The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO 1948). This may sound like a simple, correct, and complete definition, however this view of health excludes any form (and degree) of disease or disability. Much of the criticism surrounding WHO's definition is the use of the word ‘complete' with physical, mental & social wellbeing (Huber 2011). Are any of us “completely” healthy in every aspect of life? How many people are excluded from health by using this definition? How few people are actually considered healthy according to this definition? In today's culture health involves both curative means and also the management of diseases, disabilities, & conditions which in return can lead to a fulfilled and sustained life.
Seventy years ago at the time of the WHO definition the global life expectancy was approximately 48 for men, and 53 for women. Today the global life expectancy is 70 for men, and 75 for Women (Worldometer, 2020). In 1948 there were also many diseases that were rampant (and life threatening) such as polio and diphtheria. Heart disease, cancer, and stroke were the leading causes of death, often resulting in a death sentence. (Fallon & Karlawish 2019). While these conditions are still present & the leading causes of death today, their diagnosis is largely preventable and in many circumstances manageable.
WHO defines and declares people with chronic diseases and disabilities definitively ill, minimizing the ability to cope with changing physical, emotional, and social challenges. This definition does not acknowledge the human ability to function with a feeling of wellbeing with a chronic disease or disability (Huber 2011).Today having disease and being healthy are no longer mutually exclusive, especially for older adults. Approximately two thirds of adults over 65, and three quarters over 85 are managing two or more diseases & despite that many report being in good or very good health. With regular access to continuous medical care, many conditions and diseases can be managed, sometimes even without symptoms (Fallon, Karlawish, 2019). Thresholds for medical intervention tend to be lower today. New screening technologies detect abnormalities at levels that may never cause illness and we have access to drugs for conditions not previously defined as health problems (Huber 2011).
German-Croatian psychiatrist & previous director of the WHO’s division of mental health - Norman Sartorious discussed three definitions/paradigms of health that he believed possible today.
• First is that health is the absence of any disease or impairment.
• Second is that health is a state that allows an individual to adequately cope with all demands of daily life (implying also the absence of disease and impairment).
• The third states that health is a state of balance - an equilibrium that an individual has established within themselves and also between themselves and their social/physical environment.
Sartorious discussed the consequences of adopting only one or another of these definitions are considerable. If health is defined simply as the absence of disease (the first definition), a medical profession is the only one that can declare an individual healthy. Individuals who are declared healthy today may be diseased tomorrow due to advanced detection. This first paradigm of health does not take into consideration how an individual feels about his or her state, which makes it very similar to the WHOs definition.
The second definition takes into account an individual being 'diseased' but still able to cope with the demands of daily living. There are individuals who can have symptoms of a disease but do not feel ill. There are others who do not physically demonstrate illness but who feel ill and do not function well. There are individuals who experience no problems, do not know that they have a disease, and do not seek treatment for it.
Some of these individuals also do not fit the second definition of health because they function as well as expected with what they have been given. Their definition of health then falls into the question of if they have reached a state of balance & equilibrium within themselves, and between themselves and their social/physical environment. This measures them getting the most they can from their life despite the presence of disease. The advantage of this definition is that disease do not replace individuals’ health. It may affect their ‘balance’, however the patients with a disease (and their caregivers) remain aware of the need to work simultaneously on two tasks – one, to remove or alleviate the disease and the second to establish a state of balance, as best they can, within oneself and in relation with their environment. (Sartorious 2006) A classmate shared a resource discussing a book by a french physician - Georges Canguilhem. In 1943 he rejected the definition that there were either normal or abnormal states of health. He viewed health as the ability to adapt to one’s environment, and that it varies for every individual, depending on their circumstances (Lancet 2009). He also stated that health is not defined by a doctor, it is defined by the person, in accordance to their functional needs, and that the healthcare team is a resource to help an individual adapt to their unique conditions ( Lancet 2009).
To establish a definition of health there are several things we must first consider. we must explore how individual define health themselves. How those who have a disease feel about, how it influences their lives, how they propose to fight their disease or live with it, and then how successful they are at adapting to it. We also have to consider how we as the healthcare team are able to provide assistance and resources to individuals striving to achieve 'health'.
References
World Health Organization. (2020) Constitution of the World Health Organization. https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1
Huber, M. (2011). Health: how should we define it? British Medical Journal, 343, (7817), 235-237. https://doi.org/10.1136/bmj.d4163
Fallon, C.K., Karlawish, J., (July 17 2019) Its time to change the definition of 'health'. Stat news.
https://www.statnews.com/2019/07/17/change-definition-health/
Life expectancy of the Word Population. (2020) Worldometer. Retrieved February 2021. https://www.worldometers.info/demographics/life-expectancy/
Sartorius, N,. (2006). The meaning of Health and its Promotion. Croatia Med Journal, 47 :662-664. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080455/pdf/CroatMedJ_47_0662.pdf
The Lancet. (2009). What is health? The ability to adapt. The Lancet, 373(9666), 781. https://doi.org/10.1016/S0140-6736(09)60456-6
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