away from sickness, yes, but more importantly, towards higher and higher levels of health. It is a dynamic concept that says more about a person's attitude than about his or her "state" or "condition".

The word wellness has not, thus far, found common usage because people have been largely concerned with their condition. The word "health" has sufficed to define that condition, a person having "good health" when there is no evidence of sickness, and "poor health" when there are many signs of disease. Health services and institutions have accordingly been oriented towards the restoration of a state of health, hence the medical definitions of "health centre", "health service" and "health visitor" noted above. (Medicine, by the way, is defined in the COD as: "the science or practice of the diagnosis, treatment, and prevention of disease"; more anon.)

Wellness is not about the attainment of health through diagnosis, treatment, and prevention of disease. True, it results in a lowered risk of disease, but wellness is more concerned with growth; with action, and with improvements in health through striving for higher standards. It is proactive, and it is synonymous with "continuous improvement" as described by Total Quality Management (TQM) advocates.

Health problems are the raison d'etre for medical services and medical professionals. For those who provide wellness services, however, they are merely hurdles along the way. Wellness objectives have little to do with whether or not a person is "sick". Sick individuals have a bigger task ahead of them than those who are not sick - and they may need medical care and should not hesitate to seek it. But more is required of them in a wellness perspective than simply overcoming their sickness.

Trained as they are to fight disease, doctors often have trouble seeing beyond that fight. They are bewildered by the fact that someone would spend money for a consultation even though they have no complaints, unless that consultation was for a medical "check up". A medical check up, however, is simply a search for disease. A wellness consultation, on the other hand, is the beginning of a search for higher standards of health.

There can be no "clean bill of health" at the end of a wellness consultation. There are no reports that say "no abnormalities found" or "results are within the normal range". A wellness report is not about "normal" and "abnormal", but about "poor, fair, good, or excellent". It is a baseline for change rather than a categorisation. If there are conditions that need treatment, they must be treated, but that is not the point of the exercise.

Wellness is a further step in the evolution of health care. In primitive societies, ill-health was seen largely to be the result of a curse or ill-favour with the gods. The main response was countervailing sorcery or prayer and supplication. The next step was the search for treatments that would eliminate sickening elements from the body, a search that was based largely on haphazard trial and error of naturally occurring substances, with a gradual accumulation of traditional remedies. Then there came public health measures designed to protect people from noxious influences with hygiene, immunisation and environmental control. For most of this century we have seen a systematic search for treatments based on an analysis of the properties of natural and synthetic substances, and on an understanding of the anatomical, physiological and biochemical systems of the body (and the mind).

Throughout history the underlying assumption has been that one would be well if one could avoid getting sick. Doctors were there to help in this endeavour, and the more and the better the doctors, the healthier people would be. The last few years has seen this assumption turned on its head. Poor health is now recognised to be mainly a result of poor lifestyle choices and unhealthy habits. Good health is no longer a matter of what the doctor can do for you, but what you can do for yourself. Hence the evolution of the concept of health promotion.

As doctors and patients stuck in the old paradigms sit and watch each other succumb to cancer, heart disease and other "lifestyle" diseases, wellness-oriented people are taking matters into their own hands. They are not looking for better treatments, but better health. They are not taking things, but doing things. The are not seeking help, but seeking knowledge. Knowledge is power, but it must be knowledge in their heads, not in the heads of medical specialists. In other words, they have recognised that personal responsibility is the key to higher standards of health in the twenty-first century.