Health isn’t what it used to be – namely the absence of being sick.

Ask any teenager today what it means to them to be healthy, and you’re likely to hear about the vast array of areas in their lives they are “working on”.

This can include emotional health, aesthetic health, fitness, nutrition, social health, financial health, social media health, mental health, spiritual health … the list goes on.

When I was a teenager in the 1980s, health wasn’t something I or my friends thought about much. We took it for granted it was either something you had, or were unfortunate to have lost.

In contrast, today’s young people view health as something they can “grow” and should already be working on. Health has become an investment. And, through a process of expansion I call “healthization”, it has become an increasingly diverse one.

Beyond Dr Google

In my recent research, I asked 235 young New Zealanders aged 14–24 to talk about how they use digital technology as part of understanding their health. The results inform my recent book, Healthization: Turning Life into Health.

Some of the results were not unexpected: young people discussed googling their symptoms and self-diagnosing anything from a sore throat to a miscarriage.

They also talked about using online quizzes and a variety of websites and forums to ascertain their mental wellbeing, including self-diagnosing themselves with anxiety, post-traumatic stress disorder and depression.

But at the same time as invoking the value of using “Dr Google”, they also talked about sophisticated strategies they use for determining what forms of online and offline knowledge are trustworthy.

They described how they triangulate online results, determine when to check with medical professionals, and frequently compare their understanding of health information with friends, siblings or parents.

Perhaps more unexpectedly, their definitions of what it means to be healthy were all-encompassing. So much so that for some there appeared to be almost no limit to the role that striving to be healthy plays in their lives.

Things that a generation ago were thought to be important but not necessarily part of being healthy – such as friendship, beauty, having a sense of community, dating, doing well in school, creating “down time” or moments of relaxation – are now rolled into this expansive concept of health.

Not having these things is no longer seen as sad or due to misfortune, but as being actively detrimental to one’s health.

Health’s moral dimension

In a country often stereotyped for its rugged but sometimes cavalier “she’ll be right” ethos, young people openly worry about their own and other people’s physical health in ways strikingly at odds with previous generations.

There has been a lot written about the 21st-century focus on self-improvement. But young people also describe eagerly helping others in their health projects or “journeys”, spending time googling mental health issues so they can help diagnose friends, or even taking their parents along on a run.

Indeed, mental and emotional health in particular are singled out as areas where young people see a generational role to promote greater transparency and social acceptance.

Health takes on a moral dimension as young people describe investing in their own and others’ health as a means to achieve “a good life”. In fact, not to work on one’s health was often depicted as morally wrong.

Through the process of healthization, health has come to cover a much broader terrain than it did a generation or so ago. So, is it even achievable?

Or, given so many different components to health – from minding one’s time on social media to drinking enough water, from working on establishing meaningful friendships to logging in with MapMyRun – is it an illusion that no one can possibly fulfil?

While this might initially appear to be the case, the young people I interviewed suggest differently.

While some did indeed seem overwhelmed by the amount of necessary “work” on health that faces them, others noted the need for “balance” and pathways (sometimes multiple ones) toward enacting those aspects of health that appear most meaningful and achievable.

Finding real balance

In my book I suggest the turn towards such holistic views of health not only helps us acknowledge the wide variety of things that affect our wellbeing, but highlights how the mind and body are interrelated – how our mental wellbeing can influence our physical health and vice versa.

The downside is that it can feel overwhelming and also draw attention away from other things we value and which we need or want to do. These may not necessarily be good for our health but are nonetheless socially meaningful.

That might include devoting time to caring for family members, for example, rather than working on our physical fitness. Or sacrificing our time or wellbeing to promote or protect a greater cause.

The trick, the book concludes, might be to adopt a point of view that embraces the merits of a broad view of health while also encouraging ourselves to look beyond it.

Just as young people are recognising the importance of working on the self while also emphasising the importance of their relationships with others, maybe we can all discover a better kind of “balance”.

Susanna Trnka, Professor of Anthropolgy, University of Auckland, Waipapa Taumata Rau

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A persistent cough can be embarrassing, especially if people think you have COVID.

Coughing frequently can also make you physically tired, interfere with sleep and trigger urinary incontinence. As a GP, I have even treated patients whose repetitive forceful coughing has caused stress fractures in their ribs.

So, why do some coughs linger so long? Here are some of the most common causes – and signs you should get checked for something more serious.

Why do we cough?

The cough reflex is an important protective mechanism. Forcefully expelling air helps clear our lungs and keep them safe from irritants, infections and the risk of choking.

Some people who have long-term conditions, such as chronic bronchitis or bronchiectasis, have to cough frequently. This is because the lung’s cilia – tiny hair-like structures that move mucus, debris and germs – no longer work to clear the lungs.

A wet or “productive” cough means coughing up a lot of mucus.

A cough can also be dry or “unproductive”. This happens when the cough receptors in the airways, throat and upper oesophagus have become overly sensitised, triggering a cough even when there’s no mucus to clear.

Causes of a chronic cough

A cough is considered chronic when it lasts longer than eight weeks in adults, or four weeks in children.

The three most common causes are:

• post-nasal drip (where mucus drips from the back of the nose into the throat)
• asthma
• acid reflux from the stomach.

These often go together. One study found 23% of people with chronic cough had two of these conditions, and 3% had all three.

This makes sense – people prone to airway allergies are more likely to develop both asthma and hayfever (allergic rhinitis). Hayfever is probably the main cause of persistent post-nasal drip.

Meanwhile, prolonged, vigorous coughing can also cause reflux, possibly triggering further coughing.

Chronic cough is the primary symptom of two other conditions, although these can be more challenging to diagnose: cough-variant asthma and eosinophilic bronchitis. Both conditions inflame the airways. However, they don’t rapidly improve with ventolin (the standard clinic test to diagnose asthma).

Coughs after respiratory infections

Coughs can also persist long after a viral or bacterial infection. In children with colds, one systematic review found it took 25 days for more than 90% to be free of their cough.

After an infection, cough hypersensitivity may develop thanks to inflamed airways and over-responsive cough receptors. Even minor irritants will then trigger the coughing reflex.

The body’s response to infection makes the mucus more sticky – and more difficult for the overworked, recovering cilia to clear. Allergens in the air can also more easily penetrate the upper airway’s damaged lining.

This can trigger an unhelpful feedback loop that slows the body’s recovery after an infection. Excessive and unhelpful coughing tends to further fatigue the recovering cilia and irritate the airway lining.

Could I still have an infection?

When a cough persists, a common concern is whether a secondary bacterial infection has followed the first viral infection, requiring antibiotics.

Simply coughing up yellow or green phlegm is not enough to tell.

To diagnose a serious chest infection, your doctor will consider the whole picture of your symptoms. For example, whether you also have shortness of breath, worsening fever or your lungs make abnormal sounds through a stethoscope.

The possibility you have undiagnosed asthma or allergies should also be considered.

What treats a persistent cough?

People with a persistent cough who are otherwise healthy may request and be prescribed antibiotics. But these rarely shorten how long your cough lasts, as irritation – not infection – is the primary cause of cough.

The most effective treatments for shifting sticky mucus from the airways are simple ones: saline nose sprays and washes, steam inhalation and medicated sore throat sprays.

Honey has also been shown to reduce throat irritation and the need to cough.

The effectiveness of cough syrup is less clear. As these mixtures have potential side effects, they should be used with care.

Signs of something more serious

Sometimes, a cough that won’t go away could be the sign of a serious condition, including lung cancer or unusual infections. Fortunately, these aren’t common.

To rule them out, Australia’s chronic cough guidelines recommend a chest x-ray and spirometry (which tests lung volume and flow) for anyone presenting to their doctor with a chronic cough.

You should seek prompt medical attention if, in addition to your cough, you:

• cough up blood
• produce a lot of phlegm
• are very short of breath, especially when resting or at night
• have difficulty swallowing
• lose weight or have a fever
• have recurring pneumonia
• are a smoker older than 45, with a new or changed cough.

What if there’s no clear cause?

Very occasionally, despite thorough testing and treatment, a cough persists. This is called refractory chronic cough.

When no cause can be identified, it’s known as unexplained chronic cough. In the past, unexplained cough may have been diagnosed as a “psychogenic” or “habit” cough, a term which has fallen from favour.

We now understand that cough hypersensitivity makes a person cough out of proportion to the trigger, and that both the peripheral and central nervous systems play a role in this. But our understanding of the relationship between hypersensitivity and chronic cough remains incomplete.

These are disabling conditions and should be referred to a respiratory clinic or a chronic cough specialist. Speech pathology treatments may also be effective for refractory and unexplained coughs.

There are a class of new medications in the pipeline that block cough receptors, and seem promising for persisting, troublesome coughs.

David King, Senior Lecturer in General Practice, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.