What is Health?

WHO definition of health

In 1948, the World Health Organization (WHO) defined health as a “state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”.

To fully understand the 1948 definition of health, one must consider the context within which it was conceptualized. The WHO was created in 1946, one year after the end of WWII. In this immediate post-war era, the belief that world peace was influenced by the overall health and well being of all individuals prevailed (Callahan, 1973). The first director, Dr. Chisholm, played a critical role in molding the definition (Callahan, 1973). Dr. Chisholm argued that:

the work is sick and the ills are due to the perversion of man…The microbe is not the enemy; science is sufficiently advanced to cope with it...were it not for the barriers of superstition, ignorance, religious intolerance, misery and poverty…These psychological evils must be understood in order that a remedy might be prescribed… (Callahan, 1973, p. 79).

One can see his beliefs and ideals portrayed in the definition, with the inclusion of mental and social well-being.

Unforeseen impacts

Unforeseen was the impact this definition would have on the next 70 years of healthcare. The focus of healthcare has been on disease and treatment of acute and life-threatening illnesses (Mitt et al., 2017) and much less on the prevention of disease (Katz, Elmore, Wild & Lucan, 2014). Many health policies and systems are operating under this definition and measuring their success by such things as mortality rates and survival years gained, as opposed to quality of life measures (Katz, et al., 2014).

Why it may no longer fit

Arguments against the idealistic expectation created by the definition abound. Most criticism has centered around the definitiveness of the word “complete”. Huber (2011) argues that this has added to the ‘medicalization of society’. Some argue that in today’s reality, most people would be considered unhealthy, most of the time, as defined by the WHO (Huber, 2011). This argument mirrors others that suggest the definition does not reflect the current reality of population health. Acute disease is no longer the main burden of health care, as it was in 1948 (Huber, 2011). There is now a world wide trend of aging with chronic disease (Huber, 2011). A person can continue to function at full capacity despite chronic illness. This reality has led yet others to theorize that health is not a static but a dynamic process (Katz, et al., 2014), that moves along a continuum (Card, 2017).

Modernizing the definition of health

How should we define health, if the WHO definition has outlived its usefulness? While there have been many arguments made against the definition, there have also been many suggestions on how to modernize it. Some suggestions include:

• Dubos’ (1961) definition (as cited in Katz, et al., 2014, p. 173): health or disease are the expressions of the success or failure experienced by the organism in its efforts to respond adaptively to environmental challenges.

• Mitt et al.’s (2017) definition: …health is a state of well-being in body, mind, and spirit that reflect aspects of the individual community and population. It is affected by: 1) individual biological factors and behaviours, social values, and public policy, 2) the physical, social and economic environments, and 3) an integrative healthcare system that involves the active participation of the individual and the healthcare team in applying a broad spectrum of preventative and therapeutic approaches. Integrative health encourages individuals, social groups, and communities to develop ways of living that promote meaning, resilience and well-being across the life course.

• WHO clarification (1986): health is a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities” (Nordqvist, 2017).

• Card’s 2017 definition: health is the experience of physical and psychological well-being. Good health and poor health do not occur as a dichotomy, but as a continuum. The absence of disease or disability is neither sufficient nor necessary to produce a state of good health.

A way forward

When reviewing these ‘modern’ definitions, I was struck by their similarities. First, most of these definitions consider more than just physical health as a contributor to overall health. Second, most speak to the belief that not only is health experienced as a continuum, it is also affected by our ability to cope with the ‘stressors’ we experience. Finally, these definitions all lend themselves to the application of different metrics of healthcare outcomes. No longer are mortality rates the most indicated measure; conversely, quality of life, health status index, quality adjusted life years and other health profile measures would lend themselves better to this task (Katz, et al., 2014).

When considering these definitions I am drawn to the potentials of the ‘unintended impacts’. Under these definitions, I see the potential for increased value being placed on preventative medicine, self-management of chronic conditions, and social determinants of health. With increased value comes increased funding, and changes in social policies. Should these definitions be considered when modernizing the Canadian Health Act, improved linkages between health care and other social policies affecting determinants of health could be made; a truly universal health care system could be possible.

References

Callahan D. (1973). The WHO definition of ‘health’. The Hastings Center Studies, The Concept of Health, 1(3), 77-87. http://www.jstor.org/stable/3527467

Card, A.J. (2017). Moving beyond the WHO definition of health: A new perspective for an aging world and the emerging eral of value-based care. World Medical and Health

Policy, 9(1), 127-137. https://doi.org/10.1002.wmh3.221

Huber, M. (2011). Health: How should we define it? British Medical Journal, 343(7817), 235-237. https://doi.org/10.1136/bmj.d4163

Katz, D.L., Elmore, J.G., Wild, D.M.G., & Lucan, S.C. (2014). Introduction to Preventive Medicine. In Jekel’s Epidemiology, Biostatistics, Preventive Medicine, and Public Health (4th ed., pp.173-180). Philadelphia, PA: Saunders.

Mitt, C.M., Chiaramonte, D., Berman, S., Chesney, M.A., Kaplan, G.A., Stange, K.C., Woolf, S.H., & Berman, B.M. (2017). Defining health in a comprehensive context: A new definition of integrative health. American Journal of Preventive Medicine, 53(1), 134-137. https://doi.org/10.1016/j.amepre.2016.11.029

Nordqvist, C. (2017). Health: What does good health really mean? Medical News Today. Accessed October 1, 2018 from: https://www.medicalnewstoday.com/articles/150999.php