In 1948, the World Health Organization (WHO) described health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition was initially seen as progressive for its time; however, it has not been modified since its origin. I believe the overall concept of including physical, mental and social well-being has relevance in 2021, however, the definition is vague, yet restrictive at the same time. A strength of the definition noted by Nobile (2014) was that “healthcare has generally a smaller effect on morbidity and mortality in respect to social and environmental conditions.” Several authors have identified criticisms of the WHO definition. Huber (2011) noted that the requirement for complete health is an unrealistic expectation. This term (complete) indicates that in order to be considered healthy, there can be zero evidence of physical, mental or social concerns. Secondly, Huber (2011) identified that population demographics and disease patterns have changed significantly since 1948 with the improvements in public health practices and health care interventions. People are living longer with chronic illness and by the above definition would never be considered healthy. Finally, Huber (2011) recognized that operationalization of the definition is unfeasible despite the WHO developing systems to classify disease and describe various aspects of health, as the definition remains unmeasurable. Nobile (2014) concluded that “a state of complete physical, mental and social well-being corresponds much more closely to happiness rather than to health, hence including human happiness in those issues that enter the area of competence of healthcare.” She identifies that a consequence of this is the public expectation that healthcare would be able to solve social problems as well.
More recently, The Ottawa Charter for Health Promotion (1986) states that in order to be healthy, an individual or group must be able to identify and realize aspirations, to satisfy needs, and to change or cope with the environment. Health is considered “a positive concept that emphasizes social and personal resources, as well as physical capacities.” An article by Bradley, Goetz and Viswanathan (2018) describes a contemporary definition of health that “recognizes that disease and disability can and often do co-exist with health.” They identify the involvement of mind, body, and spirit while recognizing sociologic, environmental and behavioral factors.
In summary, the WHO definition of health can be considered progressive for its time as it embraces the concepts of mental and social health when those domains were not as well understood as they are now. There does appear to be an appetite to modify the definition of health to allow for a more holistic equation, one that encompasses the concept that living with a chronic illness does not preclude one from being deemed healthy.
References
Bradley, K.L., Goetz, T., & Viswanathan, S. (2018). Toward a Contemporary Definition of Health. Military Medicine183(3), 204-207. https://doi.org/10.1093/milmed/usy213
Government of Canada (2017, November 14). Ottawa Charter for Health Promotion: An International Conference on Health Promotion. https://www.canada.ca/en/public-health/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion.html
Huber, M., Knottnerus, J. A., Green, L., van der Horst, H., Jadad, A. R., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M. I., van der Meer, J. W. M., Schnabel, P., Smith, R., van Weel, C., Smid, H. (2011). Health How Should We Define it? BMJ 343(7817), 235-237. https://www.jstor.org/stable/23051314
Nobile, M. (2014). The WHO Definition of Health: A Critical Reading. Med Law 33(2). https://pubmed.ncbi.nlm.nih.gov/27359006/
World Health Organization (n.d.).Constitution of the World Health Organization.https://www.who.int/about/governance/constitution
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