The concept of health and defining it in a simple statement has been an ongoing challenge for many years. Rather than being mutually exclusive, perhaps health and illness may need to be considered together, and with different factors and perspectives to make it's definition not only accurate but dynamic. Can one thrive or flourish while living with an illness?
Over 74 years ago, the World Health Organization’s Constitution defined health in what, at the time, was considered a modern way. Health was “a state of complete physical, mental and social well-being” and added emphasis on that health was more than just the absence of disease, and that child development and environmental factors. Fallon et al. (2019) explain that “this circa-1948 definition reflected post war optimism for the control of communicable diseases and the promise of the world’s children.” Since 1948, many have criticized the definition, as it lacks the ability for health to co-exist with disease, illness, or disability.
In 2022, certainly, many individuals are thriving with multiple chronic conditions, and both males and females lifespans have extended on average 25+ years longer than in 1948. The word 'complete', has also been the subject of much scrutiny for the WHO definition. As screening technology, and medicine advances, the realistic ability for anyone to achieve this complete state of wellness would seem to be impossible, and could cost our healthcare system much more, to potentially treat patients who do not meet the definition.
One newer concept of health called Positive Health resonates with me. Positive Health is foundational in the health policies of the Netherlands. According to the Institute for Positive Health “Positive Health is not a definition. This is no accident. It is a characterization, a philosophy, rather than a restriction.” The philosophy includes the understanding that health must encompass a broad viewpoint, and itemizes actions within six dimensions: bodily functions, mental well-being, meaningfulness, quality of life, participation, and daily functioning.
Similarly, the International Classification of Functioning, Disability and Health (ICF) focuses on performance as well as capacities of an individual, which includes a broad set of aspects in its measurement of health: body functions, activity and participation, environmental and personal factors, and body structures.
But is there still something missing in these examinations of health? Can we represent different perspectives and apply a health equity lens within a definition of health? Pallai et al., (2019) discuss “by focusing on people in communities, we can begin to understand social determinants of health and paths to health equity. We must listen to the stories of those in the community, their definitions of health, and the issues they see as important to the health of individuals, and the health of their community.” Narrative health moves away from a government, national or international organization being the notary on defining health, even moves past health care perspectives, and implores us to listen to the patients, the people, the stories.
Perhaps, we need to think of health along a spectrum or continuum to capture the full picture. Defo (2014) suggests “the definition of the health/disease boundary being inevitably arbitrary, there needs to be measures for illness, sickness, disease along a continuum from conception to death in specific contexts, so as to capture the epidemiological profiles of populations.”
Analysis has been ongoing for over 70 years since the WHO definition was adopted, and yet, we are no closer to having a universally accepted understanding of health. According to van Druten et al., (2022) “the question remains whether a general health concept can guide all healthcare practices. More likely, health concepts need to be specified for professions or settings.” With any discussion or debate, there is a matter of perspective. When considering the definition of health, the health care provider may have a different perspective than the patient themselves, and likewise the policy makers. Is achieving a unified definition possible, or even necessary? If every perspective has unique definitions, assessments and objectives toward improving the human experience, are we all working toward the same goal regardless of the semantics?
References:
Becker, C. M. (2011). Re: How should we define health?. BMJ, 343, d4163.
Defo, B. K. (2014). Beyond the ‘transition’ frameworks: the cross-continuum of health, disease and mortality framework. Global Health Action, 7(1), 24804.
Fallon, C. K., & Karlawish, J. (2019). Is the WHO definition of health aging well? Frameworks for “Health” after three score and ten. American journal of public health, 109(8), 1104-1106.
Jadad, A. R., & O’Grady, L. (2008). How Should Health Be Defined? BMJ: British Medical Journal, 337(7683), 1363–1364. http://www.jstor.org/stable/20511543
Jambroes, M., Nederland, T., Kaljouw, M., Van Vliet, K., Essink-Bot, M. L., & Ruwaard, D. (2016). Implications of health as ‘the ability to adapt and self-manage’ for public health policy: a qualitative study. The European Journal of Public Health, 26(3), 412-416.
Pallai, E., & Tran, K. (2019). Narrative health: Using story to explore definitions of health and address bias in health care. The Permanente Journal, 23.
Potvin, L., & Jones, C. M. (2011). Twenty-five years after the Ottawa Charter: the critical role of health promotion for public health. Canadian Journal of Public Health, 102(4), 244-248.
Public Health Agency of Canada. (n.d.). What is health? - Canada.ca. Retrieved October 11, 2022, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-approach/what-is-health.html
Sartorius, N. (2006). The meanings of health and its promotion. Croatian medical journal, 47(4), 662.
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