Defining health: Do we need a modern upgrade?

What is health? As a healthcare worker whose career is centred upon the health and wellbeing of others, this should be a simple question to answer. After researching the topic and exploring different definitions, I have found that the answer is actually not at all straightforward.

The World Health Organization (WHO)’s definition of health was developed in 1948, stating that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 2022).” This definition has not yet been updated. There are several recent opinion pieces and research articles voicing concerns with the above definition and calling for it to be revisited or revised. Huber (2011) strongly critiqued the WHO definition, challenging the use of the word “complete” with respect to health and well-being as unachievable, and going so far as to say that “it unintentionally contributes to the medicalisation of society”. Saracci (1997) stated that the current WHO definition was more of a description of happiness than a definition of health, and that it was important to differentiate the concepts of health and happiness. Krahn and colleagues (2021) described in a commentary that the outdated WHO definition failed to consider that people living with chronic health conditions could in fact be considered healthy and thriving.

Acknowledging these shortcomings, I was motivated to seek out a modern alternative to answer the nagging question, “what is health?” When I researched different viewpoints regarding what the new, updated definition of health should be, I initially found no clear answer. Van Druten and colleagues (2022) conducted a literature search exploring different concepts of health and questioning whether a global definition of health is appropriate. They did not find a clear new definition, and instead they described that health is actually relative, with varying focus depending on whether a person is a healthcare professional or a person seeking out healthcare services, and that it is important that communication between these individuals acknowledges these differing viewpoints (Van Druten et al., 2022). Ashcroft and Van Katwyk (2016) analyzed the definition of health from a social worker lens, and found that their study participants felt that health and relationships were inextricably linked, offering comments such as, “relationships… this is what gives us meaning!”

With all of the shades of grey, I was determined to find a concrete alternative offered up in the literature. After returning to Krahn and colleagues’ (2021) article, I saw that they reviewed several articles on the subject and did propose a new definition, “Health is the dynamic balance of physical, mental, social, and existential well-being in adapting to conditions of life and the environment.” I like how this definition allows for the vague descriptions I found in other research, and how it makes room for the importance of adaptability while respecting the impact that one’s environment can have on health. It feels more fluid and achievable than the previous iteration. If “the environment” can be interpreted to include one’s financial situation, then this could be seen as a promising, overarching new definition.

“What is health?” is a simple question with a very complicated answer, dependent on one’s individual lived experience. In developing a modern definition, we need to be careful not to include verbiage that would imply ableism or ageism, and to consider factors such as relationships and differing perspectives and values. It feels as though my research on this topic is just the tip of the ice berg, and I can see how WHO would find it challenging to redefine health in an all-encompassing way.

References:

Constitution of the World Health Organization. Retrieved October 11, 2022, from

https://www.who.int/about/governance/constitution

Huber, M. (2011). Health: How should we define it? British Medical Journal, 343,(7817), 235-237. https://doi.org/10.1136/bmj.d4163

Saracci, R. (1997). The world health organization needs to reconsider its definition of health. British Medical Journal, 314 (1409). https://doi.org/10.1136/bmj.314.7091.1409

Krahn, G. L., Robinson, A., Murray, A. J., Havercamp, S. M., & The Nisonger RRTC on Health and Function (2021). It's time to reconsider how we define health: Perspective from disability and chronic condition. Disability and Health Journal, 14(4), Article 101129. https://doi.org/10.1016/j.dhjo.2021.101129

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

Ashcroft, R., and T. Van Katwyk (2016). Joining the Global Conversation: Social Workers define health using a participatory action research approach. British Journal of Social Work Advance Access, 0, 1-18. https://doi.org/10.1093.bjsw/bcw005