Analysis

How should we define health?

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d4163 (Published 26 July 2011) Cite this as: BMJ 2011;343:d4163
  1. Machteld Huber, senior researcher1,
  2. J André Knottnerus, president, Scientific Council for Government Policy 2,
  3. Lawrence Green, editor in chief, Oxford Bibliographies Online—public health3,
  4. Henriëtte van der Horst, head 4,
  5. Alejandro R Jadad, professor5,
  6. Daan Kromhout, vice president, Health Council of the Netherlands6,
  7. Brian Leonard, professor7,
  8. Kate Lorig, professor8,
  9. Maria Isabel Loureiro, coordinator for health promotion and protection9,
  10. Jos W M van der Meer, professor10,
  11. Paul Schnabel, director 11,
  12. Richard Smith, director12,
  13. Chris van Weel, head 13,
  14. Henk Smid, director 14
  1. 1Louis Bolk Institute, Department of Healthcare and Nutrition, Hoofdstraat 24, NL-3972 LA Driebergen, Netherlands
  2. 2Department of General Practice, Maastricht University, Scientific Council for Government Policy, Postbus 20004, NL-2500 EA The Hague, Netherlands
  3. 3Department of Epidemiology and Biostatistics, School of Medicine, University of California at San Francisco, USA
  4. 4Department of General Practice, VU Medical Center, Amsterdam, Netherlands
  5. 5Centre for Global eHealth Innovation, Toronto General Hospital, Toronto, Canada
  6. 6Department of Public Health Research, Wageningen University, The Hague, Netherlands
  7. 7Pharmacology Department, National University of Ireland, Galway, Ireland
  8. 8Stanford Patient Education Research Center, Palo Alto, CA, USA
  9. 9National School of Public Health/New University of Lisbon, Portugal
  10. 10General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
  11. 11Netherlands Institute for Social Research, The Hague, Netherlands
  12. 12UnitedHealth Chronic Disease Initiative, London, UK
  13. 13Department of Primary and Community Care, Radboud University Nijmegen Medical Centre
  14. 14Netherlands Organisation for Health Research and Development, The Hague, Netherlands
  1. Correspondence to: M Huber m.huber{at}louisbolk.nl
  • Accepted 15 June 2011

The WHO definition of health as complete wellbeing is no longer fit for purpose given the rise of chronic disease. Machteld Huber and colleagues propose changing the emphasis towards the ability to adapt and self manage in the face of social, physical, and emotional challenges

The current WHO definition of health, formulated in 1948, describes health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”1 At that time this formulation was groundbreaking because of its breadth and ambition. It overcame the negative definition of health as absence of disease and included the physical, mental, and social domains. Although the definition has been criticised over the past 60 years, it has never been adapted. Criticism is now intensifying,2 3 4 5 and as populations age and the pattern of illnesses changes the definition may even be counterproductive. The paper summarises the limitations of the WHO definition and describes the proposals for making it more useful that were developed at a conference of international health experts held in the Netherlands.6

Limitations of WHO definition

Most criticism of the WHO definition concerns the absoluteness of the word “complete” in relation to wellbeing. The first problem is that it unintentionally contributes to the medicalisation of society. The requirement for complete health “would leave most of us unhealthy most of the time.”4 It therefore supports the tendencies of the medical technology and drug industries, in association with professional organisations, to redefine diseases, expanding the scope of the healthcare system. New screening technologies detect abnormalities at levels that might never cause illness and pharmaceutical companies produce drugs for “conditions” not previously defined as health problems. Thresholds for intervention tend to be lowered—for example, with blood pressure, lipids, and sugar. The persistent emphasis on complete physical wellbeing …

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