In 1948, the World Health Organization (WHO) proclaimed the definition of health as "a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity" (WHO, 1948). Huber (2011) implies this definition was over-ambitious at the time. This definition is still the one used today without considering the changes of advanced management of disease and its association with longer lifespan despite people not meeting "complete" health. Saracci (1997) links an interesting timeline when he implies that defining health was the aftermath of the second world war when peace and health were inseparable. Two very vague words with incredible significance consisting of many complex contributing factors of post-war physical and emotional trauma.
The more I think about the WHO defined expectations of "health" established 73 years ago, for some reason, I keep referring back to the old Seinfeld episode (chuckling, of course) where George starts with a fixed amount of a tip intended for the waitress at a restaurant. For every error or imperfection the waitress made, he would take away from the set amount tip. I think this scenario could apply to health as in imagining a person who starts without any disease or ailment (a full tip on the table). Over the years, imperfection and health concerns and conditions develop; it is too late despite adaptation and management. Both of which Huber includes in his stance on redefining health as the "ability to adapt and self manage" (2011, p. 236). In the scenario above that I described, the person has already lost their "tips," and they no longer hold complete health status.
I can provide personal testimony to a chronic condition (endometriosis) that I have adapted to and manage daily and still perceive myself as healthy. I chose and am fortunate to have healthy foods to eat, minimize alcohol intake, avoid substance use and stay physically fit by strength training and running. I am fortunate to have effective coping mechanisms established that support adaptation to life's changes while maintaining mental health and well-being. Personally and to most, what I am describing would be whole and complete health. However, as per the WHO definition of health, I would be considered unhealthy because I do not have complete physical health. My perception of my health is similar to Bradley et al., (2018), which acknowledges chronic illness/disease "can and often do co-exist" (p. 204). Health involves integrating body, mind, and spirit, all influenced by sociologic, environmental and behavioral factors (Bradley et al., 2018).
Video 1
Let's start a conversation about health
(Halton Region Ontario, 2012)
Like my thoughts on using the word "complete," one of Huber's notable criticisms of this definition is the "absoluteness of the word 'complete' - in relation to well-being" (2011, p. 235). To be accurate, one would require perfect health, which would mean no room for imperfections or no need for improvement as one's health is 100% in all aspects of the body and brain. Bradley et al., (2018) recognize that "we are all, to some extent, less than perfect, that we each have aspects that need care" (p. 204). This definition of health is nearly impossible to achieve, leaving many of us with the status of being unhealthy (Huber, 2011). Perhaps a reconsideration of reformulation would be to remove the terminology of "complete" health to relate to more people across different times in their lives, allowing space for those managing an illness because health is not static and can be fluid depending on circumstance.
Leonardi (2018) states that the "WHO definition of health has become unfit for dealing with new challenges arising from the growth of the ageing rate and the increasing number of people with chronic illness" (p. 236). With health promotion and prevention encompassing education that is creating awareness of positive social and environmental health determinants, people want to make changes to be better their health. With more significant advances in testing and diagnostics, treatment, and technology, people's lifespans are longer. Statistic Canada reports that in 2011, Canadians lived an average of 81.7 years, which increased by almost 25 years since 1921 (Statistic Canada, 2015). Health Canada (2017) states that 1 in 30 (>975 000 people) of Canadians over 20 years of age and 1 in 8 (>600 000 people) over the age of 65 have at least 2/4 major chronic illnesses. These statistics alone representing a developed Country indicate that people are relatively more healthy now versus 25 years ago regardless of the small number of people fitting into the WHO definition of complete health (physical and mental) and well-being.
Table 1
Areas of focus and related indicators
(Government of Canada, 2017)
In addition to removing the word "complete," I feel that the definition needs to encompass the inclusivity of other factors that impact whole health and well being. Perhaps an expansion on well-being to include adaptation. French Physician Georges Canguilhem, in his 1943 book, The Normal and the Pathological, saw health "as the ability to adapt to one's environment" with the concept that health is not a fixed entity and that it varies from everyone based on their circumstances (The Lancet, 2019, p. 781). I believe that health and the many dimensions of well-being are interchangeable and dependent on the other. An adaptation and well-being article by Heyink explains the relationship between adaptation and well-being as reciprocal. Heyink further provided meaning when someone's feelings of well being are affected, and then adaptive methods are simultaneously triggered, contributing to recovery (1993).
So how do we redefine the current definition of "Health"?
Moving forward, my thoughts and suggestions on redefining the WHO definition of health would be to replace the notion of perfection with progress, focusing on the ability to adapt, maintain and improve overall health and well-being. Doing so would be more attainable and realistically open the definition to include the many dimensions of health relevant to different populations across their lifespan as ageing occurs.
References
Bradley, K. L., Goetz, T., & Viswanathan, S. (2018). Toward a Contemporary Definition of Health. Military Medicine, 183 (3), 204–207. DOI: 10.1093/milmed/usy213
Government of Canada. (2017). How healthy are Canadians? [Table]. Retrieved February 6, 2021, from https://www.canada.ca/en/public-health/services/publications/healthy-living/how-healthy-canadians.html
Halton Region Ontario. (2012, October 18). Let's start a conversation about health [Video]. Youtube. http://www.youtube.com/watch?v=ZWhB6uqxE9g
Huber, M. (2001). Health: How should we define it? British Medical Journal, 343, (7817), 235-237. Retrieved February 3, 2021, from http://www.jstor.org/stable/23051314
Heyink, J. (1993). Adaptation and well-being. Psychological Reports, 73, (3), 1331-1342. Retrieved February 5, 2021, from http://www.journals.sagepub.com/doi/102466/pr0.1993.73.sf.1331
Leonardi, F. (2018). The definition of health: Towards perspectives. International Journal of Health Services, 48 (4), 735-748. Retrieved February 4, 2021, from http://www.journals/sagepub.com/doi/10.1177/0020731418782653
Sarraci, R. (1997). The world health organization needs to reconsider its definition of health. British Medical Journal, 314, 1409. DOI: 10.1136/bmj.314.7091.1409
Statistic Canada. (2015). Health at a glance. Ninety years of change in life expectancy. Retrieved February 5, 2021, from https://www150.statcan.gc.ca/n1/pub/82-624-x/2014001/article/14009-eng.htm
The Lancet. (2009). What is Health? The ability to adapt. 373, (9666), 781. Retrieved February 4, 2021, from http://doi.org/10.1016/S0140-6736(09)60456-6
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