Health: How Should We Define It? (2011) PDF

HEALTH: HOW SHOULD WE DEFINE IT? MACHTELD HUBER (2011) The current WHO definition of health, formulated ○ WHO has developed several in 1948, describes health as “a state of complete systems...

HEALTH: HOW SHOULD WE DEFINE IT? MACHTELD HUBER (2011) The current WHO definition of health, formulated ○ WHO has developed several in 1948, describes health as “a state of complete systems to classify diseases and physical, mental, and social well-being and not describe aspects of health, merely the absence of disease or infirmity.” disability, functioning, and quality of life. LIMITATIONS OF WHO DEFINITION ○ Yet because of the reference to a Most criticism of the WHO definition concerns the complete state, the definition absoluteness of the word “complete” in relation to remains “impracticable, because well-being. ‘complete’ is neither operational 1. The first problem is that it unintentionally nor measurable.” contributes to the medicalization of society. NEED FOR REFORMULATION ○ The requirement for complete Various proposals have been made for health “would leave most of us adapting the definition of health. The best unhealthy most of the time.” known is the Ottawa Charter, which emphasizes social and personal resources Analysis: The limitations of the current definition as well as physical capacity. are increasingly affecting health policy. ○ However, WHO has taken up none of these proposals. *The persistent emphasis on complete physical Nevertheless, the limitations of the current well-being could lead to large groups of people definition are increasingly affecting health becoming eligible for screening or for expensive policy. interventions even when only one person might ○ For example, in prevention benefit, and it might result in higher levels of programs and healthcare, the medical dependency. definition of health determines the outcome measures: health gain in 2. The second problem is that since 1948, survival years may be less relevant the demography of populations and the than societal participation, and an nature of disease have changed increase in coping capacity may be considerably. more relevant and realistic than ○ Disease patterns have changed, complete recovery. with public health measures such Redefining health is an ambitious and as improved nutrition, hygiene, and complex goal; many aspects need to be sanitation and more powerful considered, many stakeholders consulted, healthcare interventions. and many cultures reflected, and it must also take into account future scientific and *Aging with chronic illnesses has become the technological advances. norm, and chronic diseases account for most of The preferred view on health was “the the expenditures of the healthcare system, putting ability to adapt and to self-manage.” pressure on its sustainability. The definition should be replaced by a In this context, the WHO definition concept or conceptual framework of becomes counterproductive as it declares health. people with chronic diseases and ○ A general concept, according to disabilities definitively ill. sociologist Blumer, represents a characterization of a generally 3. The third problem is the agreed direction in which to look, operationalization of the definition. as reference.  ○ But operational definitions are also affected by external conditions such as needed for practical life such as social and environmental challenges. measurement purposes. ○ By successfully adapting to an illness, people are able to work or The first step towards using the concept of to participate in social activities “health, as the ability to adapt and to and feel healthy despite limitations. self-manage” is to identify and characterize it If people are able to develop successful for the three domains of health: strategies for coping, (aged-related) impaired functioning does not strongly Physical Health change the perceived quality of life, a In the physical domain, a healthy phenomenon known as the disability organism is capable of “allostasis”—the paradox. maintenance of physiological homeostasis through changing circumstances. MEASURING HEALTH ○ When confronted with The general concept of health is useful for physiological stress, a healthy management and policies, and it can also organism is able to mount a support doctors in their daily protective response, to reduce the communication with patients because it potential for harm, and restore an focuses on empowerment of the patient (adapted) equilibrium. (for example, by changing a lifestyle), which the doctor can explain instead of Mental Health just removing symptoms by a drug. In the mental domain, Antonovsky ○ However, operational definitions describes the “sense of coherence” as a are needed for measurement factor that contributes to a successful purposes, research, and evaluating capacity to cope, recover from interventions. psychological stress, and prevent Measurement might be helped by post-traumatic stress disorders. constructing health frames that ○ The sense of coherence includes systematize different operational the subjective faculties enhancing needs—for example, differentiating the comprehensibility, between the health status of individuals manageability, and meaningfulness and populations and between objective of a difficult situation. and subjective indicators of health. ○ A strengthened capability to adapt The measurement instruments should and to manage yourself often relate to health as the ability to adapt and improves subjective well-being and to self-manage. may result in a positive interaction Good first operational tools include the between mind and body. existing methods for assessing functional status and measuring quality of life and Social Health sense of well-being. Several dimensions of health can be identified in the social domain, including: CONCLUSION ○ People’s capacity to fulfill their Just as environmental scientists describe potential and obligations the health of the earth as the capacity of a ○ The ability to manage their life with complex system to maintain a stable some degree of independence environment within a relatively narrow despite a medical condition range, we propose the formulation of ○ The ability to participate in social health as the ability to adapt and to activities, including work self-manage. Health in this domain can be regarded as a dynamic balance between opportunities and limitations, shifting through life and