The existential dimension of spirituality has proven to be of great importance over the last two decades when it comes to studies of self-rated health and quality of life. We see the positive effects it has on blood pressure, depression and life expectancy for chemotherapy and HIV patients, to mention just a few examples. In the public health sector, it is interesting to note that this existential/spiritual dimension had already been present in the early years when the term public health first came into the Swedish language. In the year 1926 public health was defined as ‘a people’s physical and spiritual health’. During the intervening years of major medical and scientific technical improvements in the field, the existential/spiritual perspective had been put aside, but now once again this dimension has come into focus. The central question is, how does the existential dimension of health, understood as a person’s ability to create and maintain functional meaning making systems, affect the person’s self-rated health and quality of life? The working theories and basic perspectives in this article are drawn from health research with attention to the existential dimension, public health from the perspective of the psychology of religion, and object relations theory.