Can health be adequately described with a single definition?

The definition of health is important as it has implications in all health fields, including practice, policy, services, and promotion (Leonardi, 2018). The World Health Organization’s (WHO) definition of health has not been updated since 1948, and states that health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 1995). This definition was revolutionary at the time, in that health meant more than the absence of disease and included the physical, mental, and social domains (Huber et al., 2011). Since then, however, it is widely accepted that this definition has many limitations. In this post, I will outline some of the limitations of the current definition of health, use my profession as an example showcasing the importance of a suitable definition of health, explore the term "well-being", and present a new definition of health.

Limitations of the current definition of health

1) “Complete” well-being is unattainable: Since 1948, people are living longer, so age-related and chronic illnesses are more prevalent (Huber et al., 2011). Therefore, “complete” well-being is unattainable for most, if not all, of the population (Leonardi, 2018).

2) Health perception: The definition does not include a measure of one’s ability to adapt and cope with their health conditions (Huber et al., 2011). An individual’s quality of life will not solely depend on their diagnoses, but how they handle, adapt, and process their health conditions.

3) Technological advances: As technology advances, so does our ability to detect and diagnose illness (Huber et al., 2011). An individual who is screened and cleared for an illness ten years ago may be diagnosed with the illness today (even without any clinical symptoms or progression of the illness), simply because our ability to detect the illness has improved. Our imaging is high definition, our bloodwork tests are more precise, etc. When diagnoses are made, solutions are sought, and medications are developed.

Showcasing the importance of a suitable definition

As a Clinical Research Associate in Orthopaedic Trauma, I understand that it is important to focus our research goals and outcomes on clinically relevant topics. Patient engagement is increasingly popular in clinical research for this reason. As an example, we may research two approaches to surgical treatment of a wrist fracture. Our high-tech 3D imaging may indicate that one approach produces near-anatomic alignment, while the other shows worse alignment. It is important to also include a post-operative measurement of quality of life, range of motion, and function. If there is no difference between the groups, it would indicate that perfect alignment is not clinically relevant, and our research should be focused on more prudent topics. It is the same with other areas of health, as our increased ability to diagnose may lower the threshold for interventions by health care providers and pharmaceutical companies (Huber et al., 2011).

Well-being

"A state of well-being", as used in the WHO definition, opens the door to the term "wellness". The Global Wellness Institute defines wellness as the active pursuit of activities, choices and lifestyles that lead to a state of holistic health (Global Wellness Institute, n.d.). Models of wellness encompass several dimensions of health. The Mental Health Center of Denver's 8-dimension model of well-being includes physical, intellectual, occupational, spiritual, social, financial, emotional, and environmental well-being (Figure 1) (Mental Health Center of Denver, n.d.).

Figure 1. The Mental Health Center of Denver's wellness wheel.

A new definition

I believe that there should be many definitions of health that apply to different scopes and applications. With that said, Dr. Andrew Weil’s (2013) definition of health is an improvement over the WHO definition, summarized in the following video.

“I consider health a relative state of wholeness and balance. I believe that means balance of all internal and external forces. It’s a kind of internal springy-ness that allows you to move through the world and not get hurt by all the things that have the potential to hurt you. If you’re healthy you can interact with germs and not get infections allergens, not get allergic reactions with toxins, and not be harmed. I think all of us come into the world with that internal quality but I think it’s up to us to learn how to protect it and enhance it. In my experience, people often use fear as a motivator to make positive lifestyle changes. You know, if you have a serious health wake-up call or are faced with some major medical/surgical intervention, often, that is what catalyzes change. But I don’t think that’s the best kind of motivation to depend on, because if your fear subsides then so does your motivation. I’m an educator, and I’ve great faith in education. I believe that if you present people with information in ways that they can understand and connect with their own experience, they will follow through and run with that. I think that applies in areas of nutrition, physical activity, all of it.”

Final thoughts

While I do not believe this definition is applicable in all scopes or applications, the definition may be useful in health promotion. It is a positive, uplifting definition that feels attainable and may inspire individuals to live healthier lives. Other definitions of health can be used depending on the context, audience and scope- policy makers, health care providers and health services.

References

Global Wellness Institute. (n.d.). What is Wellness? https://globalwellnessinstitute.org/what-is-wellness/

Huber, M., André Knottnerus, J., Green, L., Van Der Horst, H., Jadad, A. R., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M. I., Van Der Meer, J. W. M., Schnabel, P., Smith, R., Van Weel, C., & Smid, H. (2011). How should we define health? BMJ (Online). https://doi.org/10.1136/bmj.d4163

Leonardi, F. (2018). The Definition of Health: Towards New Perspectives. International Journal of Health Services : Planning, Administration, Evaluation, 48(4), 735–748. https://doi.org/10.1177/0020731418782653

Mental Health Center of Denver. (n.d.). Well-being wheel. https://mhcd.org/healthy-living/well-being-wheel-english/

Weil, A. (2013). Definition Of Health | Andrew Weil, M.D. https://www.youtube.com/watch?v=n4AU-XNq04k

World Health Organization. (1995). Constitution of the World Health Organization (pp. 18 p.; 30 cm.).