David Woodhead on love and understanding

It was the end of a long and delightful day with my niece, now seven and a half. We'd been to the beach, sang loudly and eaten ice cream. But despite much protest, it was clearly time for bed. Teeth were brushed, hands and face washed, pyjamas on. She climbed into bed. 'I love you, Uncle David', she whispered. 'I love you too', I replied. 'Shall we count our blessings?'. Her list came freely: family, friends, dog and rabbit (sadly deceased). 'Good night, sweet pea', I said as I turned to leave. She shouted after me. 'It's 19, Uncle David'. I didn't understand. 'You said we had to count our blessings'.

Dewy eyed, I went downstairs and thought about the importance of love in our lives. Years ago, I read various research papers about it, some of which were philosophical and barely understandable; others were psychological. I could not recall a mainstream public health text that spoke about the importance of love.

Poverty, housing, education and access to services were regularly discussed. But I could not recall an occasion when public health folk talked about love. There was talk of networks, family and community as settings for interventions, but seldom was love considered. Perhaps emotions, which are much researched in other disciplines, could never find a comfortable place in one so closely related to the cold logic of medicine.

But the profound connections we feel to others help structure our lives and make sense of what happens to us. They bind us together and hold us firm as we deal with life's challenges. They are essential in securing our physical and mental health.

Thinking differently

Love cannot be prescribed or dispensed. But there are several steps we can take to help it flourish. Primary care, in partnership with other agencies, has a role in fostering relationships. Support can be offered to parents, on their terms, to help them build their skills. Enabling love to thrive might be a desired outcome when working with children.

We can help provide support in times of crisis and protect against their corrosive effects on close relationships. Services can be provided to help keep families together in the face of bereavement. We can help them find peace in the final days of a loved one's life. We can provide emotional and practical support when worlds crumble after redundancy, relationship breakdown or long periods of debilitating illness.

We can involve loved ones in defining pathways through illness, and recognise that diagnoses have an impact on patients' families and friends. And we can respect relationships and resist making judgements, for example by recognising that same-sex couples might wish to express their love in similar, or different, ways.

If love is all around us, why is it seldom discussed? What is the exact role of love in promoting health? And if love were a desired outcome, how would we recognise it? These questions remain. Perhaps love is too subjective to enable systematic and convincing measurement. Simply counting our blessings might not be enough.

For sure, love is not all we need. There are material factors to consider too. Equality, equity and opportunity need to be in the mix. But it is time to think differently about what impacts on health, including the less tangible aspects of our lives.

We might never fully understand just how much of a contribution love makes; it is unlikely that there will ever be a formula to express its relative importance. But we should strive to understand its role and find practical steps to promote it. The health of the population is counting on it.