The Defining of Health

What is health? Health is a concept that all humans share. Some of us are more aware of our health than others. Some of us wish to improve our health, while others are more content. But what does health really mean? How do we define it?

The World Health Organization (WHO) attempted to define health in 1946 by describing health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1946, p. 1268). Although the definition identifies that “mental and social well-being” are components of health, this definition can be viewed as unattainable due to the emphasis on being “complete” (Card, 2017; Leonardi, 2018). By this definition, Card (2017) states that people living with chronic conditions would never be viewed as healthy. Tyack et al. (2016) estimate that 35-55% of the world population is living with some type of chronic disease. Based on the WHO’s definition of health, up to 55% of the world population would never be deemed healthy. Without a doubt, the definition of health needs to be updated.

Leonardi (2018) criticizes the WHO’s definition of a health through a variety of lenses. While he agrees that complete well-being was unattainable (Leonardi, 2018), he also notes other issues with the WHO’s definition of health. Leonardi (2018) identified the following constraints: it was unmeasurable; it lacked political and social economic factors; it focused too much on the medicalization of health; the emphasis on well-being negated to acknowledge that experiencing loss (physical, emotional, spiritual) does not necessarily equate to a lack of health; and lastly it failed to include that some risky behaviours may actually positively affect a person’s well-being” (Leonardi, 2018, pp. 737-738).

Following his analysis, Leonardi (2018) compiled a framework of nine principles that a new definition should include. Leonardi’s (2018) ideologies of health are as follows:

1. Health must be beyond the absence of disease or infirmities and the biophysical parameters (…).

2. Health must be conceptualized as a capability, (…), or more precisely, a cluster of capabilities.

3. Health must be seen as an ongoing, iterative, and dynamic process, not as a state to reach (…).

4. Health must be potentially achievable for everyone in real life, in all circumstances, at every age, regardless of socioeconomic status, race, or religion (…).

5. Health must include both malaise and well-being, because most people cope with negative events and therefore feel unease, sorrow, and unpleasant emotions without reporting a loss of health (…).

6. Health must overcome individualistic approaches, (…), but, at the same time, health cannot be solely reduced to an outcome of social determinants.

7. Health must be independent of moral and ethical discourse (…).

8. Health must be based on a person’s priorities, values, needs, aspirations, and goals (…).

9. Health must be operational and measurable by clear, concrete, and definite processes (…). (pp. 740-741)

Although Leonardi (2018) did not formulate a new definition of health, his work lays the foundation for a new definition to be developed. The concepts he proposes encompass the idea of health to be more holistic and self-defined, especially when compared to the WHO’s definition.

Witt et al, (2017) focus on redefining health through the means of a concept known as integrative health. Integrative health is care that would “focus increasingly on wellness, health management across the lifespan, patient-centredness, evidence-based medicine, and the integration of complementary medicine” (Witt et al, 2017, p. 134). The addition of the word “integrative” when describing health creates more of a comprehensive definition. Witt et al (2017), described the concept as follows:

Integrative health is a state of well-being in body, mind and spirit that reflects aspects of the individual, community, and population. It is affected by: (1) individual biological factors and behaviors, social values, and public policy, (2) the physical, social, and economic environments, and (3) and integrative healthcare system that involves the active participation of the individual and the healthcare team in applying a broad spectrum of preventive and therapeutic approaches. Integrative health encourages individuals, social groups, and communities to develop ways of living that promote meaning, resilience and wellbeing across the life course. (p. 135)

This concept of integrative health, as described by Witt et al (2017), is similar to the ideas put forth by Leonardi (2018). Both emphasise the importance of identifying and acknowledging external factors to health such as socioeconomics, health policies, and an individual’s participation. Witt et al (2017) also mention the role of alternative medicines in addition to evidence-based practices (p. 134) which can be seen as undervalued.

Upon final review, there are many forthcoming ideas and concepts to redefine how we view health. However due to the complexities, a new definition of health is sure to be a challenge.

References

Card, A. J. (2017). Moving beyond the WHO definition of health: A new perspective for an aging world and the emerging era of value-based care. World Medicine & Health Policy, 9(1), 127-137. https://doi.org/10.1002/wmh3.221

Constitution of the World Health Organization. (1946). Public Health Reports (1896-1970), 61(35), 1268-1277. Retrieved from http://www.jstor.org/stable/4585812

Leonardi, F. (2018). The definition of health: Towards new perspectives. International Journal of Health Services, 48(4), 735-748. http://doi.org/10.1177%2F0020731418782653

Tyack, Z., Frankes, K., Barnett, A., Cornwell, P., Kuys, S., McPhail, S. (2016). Predictors of health-related quality of life in people with complex chronic disease including mulimorbidity: A longitudinal cohort study. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 25(10), 2579-2592. http://doi.org/10.1007/s11136-016-1282-x

Witt, C. M., Chiaramonte, D., Berman, S., Chesney, M. A., Kaplan, G. A., Strange, 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