Health is dynamic: Changing the Definition

“Health is the dynamic balance of physical, mental, social, and existential well-being in adapting to conditions of life and the environment.” (Krahn, 2021). This definition was put forth by the authors to redefine health, so the definition is more aligned with the challenges and realities of our world today. The previous definition of health (outlined below) accepted by the World Health Organization (WHO) does not align with these modern-day realities.  

The accepted definition of health has remained unchanged since its inception by the WHO in 1948 (Constitution, 2024). It states, “health is the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” (Constitution, 2024). This definition is met with many criticisms in today’s world.  

Huber noted that the criticisms of this definition are coming to a head, going as far as to note that “...as populations age and the pattern of illnesses changes the definition may even be counterproductive” (pg. 235, 2011). At the forefront of these criticisms is that the WHO definition aims to define a “complete” state of health, which suggests “absoluteness” (Huber, 2011). “The requirement for complete health ‘would leave most of us unhealthy most of the time” (Huber, 2011). It overlooks innovation and advancements that we have seen in the last 60 years. Huber goes on to describe,  

“New screening technologies detect abnormalities at levels that might never  cause illness and pharmaceutical companies produce drugs for ‘conditions’ not previously defined as health problems. Thresholds for intervention tend to be lowered – for example, with blood pressure, lipids, and sugar” (Huber, pp. 235- 236, 2011). 

 Health is no longer static and can no longer be considered possible simply because there is “no” disease present. Another prevailing criticism noted for the WHO’s definition of health, one can only be considered healthy in the absence of disease (Huber, pg. 234, 2011). Health needs to be considered along a continuum and factors that affect positive daily living need to be considered. In developing this definition, authors attempted to create a more balanced definition that proposed “the idea that health can exist in the presence of disease and impairment” (Krahn, 2021). Krahn et al., have gone further to explain that there are six features that comprise this proposed definition: “health is 1) dynamic, 2) continuous, 3) multidimensional, 4) distinct from limitations, 5) determined by balance and adaptation, and 6) influenced by social and other environmental factors.” (pg. 3, 2021).  

The use of this definition of “health” is important in 2024 because it is inclusive, adaptive, and more in line with the present world. Huber identified that the WHO’s definition of health, while innovative in its time, was developed when infectious disease was at the forefront of “unhealthiness” (2009). 

“In 1948, acute disease presented the main burden of chronic disease that led to early death. In that context WHO articulated a helpful ambition. Disease patterns have changed, with public health measures such as improved [overall wellness] ... The number of people living with chronic disease for decades is increasing worldwide” (pg. 236, 2011).

 We are now faced with unprecedented levels of chronic diseases, compared with infectious diseases that previously were at the forefront of medical ailments at the onset of this definition. Does having a well-managed, chronic disease mean one is unhealthy? By the WHO’s definition, this is the case.  

Through science and medical development, we have been able to extend life expectancy’s far beyond what they were in the past. My previous blogs have touched on this. We bear witness to the treatment of chronic diseases that would have previously been a death sentence. Should somebody ailed with hypertension, but has it medically controlled, not be considered healthy? Should an individual who has struggled with anxiety and depression, but manages with a combination of cognitive behavioural therapy and medication, be considered unhealthy? 

Having a more relevant definition of health could help how Canadians access health care. By having a better understanding of what is included in an overall definition of “health”, it might encourage Canadians to aim for an overall sense of wellness, however that may apply to their life. By this new definition, understanding that health can be dynamic and encompasses everything from physical to mental has a positive intonation, which may suggest to individuals that seeking help not only when you break your leg but also when you have symptoms of depressions is a possibility.  Health should be inclusive of social, spiritual, physical, emotional, and mental wellness (Dimensions of Health, 2024)

Furthermore, by changing this definition and changing the ways we access care, it may change our national and provincial funding structures. Previous blogs have alluded to the fact that key areas of our wellness, like dental and mental health, are not included in our federal and provincial coverages. Perhaps, broadening the scope of the definition and viewing it as a continuum rather than simply not having a disease could change the way our politicians fund these areas.  As Krahn et al. stated “This reconsidered definition of health is intended to stimulate discourse on how health is conceptualized and its implications for research, policy, and practice that can address health disparities ... this definition incorporated environmental factors and recognizes health as fluid across the life span with adaptation to life circumstance at its core.” (pg. 4, 2021). 

RESOURCES 

Constitution of the World Health Organization. (2024) World Health Organization. Accessed Feb 6, 2024 from https://www.who.int/about/accountability/governance/constitution 

Dimensions of health. HSC PDHPE. (2024, January 5). https://pdhpe.net/better-health-for-individuals/what-does-health-mean-to-individuals/meanings-of-health/dimensions-of-health/

Huber, M. (2011). HEALTH: HOW SHOULD WE DEFINE IT? BMJ: British Medical Journal, 343(7817), 235–237. http://www.jstor.org/stable/23051314 

Krahn, G. L., Robinson, A., Murray, et. al. (2021). It’s time to reconsider how we define health: Perspective from disability and chronic condition. Disability and Health Journal, 14(4), 101129. https://doi.org/10.1016/j.dhjo.2021.101129 

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