Evolving Concepts of Health

by James Snow, M.A., RH(AHG), Dean of Academic Affairs

In striving to be healthy, have you ever stopped to wonder what “health” means? Perhaps you are familiar with the definition put forth by the World Health Organization (WHO) over 70 years ago, “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO, 2006). This landmark definition shifted the focus away from health as something solely in the physical domain, and defined it as something positive and not just a lack of illness. However, much has changed in the world since this definition was conceived. More recently, Dr. Machteld Huber and a multidisciplinary set of experts proposed a new concept of health as “the ability to adapt and to self manage” in social, physical, and mental domains (Huber et al., 2011). This concept of health expands upon the WHO definition by acknowledging that people with chronic disease can still be healthy. The emphasis is removed from “complete” or perfect health and is instead placed on the ability to navigate through life’s inevitable challenges.

In further work, Huber and colleagues conducted individual, mini-group, and focus group interviews to explore concepts of health with stakeholders such as healthcare providers, public health professionals, patients, the general public, and policy makers (Huber et al., 2016). Participants were asked what they considered to be key indicators of health. The researchers categorized the responses into six broad domains and 32 specific aspects of health:

Perhaps not surprisingly, the value assigned to each domain varied by stakeholder group. Patients valued all domains relatively equally, while physicians emphasized bodily functions and quality of life as the most important domains. Living with chronic disease reoriented participants away from an emphasis on bodily functions and towards the spirituality/existential dimension as a key component of health. These results suggest that stakeholder role and life experience influence personal concepts of what it is to be healthy.

Which of the above domains do you emphasize when assessing your own state of health? Do you value all these domains or just some of them? When thinking about the domains that matter most to you, what do you consider to be the primary indicators that inform you about your state of health in that domain?

Reflecting on your own key domains and the associated indicators of health may help you to evaluate your health throughout life. Which domain or combination of domains do you want to support right now? Take a moment to identify one thing that you can do today to support your health in that area.

References

Huber, M., Knottnerus, J. A., Green, L., van der Horst, H., Jadad, A. R., Kromhout, D., … & Schnabel, P. (2011). How should we define health? BMJ, 343, d4163.

Huber, M., van Vliet, M., Giezenberg, M., Winkens, B., Heerkens, Y., Dagnelie, P. C., & Knottnerus, J. A. (2016). Towards a ‘patient-centred’ operationalisation of the new dynamic concept of health: a mixed methods study. BMJ open, 6(1), e010091. doi:10.1136/bmjopen-2015-010091

WHO. (2006). 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. Retrieved from https://www.who.int/governance/eb/who_constitution_en.pdf.