What is health? Prior to 1948, most definitions of health involved the absence of disease or pathology (Huber, 2011), and still, some continue to use this definition thanks to its simplicity. In 1948 WHO however takes this definition further and defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (Huber, 2011). Compared to the definitions of health used prior to 1948, the 1948 WHO definition of health seems far more inclusive and understanding of various states of health. Perhaps this is why the WHO has since not changed their definition of health (“Frequently asked questions,” n.d.). Nonetheless, though more inclusive than before, this definition of health still leaves a number of individuals in a grey area.
The claim that health insinuates complete well-being not only begs the question of what constitutes “complete”, but it also implies a sort of rigid, one-size-fits-all idea of health. If an individual was hard of hearing, and therefore deaf, does this mean they are unhealthy? This is an example of how such an absolute definition can result in culturally insensitive conclusions. For those part of the Deaf community, their deafness generally does not indicate a sign of ill-health. Individuals from this community are able to participate in society and feel healthy despite limitations (Huber, 2011).
Another limitation of the WHO definition of health is how it applies to individuals with chronic disease (Huber, 2011). This definition of health was created during a time when acute illnesses were more prevalent, and those with chronic illness often suffered a young demise (Huber, 2011). However, with the advancement of medicine, acute illnesses are better treated. Consequently, we see a rise in chronic diseases. By the WHO definition of health, those with chronic illness would always be unhealthy, or sick (Huber, 2011). This definition, therefore, has a functionalist foundation (conceived by Karl Marx) where those with chronic disease would always assume the sick role, thus are unhealthy, and would therefore not be able to rejoin productive society. However, we do see individuals with chronic diseases still participate in society, thus weakening the WHO definition.
Interestingly, in 1943 French physician Georges Canguilhem believed in a more flexible definition of health, rejecting the idea that health was a fixed entity (“What is health? The ability to adapt,” 2009). Instead, Canguilhem saw health as “the ability to adapt to one’s environment” entity (“What is health? The ability to adapt,” 2009). Canguilhem believed that the patient was the primary determiner of their own health and that a physician alone could not make conclusions about how their patient’s health, therefore the relationship between a physician and their patient was more of a partnership entity (“What is health? The ability to adapt,” 2009). Canguilhem claimed that there were environmental elements that influenced an individual’s health.
More recently, the Government of Canada highlights that health is far more complex than just biology and lifestyle choices, but that it also includes factors such as income and social status, employment and working conditions, education, childhood experiences, physical environment, social supports, access to health services, gender, culture, and race (“Social determinants of health and health inequalities”, 2020; “What is health?”, 2008). These factors are referred to as the social determinants of health and are the elements that influence the health outcomes individuals experience. Health researchers have also compiled a number of dimensions to wellness, such as physical, intellectual, emotional, social, spiritual, vocational, financial, and environmental (Stoewen, 2017). These dimensions to wellness are the various branches of health that individuals experience. Both the social determinants of health and the dimensions of wellness are important components in the discussion of what is health.
As stated by Martin Luther King jr. “of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” Part of this inequality and injustice in healthcare stems from an inadequate definition of health. The WHO created their definition of health in 1948, and for the time this definition may have been enough. However, health is far more complex to be defined by rigid definitions. As believed by Canguilhem, health is not an entity but is holistic and about the adaptability of an individual to their environment. In light of this, the definition of health outlined by the Government of Canada and more recent health research does a better job of appreciating the multifaceted nature of health.
References
Frequently asked questions. (n.d.). Retrieved February 9, 2021, from https://www.who.int/about/who-we-are/frequently-asked-questions
Huber, M. (2011). HEALTH: HOW SHOULD WE DEFINE IT? Medical Journal, 343(7817), 235–237. Retrieved from https://www.jstor.org/stable/23051314?seq=1&cid=pdf-
Social determinants of health and health inequalities - Canada.ca. (2020). Retrieved February 9, 2021, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Stoewen, D. L. (2017). Dimensions of wellness: Change your habits, change your life. Canadian Veterinary Journal, 58(8), 861–862. Retrieved from http://www.alleydog.com/glos-
What is health? - Canada.ca. (2008). Retrieved February 9, 2021, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-approach/what-is-health.html
What is health? The ability to adapt. (2009). The Lancet, 373, 781. https://doi.org/10.1016/S0140-6736(09)60456-6
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