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What is Health?

A Case for a New Definition – A Literature Review


What is Health?


Since its inception in 1948, the World Health Organization’s (WHO) definition of health has been challenged. From philosophers Daniel Callahan to Christopher Boorse and Leannart Nordenfelt (1970s) and more recently Machteld Huber (2011), it has been felt that the WHO definition of health does not meet the current standard of what health encompasses. The definition of health, as explained in the Constitution of the World Health Organization, has been upheld since 1948 with no changes.


Within this constitution, WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2020). It has been stated the WHO definition reflects a post-World War II era of optimism that does not reflect modern health concerns. Researchers find the definition, that encompasses the wording “complete well-being” (WHO, 2020), problematic; a nearly impossible target in modern society. In the years since the definition was disseminated globally, life expectancy has risen, child mortality has decreased, and more people are living with chronic disease (Huber, 2011; Kierhan Fallon & Karlawish, 2019; Leonardi, 2018).


Chronic Disease Argument


Huber (2011) contests that the definition of health, as it currently stands, “minimizes the role of the human capacity to cope autonomously with life’s ever changing physical, emotional, and social challenges and to function with fulfilment and a feeling of wellbeing with a chronic disease or disability” (p. 236). Therefore, the definition minimizes their experiences and defines them as permanently ill. This, by its nature, is counterproductive to the WHO’s current definition of health (Huber, 2011). To put this in context, questions surrounding health and chronic disease states have been posed lending to assert that the definition of health needs to be amended. Bradley, Goetz, and Viswanathan (2018) ask the following philosophical questions:

  • Do you feel like you are fully alive?

  • Are you in your optimal state of being based on your current conditions?

These questions deduce that a person can still be healthy and live with chronic disease until the day they die. Moreover “it is not the absence of disease that sets the stage for health but the fullness of life” (p. 204). This theory has been called the disability paradox. In a qualitative study conducted by researchers of the theory, Albrecht and Devlinger (1999) found that “53% of person’s with serious disabilities reported that they had an excellent or good quality of life” (p. 981). Compare those numbers with “80-85% of persons with no disabilities who report they are satisfied or very satisfied with their quality of life” (p. 981). What this analysis shows is that the WHO definition of health is flawed. If people are experiencing good health related quality of life, even in the face of chronic disease and disability, the current definition does not meet modern health standards or determinants of health.


Measuring Health


Another argument against the current WHO definition of health is that it is not quantifiable or operational (Leonardi, 2018). It poses many challenges as the definition is the guiding framework for many organizations including the Centers for Disease Control and Prevention, the Pan American Health Organization and various other WHO partners. Health is a difficult metric to measure. To date the most common metrics collected in relation to the “health of a nation are mortality rate and health care costs as a percentage of the GDP” (Leonardi, 2018, p. 206). The collection of meaningful data allows government agencies, policy makers, and clinicians the ability to make informed decisions to improve quality of care, advance treatment methods, enhance health outcomes and improve communication (Sakovich, 2019).


What’s Next?


The discussion over what the next definition of health should be will remain fluid. Scholars, researchers, and philosophers will continue to debate what modern health encompasses and how it should be viewed, either in the context of a definition or a conceptual framework. As we further explore what affects health (i.e. the social determinants of health) we should continue to keep questioning WHO’s definition. By WHO’s standard, I would not be considered healthy as someone who lives with a chronic autoimmune disorder. Through the examination of various research, I feel that the definition of health should be expanded to include those people who are living and thriving with chronic disease. Majority of these people do not take their health for granted and choose to live a high quality of life as well as live out their dreams regardless of their circumstances. This makes them healthy!


References

Albrecht, G.L., & Devlieger, P.J. (1999). The disability paradox: High quality of life against all odds. Social Science & Medicine 48(8), 977–88. https://doi.org/10.1016/S0277-9536(98)00411-0.


Bradley, K.L., Goetz, T., & Viswanathan, S. (2018). Toward a contemporary definition of health. Military Medicine 183(supp. 3), 204–7. https://doi.org/10.1093/milmed/usy213.


Huber, M. (2011). Health: How should we define it? BMJ: British Medical Journal, 343(7817), 235-237. https://www.jstor.org/stable/23051314

Kiernan Fallon, C. & Karlawish, J. (2019). Is the WHO definition of health aging well? Frameworks for ‘health’ after three score and ten. American Journal of Public Health, 109(8), 1104-1106. https://doi.org/10.2105/AJPH.2019.305177


Leonardi, F. (2018). The definition of health: Towards new perspectives. International Journal of Health Services, 48(4), 735-748. https://doi.org/10.1177/0020731418782653



World Health Organization. (2020). Basic Documents: 49th edition. https://apps.who.int/gb/bd/

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