What is Health? Science Don't Hurt Me!

Definition of Health by WHO

Health is a dynamic and ever-changing idea which needs a similarly dynamic definition to stay relevant (van Druten, et. al. 2022). In 1948, the World Health Organization (WHO) defined health as, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Since then, this definition has received criticism both for its terminology, the contradictory implications of the statement, and its exclusionary factors.

History of "Health" in Canada

At the time of its founding, acute illness management was the priority of healthcare, as most chronic disease led to mortality (Huber, M., 2011). The result is that the WHO definition negates quality of life in the presence of chronic disease (Huber, M., 2011). The constraints caused by the phrase “complete absence” creates a series of trickle-down implications (Huber, M. 2011). Under this definition, too many people would be considered “unhealthy”. This leads to testing or treatment which does not improve quality of life but seeks to reach the unattainable goal of "health" as it is outlined by WHO (van Druten, et. al, 2022). This focus on complete absence leads to unnecessary, excessive, and generalized screening and treatment including pharmaceutical and interventional practices, with little to no evidence-based health improvement and is fiscally irresponsible in a publicly funded healthcare system (Huber, M. 2011).

Attempts to modernize the vocabulary have been met with roadblocks, most notably with the proposal to change the word “complete” to “reasonable” such that the definition would read, “a state of reasonable physical, mental and social well-being and not merely the absence of disease or infirmity” (Rauch, R. 2022). This proposal was rejected by the WHO stating that the, “WHO has emphasized over the years that the attainment of health as defined in the Constitution remains an aspirational goal for societies to work towards” (Rauch, R., 2022). This ideology moves away from a guiding definition towards a utopian framework which is not relevant or applicable in modern medicine, and subjects populations to unrealistic and often unattainable goals. There is the implication as well that all measures should be taken to ensure complete absence of disease or illness and any failure to do so is at the detriment of the patient and the fault of the patient and providers alike.

What "Health" Can Look Like Today

In 1997, proposals to modernize the WHO focused on the inclusion of spiritual well-being into its outdated definition of health (Rauch, R., 2022). This enables a dynamic and individualized assessment of health in terms of liveability and patient autonomy. The inclusion of spiritual health is reflected in cultural norms and expectations reflected in African, Asian, and Arabic cultures, and is often overlooked in Western cultures (Rauch, R., 2022). This proposed determinant of health introduces the concept of community value and human dignity when evaluating the health of an individual, community, or population; the stark absence negates the importance of the spirit for living with, and managing, chronic disease or illness.

Spiritual Determinant of Health. Retrieved from https://www.spiritualhealth.org.au/news

Similarly, arguments have been made to include evaluation for intolerance and acceptance as part of the determinants of health (Brooks, R.H., 2017). Individuals and communities cannot be declared healthy when there is rampant intolerance in the forms of racism, agism, ableism, sexism etc. The current WHO definition focuses too much on absence of disease and life-expectancy, rather than on quality of life and societal dynamics (Brooks, R.H, 2017). Radicalization and intolerance are indicators of mental health and social health breakdowns; these indicators warrant regular evaluation and referral to appropriate clinical interventional institutions and professionals (Brook, R.H. 2017).

Under the current definition, people with disabilities and chronic illnesses would not meet the WHO’s criteria for health, even if the individuals do not view themselves as unhealthy (van Druten, et al. 2022). There has been a modern movement towards the concept of positive health which focuses on abilities rather than limitations of living with chronic illness or disabilities (van Druten, et. al, 2022). Measuring health must therefore be expanded beyond the vague qualifications of physical, mental, and social health, and examine adaptability, autonomy, self-identification, life purpose, and dignity when evaluating the health of individuals and populations (Huber, M. 2011). As health changes and evolves, and with more individuals living meaningful lives with chronic illnesses and disabilities, the WHO’s definition appears static and restrictive. To avoid an ableist bias, the definition should be as fluid and adaptable as the human spirit in terms of managing environmental and health changes, particularly with the advancement of research, technology, pharmaceuticals, and treatments (Rauch, R. 2022).

The Future of "Health"

The concept of health has become so multifactorial and diverse that the traditional definition outlined by the World Health Organization (WHO) in 1948 is too stringent. The complexities of providing a single guiding definition of health leads to vague vocabulary which is ultimately contradictory in nature (Rauch, 2022). The definition needs to be as inclusive, dynamic, and ableist as reasonably achievable while balancing the cultural views of health from a wholistic, traditional, spiritual, manageable, and ethical perspectives to maintain human dignity (Rauch, 2022). By examining the contrary use of exclusionary terminology such as “complete absence” and examining health from psychological needs, the WHO definition appears dated and in need of modernization to maintain its relevance.

References:

Brook RH. (2017). Should the Definition of Health Include a Measure of Tolerance? JAMA.;317(6):585–586. doi:10.1001/jama.2016.14372

Huber, M. (2011). Health: How Should We Define It? BMJ: British Medical Journal, 343(7817), 235–237. http://www.jstor.org/stable/23051314

Rauch, R. (2022). Attempts to Reform the WHO Definitions of Health (1997-1999). Oxford University Press. https://doi.org/10.1093/oso/9780192865502.003.0008

Van Druten, V.P., Bartels, E. A., van de Mheen, D., de Vries, E., Kerckhoffs, A. P. M., and Nahar-van Venrooij, L. M. W. (2022). Concepts of health in different contexts: a scoping review. BMC Health Services Research, 22(389), 1-21. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-07702-2