Defining Health

Study Notes

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."
This definition has been criticized for being too broad and ambitious, and for not being operationalized or measurable.

The requirement for complete health unintentionally contributes to the medicalization of society.
The definition supports the tendencies of the medical technology and drug industries to redefine diseases and expand the scope of healthcare.
It minimizes the role of human capacity to cope autonomously with life's challenges and function with fulfillment and a feeling of wellbeing with a chronic disease or disability.

Various proposals have been made for adapting the definition of health, but WHO has not taken up any of these proposals.
Reformulation is needed to reflect the changing patterns of disease and the increasing importance of chronic disease management.

Experts propose a more dynamic concept of health based on the ability to adapt and self-manage in the face of social, physical, and emotional challenges.
This concept should be operationalized for measurement purposes, research, and evaluating interventions.

Physical health: the ability to maintain physiological homeostasis through changing circumstances (allostasis).
Mental health: the sense of coherence, which contributes to a successful capacity to cope, recover from strong psychological stress, and prevent disease.
Social health: the ability to fulfill one's potential and obligations, manage life with some degree of independence, and participate in social activities despite a medical condition.

Measurement instruments should relate to health as the ability to adapt and self-manage.
Examples of measurement tools include the COOP/Wonca Functional Health Assessment Charts, which present six dimensions of health and measure the ability to perform daily life activities on a 1-5 scale.### Defining Health
A conference was held in the Netherlands to discuss defining health, organized by the Health Council of the Netherlands and the Netherlands Organisation for Health Research and Development.
The conference was guided by a review of the literature and featured a multidisciplinary group of 38 international experts.

A chronic disease self-management program was found to improve health status while reducing utilization and costs in a randomized trial (Med Care 1999;37:5-14).
A randomized community-based outcome trial showed that Hispanic chronic disease self-management programs can be effective (Nurs Res 2003;52:361-9).

The COOP/Wonca charts can be used to measure functional health status (Northern Centre for Health Care Research, University of Groningen, 1995).
The COOP Chart method is a way to assess function in routine clinical practice (J Chron Dis 1987;40(suppl 1):55S-63S).

A study on successful aging in the oldest old found that certain individuals can be characterized as successfully aged (Arch Intern Med 2001;161:2694-700).
The WHO family of international classifications provides a framework for understanding health (www.who.int/classifications).