Defining health isn’t as easy as you might think. An article in the BMJ before Christmas raised the issue again and amongst the responses they received this one particularly appealed to me.
The definition of health is important. There is a biomedical component to health, but it exists in a setting that includes biological, personal, relational, social, and political factors. For too long, we as doctors have been timid about defining health, and mostly operated at the level of “absence of disease.” For too long, we as a society have allowed politicians to get away with shunting health off to a “medical domain,” thus avoiding focus on the large scale social and political forces that create health and illness. We need to rediscover the force of Virchow’s statement: “Medicine is a social science and politics is nothing but medicine on a grand scale.” In my essay I propose: “Health is best seen as an ongoing outcome from the continuing processes of living life well. Living life well would be defined in terms of wealth, relationships, coherence, fitness, and adaptability. Disease avoidance would be a minor part of this view of health.” Such a definition is a political statement, informed by my knowledge of medicine and its social context. I believe that achievement of health should be a goal of public policy and that we should want to achieve healthy individuals in a healthy society. I see health as being a moral and practical good in itself, as well as a means towards other ends. If health is to mean anything it has to include ideas of human flourishing and abundance. As a doctor I need an aim, and a context, for my practice of medicine that goes beyond treatment of illness, important though that is.
This was a published as a letter from GP, Dr Peter Davies, in the BMJ. I enjoyed everything he had to say, but I especially agree with the sentiment that health is a process and that “Disease avoidance would be a minor part of this view of health”. Not only disease avoidance but death avoidance, I argue! But what really caught my attention was “If health is to mean anything it has to include ideas of human flourishing and abundance.” Couldn’t agree more!
