What is health?

Fabrice Coffrini

What is health?

After completing the assigned readings I looked for an article that would attempt to update the World Health Organization’s (WHO) definition of health. While the WHO (2005) had great intentions in 1948 when attempting define health “as a state of complete physical, mental and social well-being”, this definition has become outdated. It is a prescriptive definition that may not be attainable in the presence of chronic diseases and conditions. “Complete” health is an unrealistic definition.

Current definition of health?

I have added an article by Noble (2014) to my list of curated resources. She critiques the WHO’s 1948 definition of health and argues in order to use the concept of health as ability to adapt and self-manage it is necessary to identify and characterize if for the three domains of health: physical-biological, mental and social. This concept of health resonates with me as it acknowledges that health is a subjective state influenced by many factors. Each individual has unique genetics, mental coping abilities, and social environments. It is possible that two individuals may be experiencing the same disease process, and have contrasting perceptions of their individual health based on their mental capacity to cope and their social support system. This updated definition of health is not merely based on the absence of illness but rather, gives some power and control to the individual to define their level of health or illness.

Compared to the 1948 WHO definition of health

According to Sartorius (August,2006) there are three types of definitions of health that are used. The first is that health is the absence of any disease or impairment which is in line with the 1948 WHO definition. The second is that health is a state that allows the individual to adequately cope with all demands of daily life (implying also the absence of disease and impairment). The third definition states that health is a state of balance, an equilibrium that an individual has established within himself and between himself and his social and physical environment. Sartorius mirrors Noble in his definition of health.

Is the 1948 definition helpful and relevant today?

The 1948 definition is not helpful or relevant today as it does not allow health as a dimension of existence which can co-exist with the presence of a disease or impairment. Steffler et al (2021) reported the number of patients with chronic disease increased by 11.0% over the 10-year study period to 9.8 million in 2017/18, and the number with multimorbidity increased 12.2% to 6.5 million. When the WHO (1948) defined health as a complete state the scourge of chronic conditions had not reached the level it has in modern times.

Contemporary criticism of WHO definition/Do you agree or disagree with these?

In Brook’s (2017) opinion piece he posits that perhaps tolerance should be included in a modern measure of health. I found his column to be poorly written, lacking concrete data, and reliant on scare tactics. In his rendition of a hypothetical OB-GYN appointment, he imagines the physician does not access the patients “tolerance” and “fifteen months later she leads a terrorist attack that kills several dozen people.” While I understand the societal concern around radicalization and terrorist attacks, I do not feel it is the responsibility of a medical professional, aside from a psychiatrist to assess levels of tolerance and potential risk. His article speaks in generalities and does not provide any tools or strategies for medical professionals to complete this extremely subjective assessment. I absolutely disagree with the argument which is poorly executed by Brook.

References

Alexander, D. [Untitled image comparison]. (2019). The comparison trap. Retrieved from https://www.psychologytoday.com/us/articles/201711/the-comparison-trap

Brook, R.H. (2017). Should the definition of health include a measure of tolerance? JAMA. 2017;317(6):585-586. doi:10.1001/jama.2016.14372

Geneva: World Health Organization. (2005). In: World Health Organization: Basic documents. 45th ed. Constitution of the World Health Organization. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080455/#R1

Noble, M. (2014). The WHO definition of health: a critical reading. Medicine and Law. 33(2). Retrieved from https://www.jstor.org/stable/23051314

Sartorius, N. (August,2006). The meanings of health and its promotion. Croatian Medical Journal. 47(4): 662–664. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080455/#R1

Steffler, M., Li, Y., Weir, S., Shaikh, S., Murtada, F., Wright, J.G. Kantarevic, J. (February, 2021). Trends in prevalence of chronic disease and multimorbidity in Ontario, Canada. CMAJ. February 2021, 193(8). E270-E277. DOI:10.1503/cmaj.201473