How do we define health anyway?

I struggle to write this blog and define the term `health’ as I imagine they did in 1948 when the first definition put out by the World Health Organization (WHO) came into force and at each attempt to assess its validity since. Prior to engaging in class discussion I wanted to come to my own understanding of the term `health’ recognizing that we are all in the business of providing healthcare to those who require it—be it preventative health, supportive health or a reactionary response to `falling out of health’—we all rely on this definition to support our work. My reality is that I work in healthcare, I am a healthcare provider by training and practice and I therefore rely on the definition of health to define myself as a professional as well as to define my practice as a value to the population that I see myself as providing care for.

To have a widely accepted definition of health is essential—but why is this important? Without a definition, and a means of measuring the effectiveness of our response to maintain and/or restore health it is difficult to ensure that providers and organizations are meeting the expectations of the users, and/or to provide evidence to validate the provision of equitable funding to support the work that is being done to keep our populations ‘healthy’. The WHO defined health in 1948 as` a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, (WHO, n.d.); but how does this work today? How is this measured? How can we ensure equity under the direction of this definition? I find that it is difficult to accept the term `absolute’ meaning having no restriction, exception, or qualification (Marriam Webster, 2019) as an integral part of the definition of health as defined by the WHO.

The definition that is put forth by the WHO is especially important as the WHOs primary role is: to provide the basis to practices, policies and coordinate the efforts of governments and private sectors to work together to attain health objectives by supporting national/international health policies and strategies (WHO, n.d. b).To use the term `absolute’ indicating that there are no variations in their definition seems short-sighted or restrictive. Further, I question, is there such a thing as `absolute’ in the field of health as it is related to medicine when there are so many areas un-discovered, under-discovered, mis-understood, or in the process of evolution? Can it be absolute across populations (geographic, gender, economic, social, age etc.)? Does it mean the same thing to a 95 year old male in Southern Ontario to be `healthy’ as it does to a 95 year old male in the Sudan? Likewise, who says so- the person, or is it social acceptance that defines what it is to be `healthy’ or having `health’?

The WHOs definition of health was far from the first attempt at defining `health’ as a concept or construct. In fact, health was defined by various philosophers and through time and evolution in different ways, as discussed in Concepts and definitions of health and health-related values in the knowledge landscapes of the digital society by Svalastog et al, 2017:

In examining the various definitions it’s difficult not to think that some of the earlier definitions, to no surprise, not only provided a foundation to the working definitions later written, but may in fact be even more relevant today than that of the WHO from 1948, suggesting that to fall within the current WHO definition of complete health “would leave most of us unhealthy most of the time.” (Huber et al, 2008) and how can one measure health if it is to be an absolute?

In looking at the more modern attempts at defining health it is apparent that giving health a definition is quite complicated and multi-faceted and often reflects the `view/angle’ from which the definition is created. This is to say that the definition has to, in part, answer the questions that are asked by the group that is providing the definition. This, in my opinion, further suggests that there is not one answer to the question `what is health’. To ask this question is to engage in further discussion, and apply somewhat of a culturally, socially, and economically appropriate definition in that time.

References

Huber M., Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, Leonard B, Lorig K, Loureiro MI, van der Meer JW, Schnabel P, Smith R, van Weel C, Smid H. How should we define health? BMJ. 2011 Jul 26;343:d4163. doi: 10.1136/bmj.d4163. Retrieved from https://www.bmj.com/content/343/bmj.d4163.long

Marriam Webster, 2019. Definition of absolute. Retrieved from https://www.merriam-webster.com/dictionary/absolute

Svalastog, A. L., Donev, D., Jahren Kristoffersen, N., & Gajović, S. (2017). Concepts and definitions of health and health-related values in the knowledge landscapes of the digital society. Croatian medical journal, 58(6), 431–435. doi:10.3325/cmj.2017.58.431Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778676/

World Health Organization (WHO), n.d a. Constitution. Retrieved from: https://www.who.int/about/who-we-are/constitution

World Health Organization (WHO), n.d.b. About Who. Retrieved from https://www.who.int/about