This week in #MHST601 we embarked on a journey to analyze current definitions of health and see how they compared to the World Health Organization's 1948 definition of health.
The World Health Organization [WHO] defines health as “complete physical mental and social well-being and not merely the absence of disease or infirmity (McCartney et al., 2019, Table 1)”. This definition of health has been widely criticized as being out of date, and not something that is realistic or obtainable in our modern society. This has been described as an aspirational definition, not a realistic one (McCartney et al., 2019). McCartney et al. (2019) use the Ottawa Charter to expand the WHO’s definition of health to include health as a positive concept that envelops the aforementioned facets as well as health promotion, security, and resilience. Even this expanded definition has been critiqued for implying that one must be happy to be healthy (and the converse) and because some dimension of health can be in conflict with another, which does not necessarily mean that a person or community is experiencing ill health (McCartney et al., 2019). Some of the definitions this author examines suggest that health is the capability to cope with or manage one’s conditions as they are experienced. or that “health is the experience of . . . well-being. Good health and poor health do not occur as a dichotomy but as a continuum. The absence of disease or disability is neither sufficient nor necessary to produce a state of good health(McCartney et al., 2019, Table 2)” The author believes that these new definitions avoid the binary and absolutist difficulties of the WHO’s definition, and suggests that since there are vast differences in mortality and morbidity between populations or changes in expectations over time definitions must be dynamic in nature in such a way that they appeal to researchers, policymakers, and practitioners for standardized use, but that they can hold true when applied to different places, communities, and cultures.
I looked at a 2016 study that interviewed middle-aged and older men living in Norway in an attempt to define health (Kolderup Hervik, 2016). He found that laypeople understand health as an important part of life, but not just as something that concerns “complete” physical mental and social well-being. These men defined health as “living a good life” and shared experiences and personal histories that shaped how the group understood and expressed health (Kolderup Hervik, 2016, p. 224). The author notes that Norway is a fairly equitable and wealthy society, and as such the expectation for health is different than in other countries. The author also notes that:
"Those respondents who experienced situations where those aspects of health which constitute the premises for wellbeing or the good life were threatened or reduced, be it illness or pain, loss of functionality, loss of social network or overweight, more often expressed those elements as important for health. (Kolderup Hervik, 2016, p. 232)"
which suggests health as a very dynamic term, and in a way suggests that we can never really define health unless some aspects of ill health have first been thrust upon us.
In Ryan Meili’s book on democracy’s impact on Canada’s approach to the social determinants of health, he suggests that “if we as a society address the social determinants of health – economy, education, the environment, and more – people will live fuller, healthier lives . . . we will also foster a common purpose that deepens community, build solidarity, and rejuvenates democracy (Meili, 2012, p. 26). Maybe the WHO does not just need to define what “complete” health is, we need to redefine how health is created. Meili references a work by Wilkinson & Pickett (2009) where health is both determined and defined by the equality of the society, and as such is a globally dynamic concept. No matter how rich or how poor a country is, health outcomes will be worse if its ideals and political policies are less equitable. Both Meili (2012) and Wilkinsin & Pickett (2009) use politics as a foundation for defining and determining health, a concept that would be extraneous for the WHO to try to incorporate into its globally applicable definition. To add to this discussion, I shared a TEDx talk on my Twitter feed [@BrittanyM_AU] that expands on how policy with a focus on place can shift the democratic approach to health care (TEDx Talks & Walczak, 2020).
As far as the relevance of the WHO’s definition of health goes, I think the aspiration of complete health might be a big ask, especially for those people born with conditions or in social situations that would completely make this definition an unattainable enigma. I also think that in order to produce a comprehensive definition of health that is to be applicable globally we would have to pander to too many interest groups, and we would come up with one definition so vague, no one would even know what to strive for as it pertains to health. I align my ideas most closely with Kolderup Hervik, Meili, and Walczak and suggest health as dynamic and widely varied based on the equity of the person's society, and the standard that health is upheld to, in each community.
References
Kolderup Hervik, S. E. (2016). "Good health is to have a good life": How middle-aged and elderly men in a rural town in Norway talk about health. International Journal of Men's Health, 15(3), 218–234. https://doi.org/10.3149/jmh.1503.218
McCartney, G., Popham, F., McMaster, R., & Cumbers, A. (2019). Defining health and health inequalities. Public Health, 172, 22–30. https://doi.org/10.1016/j.puhe.2019.03.023
Meili, R. (2012). A healthy society: How a focus on health can revive Canadian democracy. Purich Publishing.
TedMed. (2013, April 15). In six words, what’s your vision for the future of health? TedMed Blog. Retrieved February 6, 2022, from https://blog.tedmed.com/in-six-words-whats-your-vision-for-the-future-of-health/
TEDx Talks & Walczak, B. (2020, May 18). Unlearning & expanding our definition of health - TEDxBeaconStreetSalon [Video]. YouTube. https://www.youtube.com/watch?v=3Q-mmfjIQUg
Wilkinson, R., & Pickett, K. (2009). The spirit level: Why more equal societies almost always do better. Allen Lane.
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