6 September 2017
It may seem an obvious question: ‘Do you know what “health” means?’ But there is much debate over the definition.
The World Health Organization (WHO) defines health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. But how accurate is this? Consider a person who has diabetes and manages it with medication, or someone who has back pain that they manage with physiotherapy. These people are clearly not in a state of complete physical wellbeing. But does that make them unhealthy?
Perhaps infirmity and disease can coexist with health. This would mean that there is not a binary ‘healthy’ or ‘unhealthy’ state, but rather a spectrum. In our lifetimes, we all experience periods of good and bad health. And we may even experience the two states at the same time.
Huber and colleagues suggest that the problem with the WHO definition is the absoluteness of ‘complete’ wellbeing. This, they suggest, inadvertently contributes to the ‘over-medicalisation’ of the population. It allows a platform for industry, medical technologies and professionals to redefine our health status. In effect, it could imply that no one is ‘healthy’ any of the time, and everyone needs some level of treatment for any given condition. It doesn’t allow the individual to define their own health, and their own health goals.
The absoluteness of ‘complete’ wellbeing may inadvertently contribute to the over-medicalisation of the population.
When the WHO defined health in 1948, it was revolutionary in its notion that health means more than the absence of disease. However, Huber et al. suggest that, owing to our ageing population and the increasing focus on management of communicable diseases, this definition is no longer fit for purpose. They propose shifting the emphasis of health towards the ability to adapt and self-manage in the face of social, physical and emotional challenges.
This echoes the concept of resilience, which has been defined as ‘the capacity for populations to endure, adapt and generate new ways of thinking and functioning in the context of change, uncertainty or adversity’.
Thanks to medical advances and disease management, the concept of health now encompasses more than traditional definitions encapsulate. There is a level of health that each of us can aspire to attain. Every person is exposed to a unique selection of beneficial and adverse circumstances over the life course. Ultimately, it is how we manage – and adapt to – these circumstances that defines our health status.
Sandra Evans is a former Researcher for The Health Policy Partnership.
