Complete, entire, undiminished, all. The WHO (1948) describes ‘what is health’ as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Though, do we have poor health if we do not have a state of completeness in all domains of our health? If we do not have complete physical, mental and social well-being does this mean we are incomplete, deficient and lacking good health? Though the above audio/visual video provides a clear and general representation of what health is the example still refers to the presence of illness to be considered poor health. As explained by Huber (2011), the WHO’s definition of health and use of the term ‘complete’ leaves many grey areas for the health care system regarding eligibility for coverage as well as determination of if a person is healthy or not. We know that health refers to our being, including our physical, psychological, social, and spiritual being. However, these aspects that we use to define, and measure health are product of environment including our relationships, community and country at large. Yet the WHO’s definition fails to include the influences of external forces on our health. I believe that to truly operationalize the term ‘health’ we must change the language we use to determine one’s health or ability to be healthy. I will contrast the WHO’s definition of health with more modernized approaches to 'what is health’ while further outlining gaps in the existing definition.
Firstly, I found it necessary to review The Ottawa Charter for Health Promotion who first shared their definition of health in 1986 to set out for action to achieve health for all. This definition is built off the existing WHO definition and consequently needs improvement.
Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being (p.1).
I have two main concerns with this definition of health: (1) I find the referencing of the term ‘complete’ problematic as Huber (2011) describes the term to be in-operational and non-measurable regarding one’s health. (2) I do not believe that people always have the choice or resources to adapt to their environment nor the ability to realize aspirations. I find this definition be very narrow and selective in nature as it does not consider determinants of health (socioeconomic status, education, physical environments, social supports etc.,) and how this may inhibit one’s ability to adapt to certain environments or situations and make positive decisions that promote good health.
To understand the meaning and definition of health we must stop and think ‘what is health?’ to ourselves. When I ask myself ‘what is health’ I answer: health is a state of happiness through an overall sense of well-being in respect to physical, psychological, spiritual, and social-well-being. To me health is something we feel through happiness and enjoyment of life despite limitations and obstructions on our health throughout the lifespan. To support my definition of health Boyd (2000) further explains that health is strongly influenced by one's perception of their own health and well-being. Boyd (2000) dissects philosophical approaches on what is health and concludes that we cannot quantify the health of an individual and we must incorporate an individual's perception of well-being into their state of overall health. If we accept the WHO's definition of health, we assume that those who have good physical, mental and social well-being have a ‘complete’ and positive state of well-being and happiness. Though, the WHO’s definition does not extend its definition enough to incorporate the correlation of happiness, well-being and health and the influence our environment and relationships have on our health. The meaning of health is subjective in language and therefore cannot be measured objectively.
To move toward a more inclusive and appropriate definition of health we must begin to change language we use in referencing health. Redefining the definition of health could impact health policy, coverage and legislation in the health care system. In thinking of terminology that would best describe good health I often think of well-being, productivity, happiness, relationships, and community. The following is a modernized and a more accurate representation of ‘what is health.’ In this definition the word health is replaced with ‘wellness’. According to the McKinley Health Centre (2019) ,“Wellness is a state of optimal well-being that is oriented toward maximizing an individual’s potential. This is a life-long process of moving towards enhancing your physical, intellectual, emotional, social, spiritual, and environmental well-being(p.1).” This definition eliminates the term complete and creates a broader definition of health/wellness that includes both internal and external factors that influence health. Below is the "wheel of health" designed by the McKinley Health Centre, as displayed wellness is influenced by six dimensions: emotional, mental, physical, spiritual, social, and environmental.
To challenge the WHO’s definition of health I think of individuals like Steven Hawking, diagnosed at an early age with amyotrophic lateral sclerosis (ALS) lived on to have a more than extraordinary lifestyle full of accomplishments and successes. Though I cannot speak to his sense of well-being or happiness throughout the life course I can certainly say that he exceeded productivity and lived to his full potential resulting in a positive influence on his health and well-being. Another example is Nicholas Vujicic born with tetra-amelia syndrome (absence of arms and legs) who defies WHO’s definition of health by having used his spirituality and outlook on life to become on inspiration to many and a motivational speaker. As Boyd (2011) supports, there are people who may are considered as unhealthy, unwell, or disabled yet perceive themselves as happy and healthy individuals with a positive sense of well-being. Whereas there are people who are free of disability and exhibit ‘good health’ that do not have a good sense of well-being. Huber (2011) agrees in describing the WHO’s definition of health to be one that does not include the possibility of a person living and coping with illness’ or disease to be complete.
Another definition of health composed by (Bircher & Kuruvilla, 2014) supports the need to revise the definition of health to better suit the demographics of our population. In doing so Bircher & Kuruvilla (2014) use the Meikirch Model of Health that incorporates that state the following:
Health is a state of wellbeing emergent from conducive interactions between individuals’ potentials, life’s demands, and social and environmental determinants. Health results throughout the life course when individuals’ potentials – and social and environmental determinants – suffice to respond satisfactorily to the demands of life. Life’s demands can be physiological, psychosocial, or environmental, and vary across individual and context, but in every case unsatisfactory responses lead to disease (p.368).
As mentioned we must gear our definition of health to better suit the demographics of our population. With an aging population soon more than half the population will be 65+ and have one or more chronic illnesses and/or co-morbidities. This does not mean that they cannot be in ‘good health’ while coping with such illnesses. For example, if an older adult with type 2 diabetes fails to put efforts forth of healthy eating and proper exercise I would say this person is in poor health as a result of lack of effort to improving ones health. On the other hand if an older adult is diagnosed type 2 diabetes but consciously makes the decision to make a lifestyle change by improving their eating habits and creating more of an active lifestyle I would conclude that this person is making healthy choices and therefore in a state of good health. In broadening the WHO’s current definition of health, professionals can help populations with compromised health achieve a state of good health and positive well-being. We can do this by identifying key factors that influence and create actions plans to enhance individual and community health. Foot, Humphries & Oliver (2014) outline how we can make our health care systems fit for an aging population through identification of how to improve and sustain health in older adults.
In conclusion, with many definitions of health and existing critics of the WHO’s definition of health it is crucial to understand that health is a subjective term and is experienced differently by everyone. I believe sense of well-being and happiness to be a proper overall measure of one’s physical, psychological, spiritual and social well-being as this includes the influence that our relationships, community and environment have on our ability to be and feel healthy. In accepting this and focusing on more inclusive, modern and appropriate definitions of health that are more suitable for our existing demographics I believe that health professionals can better assist clients, patients and community in achieving good health despite the presence of illness or not.
References
Bircher, J., & Kuruvilla, S. (2014). Defining health by addressing individual, social, and environmental determinants: new opportunities for health care and public health. Journal of public health policy, 35(3), 363–386. doi:10.1057/jphp.2014.19
Boyd, K. M. (2000). Disease, illness, sickness, health, healing and wholeness: Exploring some elusive concepts. Medical Humanities, 26(1), 9-17. doi:10.1136/mh.26.1.9
Foot, C., Humphries, R., & Oliver, D. (2014). Making our health and care systems fit for an ageing population [The King's Fund]. 11–13 Cavendish Square London W1G 0AN.
Huber, M. (2011). Health: How should we define it? British Medical Journal, 343, (7817), 235-237. https://doi.org/10.1136/bmj.d4163 (link http://www.jstor.org/stable/23051314)
The Ottawa Charter for Health Promotion. (2016, May 17). Retrieved June 2, 2019, from https://www.who.int/healthpromotion/conferences/previous/ottawa/en/
McKinley Health Center. (2019). Retrieved June 2, 2019, from https://mckinley.illinois.edu/health-education/wellness
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