Define Health

The World Health Organization (WHO) defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"(https://www.who.int/about/governance/constitution). The Canadian Nurses Association and Government of Canada support this definition. Some have recently stated that this WHO definition from 1948 may be dated and needs to be amended. Some believe that health and chronic disease may not be mutually exclusive. Other's argue that the definition must be broadened to include tolerance and acceptance (Brook, 2017). It seems to me the lines between health and well-being may be getting blurred here.

Huber (2011) argues that the WHO's definition with the use of the word 'complete' when describing physical, mental and social well-being does not include people living well with chronic diseases managed by modern medicine. He proposes the definition should be altered to include a human being's ability to pivot and adapt to challenges to their health (Huber, 2017). Fallon and Karalawish (2019) also take exception to the "absence of disease and infirmity" being included in the definition of health, arguing that a person who is being managed medically with a significant number of co-morbidities can also feel healthy and live a productive fulfilling life. I believe there is some danger in this, if the definition is changed to apply to people who have not attempted some health prevention measures but instead continue to smoke, or disengage from society or remain inactive they may be able to justify their behaviours if the consequences of their poor decisions can be managed with medications and they can therefore deem themselves "healthy". Maybe the concept of health need not apply to everyone but perhaps it can be a concept for which people can aspire, to encourage health promotion.

The change that authors like Fallon, Karalawish and Huber propose appears to be more in line with what the CDC is currently using as their definition of well-being. The CDC describes well being as "what people think and feel about their lives, such as the quality of their relationships, their positive emotions and resilience, the realization of their potential, or their overall satisfaction with life" (https://www.cdc.gov/hrqol/wellbeing.htm). The CDC further describes well-being as feeling positive about your life and feeling good. The example that Fallon and Karalawish use is of an 82 year old lady with multiple co-morbidities yet she feels well and enjoy's life. They posit that the subject in their article should fit the definition of health but the WHO definition prevents this as she has been diagnosed with disease. It seems instead she may not fit the definition of health that the WHO describes but the definition of well-being.

Brook (2017) made the case that a society cannot be considered healthy if they are intolerant of others. Health Canada identifies Racism and culture as social determinants of health but does not go as far as to say that those doing the marginalization are the unhealthy ones (https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html). Most literature addresses racism and health with respect to those that are being discriminated against. Historically marginalized populations are more likely to suffer from chronic disease and more likely to die at an earlier age than those that are not discriminated against (Williams, Lawrence and Davis, 2019). Including a measure of intolerance may not be helpful here in the definition of health, though if the racist person then experiences a feeling of unhappiness due to exposure to people that they hold discriminatory beliefs about it can affect their well-being. If this were the case intolerance may be covered in the WHO's definition, however vaguely.

The problem with the WHO definition is that it seems to include both the absence of any kind of morbidity and the absence of negative feelings about one's life. A person must be both physically, mentally and socially completely healthy and also have nothing but positive feelings about life, they must be utterly thriving. Hueber and Fallon and Karawish want to exclude the stipulation that one must be free of disease to be healthy and instead lean towards having positive feelings about ones's life. Brook may also have a point in that a person who is intolerant of others and would prefer not to have a certain neighbour may not have an overall feeling of well being. The WHO definition assumes that everyone agrees that health is the absence of any kind of disease process, but this is no longer the case as people with chronic diseases are being treated medically and living full happy lives. Here it is useful to separate the two concepts, Health being the absence of disease and infirmity and well-being as an overall positive feeling, in a productive and fulfilling life.

Centre for Disease Control and prevention. (2018, October 21). Well-Being Concepts. CDC.gov. https://www.cdc.gov/hrqol/wellbeing.htm

Brook. R. H. (2017). Should the definition of health include a measure of tolerance? JAMA, 317 (6), 585-586. doi:10.1001/jama.2016.14372(link: https://0-jamanetwork-com.aupac.lib.athabascau.ca/journals/jama/fullarticle/2601506)

Fallon, C,K. & Karlawish, J. (2019, July 17). Its Time to Change the Definition of Health. Stat News. https://www.statnews.com/2019/07/17/change-definition-health/

Huber, M. (2011). Health: How Should we Define it? BMJ: British Medical Journal, 343(7817), 235–237. http://www.jstor.org/stable/23051314

Williams, D.R., Lawrence, J.A., Davis, A. D. (2019, January 2). Racism and Health: Evidence and Needed Research. Annual Reviews. 40, 105-125. https://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-040218-043750

"He who has a why to live, can bear almost any how"

-Frederich Nietzshe