This week’s BMJ carries an editorial and a paper about the definition of health. The current most widely known definition is that of WHO – a state of “complete physical, mental and social wellbeing”.
The claim is that this sets the bar too high and excludes most people from health most of the time – it’s both the word “complete” and the range across physical mental and social that seems to be problematic.
I find myself agreeing with the discomfort about the WHO definition and long ago explored an alternative – you can read how I got to my working definition here.
My working definition was that health involved three capacities – adaptability, creativity and engagement. I still find that definition useful, but in recent months I’ve been using perhaps a somewhat simpler one – Vitality and Resilience.
I do think a healthy person has good vitality. Everyone seems to grasp that straight away. It hardly needs definition. However, you can consider good vitality as containing the concepts and/or experiences of, good energy, wellbeing, or having a strong “vital force”.
Without good vitality it’s hard to be resilient.
Resilience contains both the idea of coping and that of the linked phenomena of self-defence, self-repair and self-regulation.
The paper in the BMJ proposes “adaptability and self-management” as the criteria for health. I can see where they are going with this, and don’t disagree with the adaptability part, but I find “self-management” to be pretty weak. I very much prefer creativity and engagement! I think a healthy person grows and develops. A heathy person is well connected to their environment and to others. It’s a lot more than “homeostasis”.
Frankly, I’m still pretty amazed you can’t find an entry for “health” in standard textbooks of clinical medicine and that medical education doesn’t seem to teach future or current doctors how to define health, how to assess it, or how to enable patients to increase it. Medicine in the 21st century seems stuck on the old 16th century concept of the “lesion” and has it’s eye firmly on disease, not health.
Why is this important?
Well, lots of reasons really, but not least because we are pursuing the “management” of more and more chronic diseases. We don’t have a good understanding of why people get ill, we don’t have a good understanding of how people get better, and we’re only in the foothills of knowledge about health.
Until we start to train our focus and resources on health we’ll chase disease after disease, and continue to have greater and greater proportions of our populations consuming more and more drugs. That’s a path which is not affordable, and isn’t producing healthier people.
The claim is that this sets the bar too high and excludes most people from health most of the time – it’s both the word “complete” and the range across physical mental and social that seems to be problematic.
I find myself agreeing with the discomfort about the WHO definition and long ago explored an alternative – you can read how I got to my working definition here.
My working definition was that health involved three capacities – adaptability, creativity and engagement. I still find that definition useful, but in recent months I’ve been using perhaps a somewhat simpler one – Vitality and Resilience.
I do think a healthy person has good vitality. Everyone seems to grasp that straight away. It hardly needs definition. However, you can consider good vitality as containing the concepts and/or experiences of, good energy, wellbeing, or having a strong “vital force”.
Without good vitality it’s hard to be resilient.
Resilience contains both the idea of coping and that of the linked phenomena of self-defence, self-repair and self-regulation.
The paper in the BMJ proposes “adaptability and self-management” as the criteria for health. I can see where they are going with this, and don’t disagree with the adaptability part, but I find “self-management” to be pretty weak. I very much prefer creativity and engagement! I think a healthy person grows and develops. A heathy person is well connected to their environment and to others. It’s a lot more than “homeostasis”.
Frankly, I’m still pretty amazed you can’t find an entry for “health” in standard textbooks of clinical medicine and that medical education doesn’t seem to teach future or current doctors how to define health, how to assess it, or how to enable patients to increase it. Medicine in the 21st century seems stuck on the old 16th century concept of the “lesion” and has it’s eye firmly on disease, not health.
Why is this important?
Well, lots of reasons really, but not least because we are pursuing the “management” of more and more chronic diseases. We don’t have a good understanding of why people get ill, we don’t have a good understanding of how people get better, and we’re only in the foothills of knowledge about health.
Until we start to train our focus and resources on health we’ll chase disease after disease, and continue to have greater and greater proportions of our populations consuming more and more drugs. That’s a path which is not affordable, and isn’t producing healthier people.
Heroes Not Zombies 
[…] what I’m wondering. What is our working model for health care? What are we trying to achieve? Health? And if that’s our goal, how are we doing? Does this study indicate we are on the right road? […]