What is Health?
Discussions surrounding the nature of health and its definition have become quite popular during the twenty-first century. With current conceptualizations of health having major implications for the Canadian health care system today, it is more important now than ever to revisit the archaic definition that continues to be used around the globe to drive health care policy and the nature and scope of professional practice. To recap, in 1948, the World Health Organization (WHO) defined the concept of health as “a state of complete, physical, mental and social well-being, and not merely the absence of disease or infirmity.” Despite significant shifts to the medical priorities of Canadians, and people (of all nationalities), over the last several decades, many key health concepts have been presented but this definition has not changed.
Criticisms of the WHO Definition
The 1948 WHO definition of health revolutionized the health care system during the post-war era to provide the world with optimism surrounding the control of communicable diseases and the health of the world’s children. This concept also brought about an era of public health education making the public more aware and accountable for their behaviours, especially in the context of disease prevention. Fallon and Karlawish (2019) further elaborate that since the definition's conception, “communicable diseases such as smallpox, polio, diphtheria, and tetanus have been brought under control, infant and child mortality have fallen, and life expectancies worldwide have dramatically risen” (p. 1104). However, this brings me to one of the definition’s main criticisms: it does not apply to an aging population. Leonardi (2018) summarizes this criticism, as well as 5 others, as being the most problematic aspects of the 1948 WHO definition.
Leonardi’s 6 Criticisms of the 1948 WHO definition of Health (pgs. 736-738):
Unrealistic health standards. Complete well-being is not a realistic goal for our population. With increased life expectancies come increased disease survival rates and chronic conditions. Aside from chronic illness, most people experience some form of mental symptom (anxiety, depression, stress) or minor illness (headache, fatigue, cold, flu, etc.) daily, meaning that a state of “complete well-being" could only be temporary if not impossible. Everyone these days also has some sort of risk factor for major disease/illness which would make “risk-free well-being" even more unattainable.
The definition is neither operational nor measurable. It is not possible to measure a utopian concept.
This concept of health is too broad. Leonardi (2018) states that “a complete state of physical, mental, and social well-being implies a life free of poverty, vices, iniquity, discrimination, violence, oppression, and war, which are essentially problems of living and should not be considered medical problems” (p. 737). A concept that seems more related to happiness than health.
This definition results in the medicalization of society (nonmedical problems become defined and treated as medical problems). The definition implies that the majority of the world population is "unhealthy" due to chronic illness, mental health, risk factors for disease, placing even more pressure on our health care system.
The assumption that well-being is always linked to health. When people are coping with a negative event, they feel anger, sadness, stress, but not well-being.
The assumption that physical, psychological, and social well-being have a positive correlation. Smoking (a risk behaviour leading to risk factors of disease and poorer physical outcomes) can be viewed to some as a positive aspect of their psychological or social well-being.
Concept of Health Redefined
Since the 1940s, many key health concepts have been presented on a global scale, but none have succeeded in becoming as widely influential as the 1948 WHO definition of health. More it is becoming evident that like beauty, “health is in the eye of the beholder” and it may not be possible to get the world to agree on just one unique definition of health. Leonardi (2018) argued this exact point stating that “instead of continuing to look for a new definition for substituting the WHO definition, it is time to accept that the complexity of phenomenon obliges us to have many definitions of health, among which no one will be truer, or more comprehensive, or more exact than others” (p. 740). Leonardi also proposed a “Theoretical Framework for Constructing Scientifically Sustainable Definitions of Health” arguing that “planning public health policies is very different from measuring individual’s health level before and after a treatment and assessing health among chronic patients may be very different from doing it in acute diseases” (p. 740). Based on the 9 theoretical coordinates outlined within his framework, Leonardi proposed a starting point for a new definition of health as “the capability to react to all kinds of environmental events having the desired emotional, cognitive, and behavioural responses and avoiding those undesirable ones” (2018, p. 742). This definition is helpful and relevant to today’s society because in contrast to the WHO definition, it does not reduce health to physical parameters, or the absence of disease or illness, and it is achievable for everyone regardless of social determinants, culture, religion, or ethical values.
References
Fallon, C. K., & Karlawish, J. (2019). Is the WHO definition of health aging well? Frameworks for “health” after
three score and ten. American Journal of Public Health, 109(8), 1104-1106. doi:10.2105/AJPH.2019.
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Leonardi, F. (2018). The definition of health: towards new perspectives. International Journal of Health
Services, 48(4), 735-748. doi:10.1177/0020731418782653
World Health Organization. (2021). What is the WHO definition of health? Retrieved from
https://www.who.int/about/who-we-are/frequently-asked-questions
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