What is health?
The definition of health will be subjective. It will depend on whomever is looking at this very question coming from their own unique experiences (clinical or non-clinical) combined with any relevant educational background. This subjectiveness will also be most likely influenced by a person’s cultural background based on their collective experience with their own personal “health” in their area of habitation. In different cultures “health’s” purpose may be different as well. There are so many variables to consider when in pursuit of such a question.
When we talk about the WHO’s definition of health and how it hasn’t changed in over sixty years, I believe it’s not simply out of ignorance, but due to the inability to encompass so many variables in which standardization of desired parameters from various collective “experts” would then be applied, now that we have so much scientific clinical information. Who decides which clinicians are the experts to redefine different proposed parameters that could be affiliated with the reconstruction of this definition? Do they have any evidence from investigating relevant scientific studies, or is solely based on experience? Which is better? Should they both be present when choosing personal? From which licensing bodies would such personal be chosen (as we know each country has different criterion for licensure of health care clinicians)?
Also, I believe one of the potential reasons behind the reasoning of the WHO’s definition of not being updated is because of a potential cascade effect. If you examine more proposed parameters that could affect the outcome of redefining this definition, what would that one component bring along with it in terms of action? What would need to change? Who would make the changes and how would we categorize such changes to suit specific demographics of respective persons? There would be continuous perpetuating waves of further questioning that would need to take place. These such questions would vary in answer depending on who would be asked. I agree with authors in the Huber article where they state, ‘redefining health is an ambitious and complex goal; many aspects need to be considered, many stakeholders consulted, and many cultures reflected, and it must also take into account future scientific and technological advances.’[1] My guess is years later of exhaustive collaboration and recombination, the definition would be unacceptable again due to continuous advances in the medical research community. That being said, it would appear as though this definition provides the potential characteristic as being fluid and dynamic. However, if we start considering too many variables that may enhance the existing ambiguity, we will further ourselves down the rabbit hole. Therefore, I personally do not see anything wrong with redefining this current definition per se, but the more important question that needs to be asked, is HOW would we go about doing this to create the most concise definition that addresses the TREND of an adequate of such specific domains/components over time? Such a process might mean application of trial and error in that we may need to continuously re-select specific components to their respective domains of the new model definition so that we are keeping the model simplistic through the use of basic domains, however each domain would be further characterized by it’s unique set of components that would be selected after experimentation.
In this article it would appear as though the author had selected three basic domains: physical, mental, and social. However, what I didn’t appreciate was that each domain was constituted upon a singular reference point (journal article). I personally would have appreciated a wider range of reference points of varying opinions to collectively designate these three such domains myself to prevent unbiased opinions and to broader the scope of knowledge when arriving at these domains. Bottom line: I do think keeping the quantity of such domains in redefining this definition is appropriate, but I would like to see more collaboration in terms of how each one is defined and why (observation of trends over time).
Something interesting to note, when I was searching for an alternative definition of health, I looked into the online Oxford medical dictionary and they quoted the WHO’s definition. Interesting. Health - Oxford Reference
So, because I like dictionaries, I then defaulted to the online Merriam Webster dictionary. Here is how “health” was defined:
a) The condition of being sound in body, mind or spirit
b) The general condition of the body
c) A condition in which someone or something is thriving or doing well
d) General condition or state
The WHO’s definition (once again sorry) ‘a state of complete physical, mental and social well-being and not merely the absence of disease of infirmity’.[2]
I think point “a” from MW was pretty much parallel with the WHO’s definition. I think these definitions are still relevant today myself. Earlier in this post I explored the possibility of redefining the WHO’s definition, but the importance needed to be shifted to the “how” it would need to be shifted. I also expressed the need for simplicity and the appreciation of three domains, in that they needed to remain straightforward. The straightforwardness would be a result of collaboration from varying relevant clinicians with differing opinions and cultural backgrounds but being “one” in purpose. I think we can all appreciate from our statistics days that when we draw upon a greater sample, we increase the validity of our data. Hence the need of collaboration of differing opinions from congruent experts in the same field pertaining to which designated domain.
What is a contemporary criticism of the WHO definition? Well again this is going to be subjective based on the individual answering this question. The Huber article states: ‘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 medicalization of society. The requirement for complete health “would leave most of us unhealthy most of the time.” [3]
I’m not sure how I feel about this perspective to be honest. On one hand I agree that the word “complete” is a bit ambiguous but on the other hand I think it could provide the clinician with more freedom in terms of how they define “complete” in terms of their individual patient in their care as the word “complete” may vary from patient to patient in terms of the health care provider’s perspective. Could the criterion used for how the care provider classifies “complete” be adjusted in that basic blanket criterion are met for each patient? The possibility is of course there, however, as I mentioned previously this could in fact take you down the rabbit hole trying to find this such means of standardization of basic criterion for all patients in one domain, as each patient is unique and trying to find a way to collectively create criterion that will serve as a benefit to every last patient on the planet will involve a lot of consideration and research. Again, you’d have to have a panel of clinical personal with different perspectives, relevant clinical backgrounds and experience, to best appreciate the endless spectrum of where any individual may rank on a disease/mental health scale. I’m not sure if I would like to be further classified like a specimen in general in terms of what I need either. I would like to think my care provider should have my “complete” “health” in the forefront of their mind and that when they are making decisions based on such “completeness” these decisions would be founded based on a collection of their own experience, due diligence and initiative. I say this because as after all I selected my physician based on what I decided was importance in terms of the “health” care I receive, and what I may feel is important in terms of the care I receive. My perspective may not be what another patient desires in terms of their care. When I sit back and think about the articles we had to read for this forum I can most definitely appreciate the desire to alleviate suffering of any kind and to restore homeostasis, as I’m all too familiar with the havoc a lack of homeostasis can do on a cellular level, but at the same time I feel caution is to be applied in that when making such decisions on a global level, in that our data samples would need to be extensive and span over every continent and encompass many, many different kinds of clinicians with varying backgrounds, cultures and medical opinions, so that decisions that are made for such a redefinition would be much more informed and therefore once again, more valid.
The following links are links of what I have found that help define what is health based on the three domains mentioned in the above.
What is Social Health? Definitions, Examples and Tips on Improving Your Social Wellness (hif.com.au)
Regulation of the Transcription of G Protein-Coupled Receptor Genes | Request PDF (researchgate.net)
The last link is of personal interest in terms of how cellular homeostasis can be compromised (this could pertain to the health domain from the aforementioned domains) in that signal transduction messaging could shift to up-regulate or down-regulate specific secondary messaging and nuclear transcription of specific genes. This change in balance within the cell can have dire effects in that due to disruption of homeostasis, specific pathologies such as cancer, can result.
Should the definition be revised to the point where new testing criteria for each domain was formulated to contribute to the overall quantification of an individual’s health, what modes of testing would be employed? I ask this because as women, we openly accept the routine testing of mammograms after reaching a specific age as there is correlative evidence that supports early testing = early diagnosis and that women have an increased risk of developing breast cancer at a specific age. Now that personalized medicine is large and in charge and becoming more readily available for screening for the pre-disposition of specific diseases, could this mode of measurement potentially be incorporated into the diagnostic criteria upon a revised definition of health in terms of physical and mental health domains? As per the Determinants Of Health (simcoemuskokahealthstats.org) website, biology and genetic endowment is considered a domain of health.
Also would like to point out an interesting reference that a fellow classmate of mine regarding this topic is Bickenbach’s “Handbook of the Philosophy of Medicine” was: ‘the 1948 WHO ‘definition’ may never have been intended as a definition when it was released.’[4] I, myself, found this quite interesting as to me I think people just automatically accepted this statement as a gospel definition without perhaps realizing it and then applying as a means of classification criteria for determine the level of “health” of an individual. Maybe another reason why it was never “revised” after the last 60 years.
[1][1] Huber. Machteld: Health: How Should We Define It, BMJ British Medical Journal, 30 July 2011. Vol. 343, No. 7817 (30 July 20100). P. 236. [2] Obtained from AU MHST 601 notes for unit 3: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July, 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April, 1948. [3] Huber. Machteld: Health: How Should We Define It, BMJ British Medical Journal, 30 July 2011. Vol. 343, No. 7817 (30 July 20100). P. 235. [4] Athabasca University MHST 601 unit 3 forum post by Amanda Carapelluci, Feb. 6, 2020 – referenced from Bickenbach, J. (2017). WHO’s Definition of Health: Philosophical Analysis. In T. Schramme & S. Edwards (Eds), Handbook of the philosophy of Medicine (pp. 961-974). Springer. https://onlinelibrary.wiley.com/doi/full/10.1111/jep.12793
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