Intended for healthcare professionals

Rapid response to:


How should we define health?

BMJ 2011; 343 doi: (Published 26 July 2011) Cite this as: BMJ 2011;343:d4163

Rapid Response:

Blurring of Health-Disease-Health transitions

The proposed new definition for health risks further blurring of the
health - disease transitions and possibly would lead to an oxymoronic
state of 'healthy disease'. Would a single mum in a poor country working
during her bout of flu be termed healthy since she is able to adapt and
self manage whereas a young adult in a rich country who is 'off sick from
work' with flu might be termed as unhealthy.(1).

The general public would define health as absence of disease. The
problem lies with definition of diseases not with definition of health.
Ever expanding pre-disease categories and risk factors are increasingly
viewed as physical disease. (2). 'Normal life events' are increasingly
categorised as mental health problems. (3).

The availability of rapid genome wide sequencing might detect low
penetrant disease risk genes in practically most of us and this
potentially can put most of us in some pre-disease categories.(4).

Hence there is an urgent need to define disease before we define
health. Otherwise concept of 'health' risks becoming a philosophical
concept discussed along with 'meaning of life'!

1. Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D
et al. How should we define health? BMJ. 2011 Jul 26;343:d4163. doi:

2. Moynihan R. Medicalization. A new deal on disease definition.
BMJ. 2011 May 3;342:d2548. doi: 10.1136/bmj.d2548.

3. Frances A. The first draft of DSM-V. BMJ. 2010 Mar 2;340:c1168.
doi: 10.1136/bmj.c1168

4. Cirulli ET, Goldstein DB. Uncovering the roles of rare variants
in common disease through whole-genome sequencing. Nat Rev Genet.
2010.Jun; 11(6): 415-25.

Competing interests: No competing interests

18 September 2011
S Sundar
Consultant Oncologist
Nottingham University Hospitals NHS trust