Capturing the complexity of health in a single, succinct definition is extremely difficult since health has many dimensions. A useful definition helps guide public health research, policy and practice by avoiding being overly broad or utopian (McCartney et al., 2019). Otherwise, incorrect conclusions for improving health may arise as well as misallocation of scarce resources or overtreatment (Card, 2019).
The World Health Organization (WHO) define health as,
“A state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.”
At the time of its proposal in 1948, this statement was revolutionary for including somatic, psychological, and social health elements (Charlier et al., 2016). However, this absolutist view does not recognize that health is dynamic in nature and there is a continuum of health (McCartney et al., 2019; Jackson, 2018). The WHO definition is binary, making health something you either have or you don't (McCartney et al., 2019). The word "complete" contributes to medicalization of society and does not take into account the rise of chronic disease (Huber et al., 2011). Biomedical symptoms, disease, and disability can coexist with subjective perceptions of good health (Bircher & Kuruvilla, 2014; Bradley et al., 2018). The WHO definition should include management and adaptability (McCartney et al., 2019). Overall, the WHO definition makes health unattainable, is not measurable, and has no direct operational value (Bircher & Kuruvilla, 2014; Brussow, 2013; Huber et al., 2011; Leonardi, 2018).
Rather than considering health to be an outcome or an objective, it should be seen as a resource for living, functioning, and participating in society (McCartney et al., 2019). Bradley et al. (2018) believe “Health is the combined elements of the body, mind, and spirits working in harmony to create the basis for the fullness of life,” and people with a flourishing life are healthy. Other researchers view health as a basic universal human right and have defined it as “A dynamic state of well-being characterized by a physical and mental potential, which satisfies the demands of life commensurate with age, culture, and personal responsibility.” (Yousefi & Rezael, 2017). Yet another proposed definition for health is “A structural, functional, and emotional state that is compatible with effective life as an individual and as a member of family and community groups.” (McCartney et al., 2019).
Although many have given suggestions for a new definition, I agree with Leonardi (2018) that a lot of the discussions were conflating morals and happiness with scientific assessment. Leonardi (2018) suggests that moral and ethical discourse around the concept of health are contributing to a utopian vision as opposed to an operational, useful definition. For example, flourishing is too broad a concept to serve as a workable definition (Card, 2019). Leonardi (2018) explains, "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, should not be considered medical problems."
Video 1. Meanings of Health
I do not believe that every dimension of health, as seen in Video 1, needs to be in absolute perfect harmony in order for someone to be healthy (Jackson, 2018). Otherwise, nearly everyone would be labeled as unhealthy. For example, it is not a requirement that you know your purpose or reached spiritual enlightenment to be healthy (Card, 2019). Moreover, you can have a chronic disease and so long as you adapt and manage it well, you can still be healthy. The ability to cope with limitations and manage physical, social, and emotional challenges can make a person healthier (McCartney et al., 2019). A modification of the WHO definition should put an emphasis on capability as well as changing with the environment to find equilibrium (Charlier et al., 2016; Huber et al., 2011).
The five dimensions of health are interconnected as seen in Video 1 (Jackson, 2018):
1) Physical (the body):
To avoid reductionism, health must go beyond the biophysical parameters and should be viewed as more than simply the absence of disease or infirmities (Leonardi, 2018).
2) Mental (cognitive ability):
Communities should nurture intellectual freedom and critical thinking by having easy public access to art (Charlier et al., 2016). Our ability to interpret and analyze is enriched by interacting with art of historical, cultural and political significance (Charlier et al., 2016).
3) Emotional (mood, ability to recognize and express feelings adequately):
Sometimes, a lack of well-being is an objective sign of an appropriate sense of reality and not a loss of health (Leonardi, 2018). For example, when grieving the loss of a loved one, unpleasant emotions, sorrow, and unease are healthy reactions to a negative event (Leonardi, 2018). This concept of including both malaise and well-being into health is necessary to combat medicalization of society (Leonardi, 2018). Otherwise, any minor deviation would lead people to increase their demand for health care services (Leonardi, 2018).
4) Spiritual (sense of overall purpose in life):
For some, suffering and illness can be justified as transfiguration or spiritual development (Charlier et al., 2016). For others, a spiritual connection with the divine or ancestors can be transformable (Charlier et al., 2016).
5) Social (create and maintain meaningful relationships):
This dimension of health is what makes an individual be able to fulfill obligations like going to work and managing life in general (Brussow, 2013).
Card (2019) describes 6 subscales of health: happiness, mental and physical health, meaning and purpose, character, close personal relationships, and financial stability. The Meikirch Model of Health is illustrated in Figure 1 (Bircher & Kuruvilla, 2014). It is a complex adaptive system with various categories of health determinants interacting with the demands of life; the model proposes that unsatisfactory responses to life’s demands result in disease (Bircher & Kuruvilla, 2014). Individual determinants are broken down into biologically given, such as genetic components and epigenetic regulation, and personally acquired, such as development of knowledge and skills (Bircher & Kuruvilla, 2014). Homeokinesis and procreation are examples of a physiological demand; a demand can be psychosocial in nature, such as social integration and political life; finally, a demand could be environmental such as natural disasters or food scarcity (Bircher & Kuruvilla, 2014).
Figure 1. Meikirch Model of Health
Health means different things to different people. According to traditional populations of Polynesia, to be in good health ('la ea na) means being able to complete daily tasks and activities of life such as eating, sleeping, and moving (Charlier et al., 2016). In the Anglo-Saxon culture, health is related to wholeness, being uninjured, completeness, and entirety; the word health has the same root as the word whole; whereas Greek-Latin cultures view health as harmony or equilibrium with nature and balance (Leonardi, 2018). Similarly, a First Nations community in Canada think being in good health means having a good relationship with the land and having access to food (Charlier et al., 2016). Furthermore, they argue that having access to traditional culture promotes good health (Charlier et al., 2016).
While brevity is important for a practical defintion, perhaps a more reasonable approach is to have a battery of definitions (McCartney et al., 2019). Each definition can be applied in specific context that gives it some operational value (Leonardi, 2018). The ability to be a functioning member of society should be the objective of human welfare systems, such as ability to participate in social, economic, and political activities, as opposed to the end-state utilities like happiness or desire fulfilment (Bircher & Kuruvilla, 2014).
Public health measures and healthcare interventions have targeted infectious diseases and improved lifespans, which means ageing with a chronic condition is more common now (Huber et al., 2011). Germ theory allowed us to understand the etiology of infection and resulted in policies that supported basic hygiene (Bradley et al., 2018). However, the response to counteract the growth of chronic illnesses is not as clear (Bradley et al., 2018). A good start would be to focus on empowerment of the patient so that an individual gains coping skills and feels capable of managing their disease (Huber et al., 2011). For example, researchers at Stanford trained their patients in a chronic disease self-management program (Huber et al., 2011). Following the training, patients self-reported less distress, less fatigue, more energy, and fewer perceived disabilities and limitations in social activities (Huber et al., 2011). Management of chronic conditions leading to enhanced well-being and longevity involve gaining insight to understand the situation, fostering healthy relationships, and feeling positive emotions such as a sense of accomplishment (Bircher & Kuruvilla, 2014). Resiliency and being able to restore equilibrium, integrity, and well-being are key to helping patients adapt and self-manage (Huber et al., 2011). This allows for desired emotional, cognitive, and behavioural responses to various environmental events and conditions (Leonardi, 2018).
Brussow (2013) acknowledges there are a lot more scoring systems for grading diseases compared to assessing health levels. Yousefi and Rezael (2017) believe that health and disease can be measured; an alteration in total energy or total body mass, on the basis of quantum physics laws and the measurability of subatomic particles in a body system, would be considered a disease state. They theorized that exposing a form of energy toward a specific atom or subatomic particle could fix the health status of the body system (Yousefi & Rezael, 2017). Surveys are a common scoring system for measuring health. The domains of well-being for the Gallup-Healthways Well-Being Index are life evaluation, emotional health, physical health, health behaviour, work environment, and basic access (Bradley et al., 2018). Other examples of measurement tools for health systems include the Health Enhancement Research Organization (HERO) Scorecard or the Centers for Disease Control’s Worksite Health Scorecard (Bradley et al., 2018). Interestingly, The European Values Survey is an example of a measurement tool that can be used to examine hatred (Brook, 2017). Brook (2017) argues that a community or nation cannot be healthy if hatred is pervasive and believe a measurement of intolerance or hatred should be included in patient assessments. Therefore, healthcare professionals can play a role in promoting tolerance and eradicating hate (Brook, 2017).
Modernizing the definition of health will have strategic importance in all health fields and have impacts on people’s health behaviours (Leonardi, 2018). A change of focus for health improvement is suggested by Brussow (2013). Health initiatives need to address chronic instead of acute diseases, morbidity and not mortality, as well as quality of life rather than duration of life (Brussow, 2013). Health Canada values prevention and health promotion and works with provinces and territories to improve our health care system (Health Canada, 2014). Health policies and health services are influenced by how we define health.
Bradley et al. (2018) proposes some deep questions for your consideration:
“Do you feel like you are fully alive? Are you in your optimal state of being based on your current conditions?”
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. Retrieved from https://doi.org/10.1057/jphp.2014.19
Bradley, K.L., Goetz, T., & Viswanathan, S. (2018). Toward a contemporary definition of health.
Military Medicine, 183. Retrieved from https://doi.org/10.1093/milmed/usy213
Brook, R. (2017). Should the definition of health include a measure of tolerance? Journal of the American Medical Association, 317(6). Retrieved from https://doi.org/10.1001/jama.2016.14372
Brussow, H. (2013). What is health? Microbial biotechnology, 6(4), 341-348. Retrieved from
Card, A.J. (2019). Flourishing as a definition of health. Journal of the American Medical
Association, 322(10). Retrieved from https://doi.org/10.1001/jama.2019.10343
Charlier, P., Coppens, Y., Malaurie, J., Brun, J., Kepanga, M., Hoang-Opermann, V., Correa Calfin,
J.A., Nuku, G., Ushiga, M., Schor, X.E., Deo, S., Hassin, J., & Herve C. (2016). A new definition of
health? An open letter of autochthonous peoples and medical anthropologists to the WHO.
European Journal of Internal Medicine, 37, 33-37. Retrieved from
Health Canada. (2014, February 27). About Health Canada. Retrieved February 8, 2021 from
Huber, M., Knottnerus, J.A., Green, L., Van der Horst, H., Jadad, A.R., Kromhout, A., 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? British Medical Association, 343. Retrieved from
https://doi.org/10.1136/bmj.d4163 Jackson, D. [pdhpe.net]. (2018, April 26). Meanings of health [Video]. YouTube.
Leonardi, F. (2018). The definition of health: Towards new perspectives. International Journal of
Health Services, 48(4), 735-748. Retrieved from https://doi.org/10.1177/0020731418782653 McCartney, G., Popham, F., McMaster, R., & Cumbres, A. (2019). Defining health and health
inequalities. Public Health, 172, 22-30. Retrieved from
Yousefi, H., & Rezael, N. (2017). A theory towards a measurable definition for health: Introducing
two variables. Acta Medica Iranica, 55(2). Retrieved from
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