In 1948, the World Health Organization (WHO) proclaimed the definition of health as “a state complete, physical, mental, and social well being and not merely the absence of disease or infirmity” (WHO, 1948). This definition is antiquated and irrelevant now as this it has not been amended in well over 70 years. This definition does not recognize or appreciate the changes over time with regards to health and wellness of Canadian and global citizens. One of the most notable criticisms of this definition is the “absoluteness of the word ‘complete’ – in relation to wellbeing”. (Huber, 2011). Such a harsh and slim of criteria to fall under, it should come as no surprise, that it is nearly impossible to achieve the WHO’s definition of health as a population; as it would be very difficult, and many of us would be considered unhealthy (Huber, 2011), particularly if we have a chronic illness or comorbidities. To purport this definition of health as absolute, is to diminish “the role of the human capacity to cope autonomously with life’s ever changing physical, emotional, and social challenges and to function with fulfillment and a feeling of well being with a chronic ailment” (Huber, 2011).
Not even one of us is without an aspect in our physical, mental, and social well being which could be better or improved upon. Speaking for myself, I developed some physical health concerns while I was pregnant with my daughter, some of which have continued. I also have pre-existing mental health challenges. Still, I now live with several chronic illnesses, but feel fulfilled and a sense of well being. However, I would be considered unhealthy, under the WHO’s current definition of health.
There is a call to redefine health and to make it a more realistic and objective measurement to work towards, and in the capacity of the individual to achieve a state of well being and health, as defined by themselves. It has been suggested that a more modern definition of health could include “the ability to adapt and self manage in the face of social, physical, and emotional challenges” (Godlee, 2011), and I would even go so far as to say that this definition must include mental health because mental health is health (Centre for Addiction and Mental Health (CAMH), 2021).
Moreover, we know that in Canada, 1 in 5 people will experience a mental health challenge in any given year (CAMH, 2021). For “good mental health is a state of well being that allows the individual to cope with the normal stresses of life and function productivity” (Fusar-Poli, Salazar de Pablo, De Micheli, Neiman, Correll, Kessing, Pfennig, Bechdolf, Borgwardt, Arango, & van Amelsvoort, 2020). Citing that health is flexible and adaptable, and capable of change. Health, therefore, should be considered functional, as “healthy citizens make for a healthy society”, and that there is are “tangible links between social factors and determinants of individual health” (Bradley, Goetz, & Viswanathan, 2018). These social factors and determinants must be carefully examined and addressed, where the “emphasis on the underlying psychosocial components of behaviour, environmental architecture, and societal polices that shape the links between poverty, literacy, and health” (Bradley et al., 2018).
French physician, Georges Canguilhem, in his 1943 book, The Normal and the Pathological, viewed health as the “ability to adapt to one’s environment. Health is not a fixed entity. It varies for every individual, depending on their circumstances” (Lancet, 2009). With that flexibility in mind, an even more contemporary definition of health should acknowledge that chronic illness/disease “can and often do co-exist with health” (Bradley et al., 2018). To go a step further, a dynamic new definition of health should include the “integration of body, mind, and spirit and recognizes the significant influence of sociologic, environmental, and behavioural factors” which placate “the demands of a life commensurate with age, culture, and personal responsibility” (Bircher, 2005).
In discussion with my peers this week, I learned that similar sentiments were shared amongst us all. The fluidity and adaptability towards health requires an individualized approach and one that meets our clients where they are currently in their journey on the way to health, or in the maintenance of health (Caylee, 2021). It was agreed upon that the notion of health is highly subjective and a matter of perspective. No two people will ever have the same lived experiences or view health in the same way, and to assume that the WHO’s definition of health is this ubiquitous feat for us to futility try to attain, we must instead view health as “an investment in a way, the more that we invest in each other and encourage positive health lifestyles, the more likely surrounding society will be improved” (Jillian, 2021).
Undeniably, COVID has been a detriment to individuals seeking access to primary care. Often, appointments are conducted over the phone, or through video (Jessica, 2021). And this is a failing in providing client-centred care, especially during this unprecedented time. My peer, Jessica shared that she sees patients who have not received medical attention due to the fear of contracting COVID.
Another theme that I noticed taking shape throughout discussions in response to my post, included the importance of including mental health in the modern definition of health (Caroline, 2021). My personal experience with mental health challenges, has been that there is a lot of shame, which I believe stems directly from a lack of health literacy, and judgement.
Another peer, Emily asserts that early childhood development is the most influential social determinant of health as “experiences in early childhood development play such an important role in shaping our lives” (Emily, 2021), as these early formative years are greatly needed in order to build a strong foundation from which we all grow and thrive or curtail in health.
Georges Canguilhem’s statement that “health is not a fixed entity” (Lancet, 2009), and my peer Draya, affirms that Canguilhem’s viewpoint on health is important as it “encompasses the notion that health is multifaceted and unique to each individual” (Draya, 2021). In summary, health remains both ubiquitous and an elusive notion to try to pin down. What is flexible, however, is our innate human ability to adapt to their everchanging environment. Where health and illness intersect, is at the very center in which an individual's
perceived and uniquely defined definition of their own health, and their illness or chronic ailment cross paths. It is possible to live healthily and well even with a chronic disease.
References
Bircher, J. (2005). Towards a Dynamic Definition of Health and Disease. Medicine, Health Care and Philosophy, 8(3), 335–341. https://doi.org/10.1007/s11019-005-0538-y
Bradley, K. L., Goetz, T., & Viswanathan, S. (2018). Toward a Contemporary Definition of Health. Military Medicine, 183(suppl_3), 204–207. https://doi.org/10.1093/milmed/usy213
Brüssow, H. (2013). What is health? Microbial Biotechnology, 6(4), 341–348. https://doi.org/10.1111/1751-7915.12063
Centre for Addiction and Mental Health CAMH. (n.d.). Mental Health is Health. CAMH. From https://www.camh.ca/en/driving-change/mental-health-is-health
Fusar-Poli, P., Salazar de Pablo, G., De Micheli, A., Nieman, D. H., Correll, C. U., Kessing, L.V., Pfennig, A., Bechdolf, A., Borgwardt, S., Arango, C., & van Amelsvoort, T. (2020). What is good mental health? A scoping review. European Neuropsychopharmacology, 31, 33–46. https://doi.org/10.1016/j.euroneuro.2019.12.105
Godlee, F. (2011). What is health? BMJ, 343(jul27 2), d4817–d4817. https://doi.org/10.1136/bmj.d4817
Public Health Agency of Canada (PHAC). (2012). Measuring Positive Mental Health in Canada: Myths and Facts. From https://www.canada.ca/content/dam/hc-sc/healthy-canadians/migration/publications/healthy-living-vie-saine/myths-facts-mental-health-2016-mythes-realites-sante-mentale/alt/pub-eng.pdf
The Lancet. (2009). What is health? The ability to adapt. The Lancet, 373(9666), 781. https://doi.org/10.1016/S0140-6736(09)60456-6
World Health Organization (WHO) (n.d.). Constitution of the World Health Organization Principles. From https://www.who.int/about/who-we-are/constitution
photo by: Flo Baz
Comments