The WHO Definition of Health

September 30, 2006 at 10:25 am (Sarah's Posts)

Note:  This is something that I wrote recently for class.  We were discussing the WHO definition of health, which is: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”  The more that I thought about it, the more completely impractical that definition seemed.  I have a heck of a lot of itchy mosquito bites right now that are a physical nuisance—am I not healthy because of it?  What follows is my own definition and a bit of an explanation.  See the link at the end for some more thoughts from someone who knows a lot more than I do.  Let me know what you think.  There is also a big debate on whether “spiritual” should be added as a part of the definition of health.  But, that is a whole different topic…

 

 

Health is a dynamic condition that is identifiable by a physical and mental state that allows a person to pursue his or her goals, given a set of accepted circumstances.

 

            To make a working definition of health, it is important not to be so broad and lofty that all practical meaning is buried.  Health is a foundation that is necessary for well-being across a variety of fields—personal, economic, social, and spiritual.  Good health plays a role in well-being across these areas and, conversely, well-being in these can contribute or detract from health.  Yet in order to make a workable definition of health, it is important to focus on a description that is applicable to the life of every person.

            Living systems are dynamic, and human health is no exception.  Any attempt to place a set of measured statistics on what constitutes health is bound to be inaccurate.  It seems that perhaps the best measure of health can only come from an individual and his or her expectations.  Given their life circumstances, is their physical and mental state one that allows them to pursue their goals, whatever they may be?  Even the most idealized notion of health cannot guarantee that an individual will obtain his or her goals, but health should not be the limiting factor. 

            This definition does not eliminate the difficulty of objectively measuring health across different populations.  It suggests that measures of health should focus around the expectations and aspirations of the individual, which are nearly impossible to quantitatively assess.  Nevertheless, interviewing people about their concept of health shows that individuals do have set notions of what it would take to consider themselves healthy.  Individuals tend to define health in terms of what they can and cannot accomplish, which is a tribute to the fact that health is different for each individual.  While this makes health a difficult attribute to measure, any definition of health has to take into account the personal nature of health.

            We cannot pretend that this world provides any sort of equality in terms of opportunity.  Across the globe, people have drastically different access to healthcare, economic conditions, and environments.  A more limited definition of health does not deny the fact that these inequalities are present and need attention.  Instead, perhaps adopting a practical definition of health can serve as a reminder that improving the health of people globally is an attainable goal.  

 

http://www.hsph.harvard.edu/hcpds/wpweb/Bok_wp1407_3.pdf

-Sarah Kimball

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52 Comments

  1. sstolper said,

    Sarah, I don’t think there’s too much wrong with the WHO definition of health. I agree that what is healthy is not set in stone, and more importantly that expectations and goals can act as the primary motors behind this “dynamic condition” of yours. So I like the inclusion of that word, “dynamic”, in your definition. But maybe simply because of your definition’s wording, it seems less accessible and motivating for those seeking practical gains in global health. When I read your definition I more or less wonder what to do with it. The emphasis on the understanding of the individual is integral; I’d like to see that word literally involved in the definition. WHO’s definition is simply more readable. But it needs to add that individual element that you value, so as to teach, or remind, instead of just reiterating what we all know about health.

    I think it’s the use of “complete” in WHO’s definition that I don’t like. That makes health seem more absolute, like once you get to ‘this’ level, congratulations, you are now healthy. I like the use physical, mental, and social a lot though. I think those words are clear and illuminating, and go a long way to remind the reader that it’s not just about bruises and bleeding.

    Health is a dynamic state of physical, mental, and social well-being that promotes happiness with respect to individual environment and history.

    That took a lot of deleting and rewriting. I’m sure I will come up with a different one in ten minutes. I don’t like the word ‘happiness’, but not because it’s not right. Just because it’s not eloquent.

  2. misarita said,

    Sam–sorry that I’m so slow.

    You’re probably right that the definition that is the global standard is not lousy enough that I could come up with something drastically better. My issue is that I see a lot of lofty words in the public health arena. People throw around buzzwords like “complete state of well being” and “sustainability.” I love lofty idealism in theory because I think it makes us think in new directions–but it has to be tempered with some practicality. How do I ever start to measure success if my target goal is something as intangible as a “complete state of wellbeing”?

    That being said, I like your definition. I have a terrible time being too wordy, as a general rule. 🙂

  3. msoule said,

    I agree with Sam that it is much better to emphasize the individual and I agree with you that there is something… blah about the WHO definition. It reeks of platitudes that get spread around in international fora that sound nice but lead us nowhere. I also get that sense of, “OK… so now what?” from it.
    I am also rubbed the wrong way by your phrase “accepted circumstances.” It has a sense of accepting the poverty of the poor and not pushing their case further than is “allowable” by those who hold power. How can someone with no schooling available have the goal of attaining complete literacy? Their “accepted circumstances” constrain them to methods of alleviating their poverty that do not include pushing the borders of their reality. But what if becoming literate is what will really catapult them out of their current circumstances into ones that are more acceptable? And what if this requires straining past those circumstances that have been forced upon them by poverty and have, by default, become “acceptable”?
    Sam’s definition rewords this, but not to the extent that makes me comfortable. It deprives the definition the power to rewrite an individual’s history and truly change their circumstances.
    I think that what both of you are getting at is a sense of cultural appropriateness. It is true that we ought not to impose our standards on other cultures. But Paul Farmer (that pest! Always coming back to haunt me!) puts it incredibly in “Infections and Inequalities” when he points out that we are willing to impose our economic plans on countries in the guise of “development” work (via IMF, World Bank) but we are not willing to impose our standards of healthcare. In other words, we must constrain our healthcare efforts with cultural appropriateness but not our economic ones.
    In this light, the definitions you wrote have such a strong sense of limiting the possibilities of change that I can’t get with them. I think the WHO phrasing of “complete well-being” leaves the borders more open and allows for revolutionary thought. Which is what we need when we are dealing with the economic oppression of the poor. The open-endedness also gives many different care providers space to contribute to the condition of health. For instance, “a complete state of well-being” encompasses the spiritual as well, which is something that you and the WHO leave out of your definitions.

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