The 1948 WHO description of health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”
The definition of the word has repercussions. The WHO definition implies that health is related to economic and cultural welfare and is more than campaigns against heart disease and cancer (Callahan, 1973). The responsibility for population health falls on all sectors of government and society, not just the health care system. For an individual to be physically, mentally, and socially “healthy” they must enjoy a healthy diet and exercise, be free from trauma and poverty, and have access to education and employment, in addition to health care. This part, probably ground-breaking for its time, scratched the surface of the determinants of health, and for that reason, the WHO definition once served a worthy purpose. Advances in health care and socioeconomic development reduced mortality – we are now surviving at a higher rate and living longer but with that comes age-related morbidity and chronic health conditions, making the attainment of “complete” well-being, nonsensical and unrealistic (Rahman, 2019).
Illnesses such as diabetes or asthma were a death sentence in 1948. Today they can be managed with effective medication and lifestyle. Is a 30-year-old asthmatic who has not had an attack for years unhealthy? Is a 50-year-old diet-controlled diabetic unhealthy? Of course not. Modern context has rendered the 1948 definition irrelevant.
Huber (2011) discusses health in terms of allostasis: our individual ability to adapt or cope with changing circumstances. “Allostatic load” is our physiologic response to the cumulation of both sudden and chronic elevations in stressors and is associated with mental and physical well-being, functioning, and all-cause mortality. Identifying allostatic load means that we can quantify the physiological burden of stress to describe and predict an individual’s health (Rodriquez et al., 2019). Allostatic load is the result of the complex interaction of stressors on an individual and is a reliable predictor of health risk and enlightens us to why there are disparities in risk (Rodriquez et al., 2019).
Does paraplegia mean “unhealthy” because a person without the functioning of her legs is not in a state of “complete physical wellbeing”? Absolutely not. But a person with paraplegia is likely to be at greater risk of being unhealthy if she is also experiencing barriers to employment, isolation, or an inability to access mobility aids.
The King’s Fund (2019) recognizes that not only is health affected by a range of factors, measuring the effect of each stressor on every individual’s overall health is imprecise.
The concept map below captures the most appropriate definition of what health means: a unique being’s capacity to maintain stability in the face of stressors (Huber 2011). This capacity comes from the individual’s resilience as well as the support systems available to the individual (note that each determinants' effect on health is represented to-scale). In no way does one need to be "complete" to be healthy, and perfection is unattainable anyways. The implications of this visual definition maintain that overall health is relative and improving health is a collective responsibility of society and of the individual (The King’s Fund 2019).
(Dahlgren & Whitehead 1993 as cited in The King’s Fund 2019).
Works Cited:
Callahan, D. (1973). The WHO Definition of “Health.” In The Hastings Center Studies (Vol. 1, Issue 3). The Concept of Health.
Huber, M. (2011). Health: How should we define it? British Medical Journal, 343,(7817), 235-237. https://doi.org/10.1136/bmj.d4163
The Kings Fund (2019). What does Improving Population Health Really Mean? Retrieved from: https://www.kingsfund.org.uk/publications/what-does-improving-population-health-mean
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July, 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April, 1948.
Rahman, M. S. (2019). Health care in aged population:A global public health challenge. In Journal of Medicine (Bangladesh) (Vol. 20, Issue 2, pp. 95–97). Bangladesh Society of Medicine. https://doi.org/10.3329/jom.v20i2.42010
Rodriquez, E. J., Kim, E. N., Sumner, A. E., Nápoles, A. M., & Pérez-Stable, E. J. (2019). Allostatic Load: Importance, Markers, and Score Determination in Minority and Disparity Populations. Journal of Urban Health, 96(Suppl 1), S3–S11. https://doi.org/10.1007/s11524-019-00345-5
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