What the health? A call for a modernized revision of a 74-year-old definition

74 years ago the World Health Organization (WHO) defined health as “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, n.d., para. 1).” despite many attempts to modernize, this definition remains widely accepted, and continues to circulate widely in health literature (Lewis, 2011). Many argue though that the WHO definition is both unrealistic and antiquated for many, given the current medical advances for people with chronic illness.

As medicine, technology and healthcare advances year over year, more and more people are living for years with chronic diseases. In fact, In Canada alone, 1 in 3 or 33.7% of Canadian adults are living with some form of chronic disease (Branchard et al, 2018). Further, in any given year, 1 in 5 Canadians are experiencing a mental illness (Smetanin et al, 2011) and 30% of seniors are at risk of experiencing social isolation (Keefe et al, 2006). Based on these numbers alone, millions of Canadians would not meet the definition of “health” in current state.

Many organizations have taken on the task of re-defining what is “health” or further, what it is to be “healthy”. Critiques of the WHO definition suggest that it fails to account for the fact that one can live for many years with a chronic disease that does not impact their quality of life, or even shorten their life expectancy (Pietrangelo, 2022). Other critics point to the fact that the 1948 definition fails to address the ability to cope, self-manage and have resiliency in ones self, all of which are often goals in contemporary health interventions for a number of conditions and illnesses (Huber et al., 2011). Further, Saracci argues in the British Journal of Medicine, that this current definition is needlessly expensive, having potential impact on health spending, as more and more healthcare dollars are spent on the “worried well” who are often prescribed medications, treatments and surgeries on minor and often irrelevant findings in the quest to be completely free of disease (Saracci, 1997).

Of the various contemporary definitions, an interesting one comes from the journal “Military Medicine” where the authors propose; “A contemporary definition of health recognizes that disease and disability can and often do co-exist with health. In this new conception, health is transformed from a state that requires the absence of disease to a state where the central theme is the fullness of life. Health involves the integration of body, mind, and spirit and recognizes the significant influence of sociologic, environmental and behavioral factors.“ (Bradley, K. L., et al, 2018)

This definition is a more inclusive and achievable target for many who traditionally would never be able to fall under the umbrella of experiencing “health” no matter what they do. It allows for measurable, and moveable targets that are achievable to all who strive for it. By using the term “fullness of life”, it respects the autonomy of an individual experiencing a health concern, in that the individual can determine what is important to them to live a full life. What is it that for that person allows their body, mind and spirit to be full, whole, and healthy? In this definition, a client with a progressive, chronic or permanent illness or condition, is able to participate in interventions that nourish the body, mind and spirit, to meet goals that are fulfilling to them, to be included in this goal.

This definition has an air of empowerment to it as well. For example, a person experiencing a chronic mental illness under the old definition, would not and could not be experiencing “health” under the 1948 definition. In contrast, a person who is experiencing a mental illness, but is accessing the appropriate care at the appropriate time and implementing the tools to self-manage and to cope and is incorporating body, mind and spirit self-care strategies can also be said to experience health in this new definition. This begs the question… why the health would we not move to modernize?

References;

Bradley, K. L., USA (Ret), Goetz, T., & Viswanathan, S. (2018). Toward a Contemporary Definition of Health. Military medicine, 183(suppl_3), 204–207. https://doi.org/10.1093/milmed/usy213

Branchard, B., Deb-Rinker, P., Dubois, A., Lapointe, P., O'Donnell, S., Pelletier, L., & Williams, G. (2018). At-a-glance - How Healthy are Canadians? A brief update. Aperçu - Quel est l’état de santé des Canadiens? Brève mise à jour. Health promotion and chronic disease prevention in Canada : research, policy and practice, 38(10), 385–387. https://doi.org/10.24095/hpcdp.38.10.05

Huber, M., Knottnerus, J. A., Green, L., Horst, H. v., Jadad, A. R., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M. I., Meer, J. W., Schnabel, P., Smith, R., Weel, C. v., & Smid, H. (2011). How should we define health? BMJ, 343(jul26 2), d4163–d4163. https://doi.org/10.1136/bmj.d4163

Keefe, J., Andrew, M., Fancey, P. and Hall, M. (2006). Final Report: A Profile of Social Isolation in Canada. Submitted to the Chair of the F/P/T Working Group on Social Isolation. Retrieved June 6, 2022

Lewis, D. M. (2011). WHO definition of health remains fit for purpose. BMJ, 343(aug23 4), d5357. https://doi.org/10.1136/bmj.d5357

Pietrangelo, A. (2022, March 15). People with chronic conditions living longer. Healthline. Retrieved June 6, 2022, from https://www.healthline.com/health-news/why-people-with-chronic-conditions-such-as-diabetes-are-living-longer-without-disability

Saracci R. (1997). The World Health Organisation needs to reconsider its definition of health. BMJ (Clinical research ed.), 314(7091), 1409–1410. https://doi.org/10.1136/bmj.314.7091.1409

Smetanin et al. (2011). The life and economic impact of major mental illnesses in Canada: 2011-2041. Prepared for the Mental Health Commission of Canada. Toronto: RiskAnalytica.

World Health Organization. (n.d.). Frequently asked questions. Retrieved from http://www.who.int/suggestions/faq/en/