Redefining Health

In researching existing definitions of health and proposals for its modernization, it is evident that health is an elusive concept that will be a challenge to succinctly capture in one or two sentences. There is one common theme that ties all perspectives together; that is the consideration that health is more than just being disease-free.

World Health Organization (WHO) Definition, 1948

Formulated in 1948, WHO describes health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". This definition has been criticized for no longer being relevant in modern society, where medical advances have significantly contributed to longer life expectancy with an increasing number of people living with chronic illnesses. In a paper looking towards new perspectives to define health, Leonardi summarizes the limitations of the WHO definition of health as follows:

1. The complete state of health in all aspects is a utopian concept that is unattainable

2. Health as defined by WHO is neither operational nor measurable,

3. Medicalization of society has resulted from the requirement of complete physical, mental, and social well-being; medical solutions are expected to address social issues such as poverty, discrimination, violence

4. Equating health with well-being

5. Assumption of a positive correlation among physical, mental, and social well-being

Contemporary Proposals to Define Health

The aging population, prevalence of chronic illnesses, and medical advances in effectively controlling symptoms manifested by chronic illnesses leading to the possibility of leading a “healthy” life necessitate a review and update of the WHO definition. To address health as a state of perfection and to overcome its unattainability, this editorial in the Lancet suggests that:

“By replacing perfection with adaptation, we get closer to a more compassionate, comforting, and creative programme for medicine – one to which we can all contribute.”

The concept of adaptability is central to many contemporary approaches to define health. Health is “the extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities” (Ottawa Charter).

The new concept of health emphasizes on one’s “ability to adapt and to self-manage, in the face of social, physical and emotional challenges” (Huber et al.) Resilience seems to be more relevant for those that are coping with chronic diseases as it introduces the possibility that one can be healthy and can contribute positively to society despite not being disease-free. For those patients that are living with incurable diseases, this new concept allows for assessment for treatment options to help patients adapt, rather than focusing on cure. Health can be seen as the “ability to flourish without being unduly impeded by illness or disability or, if necessary, by overcoming illness or disability” (Misselbrook).

Reflection

The ability to adapt to achieve health means health care should be directed at this goal.

“Health care should aim for the state of least possible illness or disability, or of maximal functional adaptation to illness or disability”.

This is a powerful statement and is applicable across all health disciplines. It never ceases to shock me daily in my place of work in a regional cancer centre as I walk past hundreds of patients diagnosed with cancer. Some of these patients are fortunate enough to receive treatment with a curative intent; others, not so lucky. It is inspiring to see that the ones knowing they will never be disease-free still make the trek, even in the dead of Winter, in pursuit of health in this context – that is, to adapt to and manage their life with disease.

References

Huber, M., Knottnerus, J.A., Green, L., van der Horst, H., Jadad, A.J., Kromhout, D., . . . van Weel, C. (2011). How should we define health? British Medical Journal, 343:d4163.

Leonardi, F. (2018). The Definition of health: Towards new perspectives. International Journal of Health Services, 48(4), 735 – 748.

Misselbrook, D. (2014). W is for wellbeing and the WHO definition of health. British Journal of General Practice, 64(628), 582.

Ottawa Charter for Health Promotion. (1986). Accessed on October 6, 2018 from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/.

What is health? The ability to adapt. [Editorial]. (2009). The Lancet, 373:781.