The World Health Organization’s (WHO) definition of Health (“A state of complete physical, mental and social well being and not merely the absence of disease or infirmary”) was likely quite accurate for the time (WHO, 1948). I would imagine that the inclusion of “mental and social well being” in addition to the physical components of health may have even been seen as quite progressive in 1948. However, the world has changed significantly over the past 70+ years and this definition is no longer accurate or even all that helpful. As Bradley et al. (2018) states, the main limitation in the WHO definition lies in the word “complete”. As medicine has gotten better at treating acute illnesses and people are living longer, almost no-one is completely free of any form of malady (Bradley et al., 2018). Every day at work I interact with seniors who have a whole host of medical co-morbidities, but (in those whose medical conditions are properly managed) are actually quite healthy. Just because an individual has a chronic condition does not necessarily mean that they are of ill health. For example, consider a man who has paraplegia. He monitors his diet, exercises regularly, maintains a healthy weight and is independent but uses a wheelchair. Technically he does not represent a “complete state” of physical health, yet who among us would consider this individual to be un-healthy?
One alternative definition is provided by Bircher and Kuruvilla (2014): “the state of well-being emergent from conductive interactions between an individual’s potentials, life demands, and social and environmental determinants”. What I like about this definition is the comparison that it makes between what an individual is capable of (their “potential”- consisting of both their biologically determined capabilities and their adaptive or acquired strategies) and what their life requires them to be able to do (Bicher & Kuruvilla, 2014). This definition would allow someone like the individual with the spinal cord injury mentioned above to still fit the definition of healthy. He has learned new ways of doing things (like transferring to a wheelchair and mobilizing in a wheelchair independently for example) and in this sense his adapted/acquired potential allows him to meet his life demands. I also like how this definition alludes to the fact that an individual can compensate for reductions in their biological potential (brought on by aging or injury) by increasing their acquired potential, which- as a physiotherapist-I help patients do all the time!
Another, more simple definition of health was provided by the Lancet in an editorial in 2009 as “the ability to adapt”. As a rehabilitation professional, I appreciate that this definition also touches on the capacity of an individual to adjust to changing circumstances. However I think that the definition provided by the Lancet is perhaps too simplistic and it does not specifically mention psychological or social components of health.
An alternative solution is to forget about the term health all together and replace it with the concept of “well-being”, outlined by the Centers for Disease Control (CDC). According to the CDC, an individual’s sense of well-being “tells us if people perceive that their lives are going well” (CDC, 2018). This can be seen as integrating all aspects of health. A person who is suffering from anxiety or depression would probably not report that they are doing well. Nor would an individual who is in the throws of cancer. This definition also allows for the consideration of interpersonal reationships as well as access to resources as necessary components of health (CDC, 2018)
Action for Global Health (2013). What does being healthy mean to you? [Video]. Youtube. https://www.youtube.com/watch?v=geX1V1Q1BHY
Bircher, J., & Kuruvilla, S. (2014). Defining health by addressing individual, social, and environmental determinants: New opportunities for health care and public health. In Public Health Policy (Vol. 35, Issue 3). https://0-doi-org.aupac.lib.athabascau.ca/10.1057/jphp.2014.19
Bradley, K. L., Goetz, T., & Viswanathan, S. (2018). Toward a contemporary definition of health. Military Medicine, 183, 204–207. https://doi.org/10.1093/milmed/usy213
Centers for Disease Control (2018). Well-being concepts. Centers for Disease Control and Prevention. https://www.cdc.gov/hrqol/wellbeing.htm
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July, 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April, 1948.
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