What Is Positive Health? Why being free from illness isn't the whole story.

You might have no diagnosed health problems, eat reasonably well and get through your days without too much difficulty. But perhaps you're permanently exhausted, haven't had time for friends in months, and can't remember the last time you did something simply because you enjoyed it.

Would you describe yourself as healthy? It's an interesting question, because being free from illness isn't necessarily the same thing as being well. This distinction is at the heart of an emerging area of research known as positive health.

Back in 1948, the World Health Organization (WHO) recognised that health was about more than simply the absence of disease. Its definition included physical, mental and social wellbeing. Yet much of modern healthcare has understandably focused on identifying, treating and preventing illness. These are essential aspects of healthcare, but they leave another question worth exploring: what helps people not just avoid illness, but actually thrive?

What does positive health mean?

Researchers associated with RCSI's Centre for Positive Health Sciences have developed a working model that offers an interesting way of thinking about this question*.

Imagine a scale running from −10 to +10, with zero representing the absence of illness. Traditionally, much of healthcare has focused on the negative side of that scale, helping people recover from illness, manage conditions or prevent their health from deteriorating. But reaching zero doesn't necessarily mean we're thriving. Someone might have no diagnosed illness but still feel lonely, exhausted or lacking in purpose.

The positive side of the scale encourages us to look beyond the absence of disease and consider what contributes to our physical, mental, emotional and social wellbeing, along with our sense of meaning and purpose. Of course, health is far more complicated than a single number, and we can be doing well in one area of life while struggling in another. The continuum is simply a useful way of illustrating this broader perspective.

What if you're living with an illness?

One of the things I particularly like about this approach is that you don't have to be free from illness to experience improvements in your wellbeing. Someone living with a chronic condition or disability might develop stronger relationships, discover an enjoyable activity or find greater meaning in their daily life, even if their underlying condition doesn't change. None of this makes their illness or the difficulties they experience disappear, but it may make a meaningful difference to their quality of life.

Equally, someone without a diagnosed illness might be struggling with several aspects of their wellbeing. Whether someone is managing a long-term health condition or has no diagnosed illness, there's still room to consider what might help them feel and live better.

RCSI's researchers describe positive health as both a destination and a journey. The destination involves thriving across different areas of life, while the journey recognises that movement towards thriving matters, wherever we're starting from. We don't have to achieve some ideal state of health before improvements in our wellbeing become worthwhile.

Where does positive health coaching fit in?

Positive health coaching brings together lifestyle medicine, positive psychology and coaching to help people explore what better health and wellbeing might look like for them. Lifestyle medicine considers how factors such as sleep, nutrition, physical activity, stress and social connection influence our health. Positive psychology explores what supports wellbeing and flourishing, while coaching provides a collaborative space to consider our priorities, circumstances and what might help us move forward.

Our health is influenced by all sorts of things, many of which are outside our control. Our circumstances, relationships, environment and access to resources all play a part, and these can make looking after our health considerably easier or harder.

This is something I think is important to recognise in positive health coaching. We're all different, and what works well for one person may be entirely unsuitable for another. Taking the time to understand the individual, what matters to them and what's realistic in their circumstances is an important part of helping them make changes that are meaningful and sustainable.

References and further reading

*O'Boyle, C. A., Lianov, L., Burke, J., Frates, B., & Boniwell, I. (2024). Positive health: An emerging new construct. In Routledge International Handbook of Positive Health Sciences: Positive Psychology and Lifestyle Medicine Research, Theory and Practice. Routledge.

RCSI Centre for Positive Health Sciences. What is positive health?

World Health Organization. Constitution of the World Health Organization.

Shauna Garvey, PhD, is the founder of Éistim Coaching and an EMCC-accredited Senior Practitioner. She holds an MSc in Positive Health Coaching from RCSI and a PhD in Pharmacology from the University of Cambridge. Her coaching approach draws on lifestyle medicine, positive psychology and evidence-informed behaviour change, with an emphasis on understanding each person and their individual circumstances.