Intended for healthcare professionals

Analysis

How should we define health?

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4163 (Published 26 July 2011) Cite this as: BMJ 2011;343:d4163

Re: How should we define health?

Huber and colleagues bring needed attention to the WHO definition of health. Their suggestions are to move the definition toward adaptation and self-management in the face of challenges. (1) However, since challenges to be faced in life can never be known until they occur, their suggestion would encourage reactive instead of proactive actions by individuals and professionals. This author suggests it is necessary to define health, as WHO has done, in a way that inspires the desire to improve physical, mental and social well-being for its own sake. By doing this, abilities to adapt and self-manage are improved as a better life is created. (2-5)

Improved health provides an opportunity to manifest a better life. Health is a dynamic, not static state that one must work to continuously generate. Health is not something that can be achieved by reacting to current circumstances. The WHO definition provides an ideal state to work toward by defining health as a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity (6).

Humans have a unique, innate ability and desire to adapt and continually improve their state of well-being. Health is not as much an end point as it is an enabling capacity to facilitate progress toward a desired life. Huber and colleagues’ commentary suggests that the WHO definition would consider most individuals to be unhealthy or definitively ill most of the time and that this would then lead to the undesired outcome of increased medicalization. (1) This interpretation is correct if health is understood to be the absence of disease and infirmity and not as the presence of well-being.

WHO explains that health is the PRESENCE of physical, mental and social well-being and not merely the ABSENCE of disease and infirmity. (6) Only conscious action can create these desired states of well-being. Seeing health as the absence of disease and infirmity is narrow and incomplete. Instead of defining health as a higher state to be created and continually achieved, Huber and colleagues suggested redefinition would seem to encourage a return to a predetermined baseline instead of a move toward a higher state of well-being. Putting a focus on the precursors to achievement, accomplishment and thriving, something required with the current definition, inspires action to enhance physical, mental, and social well-being.

Though we are pulled to the status quo or maintenance by the endowment effect, (7) it does not inspire. Furthermore, passive reactionary stances and maintenance of the status quo through "…the ability to adapt and to self-manage" would be encouraged if this redefinition were accepted. Accomplishment and achievement of one’s desires, on the other hand, inspires action. The current WHO definition inspires action to create a dynamic and improving state of health that can be measured by determining engagement in health promoting actions. Results document that the more people engage in health promoting actions, the greater their well-being, satisfaction, and performance and the lower their incidence of symptoms and problems associated with disease and infirmity because of a better ability to adapt and self-manage in the face of challenges. (8,9)

(1) Huber M, Knottnerus JA, Green L, Horst H, Jadad AR, Kromhout D, et al. How should we define health? BMJ 2011;343.
(2) Breslow L. A quantitative approach to the World Health Organization definition of health: physical, mental and social well-being. Int J Epidemiol 1972 Winter;1(4):347-355.
(3) Breslow L. From disease prevention to health promotion. JAMA 1999 Mar 17;281(11):1030-1033.
(4) Antonovsky A. Unraveling the mystery of health : how people manage stress and stay well. 1st ed. San Francisco: Jossey-Bass; 1987.
(5) Becker C, Glascoff M, Felts W. Salutogenesis 30 Years Later: Where do we go from here? International Electronic Journal of Health Education 2010;13:25-32.
(6) World Health Organization. World Health Organization Constitution. Dublin: Stationery Off; 1948
(7) Ariely D. The upside of irrationality : the unexpected benefits of defying logic at work and at home. New York, NY: Harper; 2010.
(8) Becker CM, Whetstone L, Glascoff M, Moore J. Evaluation of the Reliability and Validity of an Adult Version of the Salutogenic Wellness Promotion Scale (SWPS). Am J Health Educ 2008;39(6):322-328.
(9) Becker CM, Dolbier CL, Durham T, Glascoff MA, Adams TB. Development and Preliminary Evaluation of the Validity and Reliability of a Positive Health Scale. Am J Health Educ 2008;39(1):34-41.

Competing interests: No competing interests

16 December 2012
Craig M. Becker
Associate Professor
East Carolina University
3207 Carol Belk Building; Greenville, NC, 27858; USA