MHST 601: Contemporary criticisms of the World Health Organization's definition of health

Origins of the current definition

In 1948, the World Health Organization (WHO) defined health as a state of "complete physical, mental and social well-being and not merely the absence of disease or infirmity.” At the time, the definition was considered revolutionary, as it introduced progressive “public health ideas about social and socialized’ medicine” (Larson, 2022). Although several iterations have emerged since 1948, the WHO definition remains prominent in literature and continues to guide global healthcare practices, and service delivery.

Under the current WHO definition of health, an individual who is not completely physically, mentally or socially well, may be deemed as ‘unhealthy,’ even though they are symptom free and feel good for the majority of the time (Huber, 2011). For instance, if a person is living with a chronic illness such as asthma, but they successfully manage their illness with medication and positive lifestyle choices, is it accurate or fair to classify them as unhealthy? The current definition does not take this into account.

Is complete well-being a realistic goal?

Advancements in medicines, the rise in “global life expectancy” and the decline in child mortality rates means there are “more people living well with chronic conditions” especially older adults. The WHO definition inadvertently presents unrealistic expectations for older adults, or categorically excludes them from frameworks of health (Fallon & Karlawish, 2019).

Huber (2011) goes on to argue that the "absoluteness of complete wellbeing” may also lead to the the population care becoming over-medicalized by health care systems that work to remove symptoms, to move people into states of physical and mental completeness with pharmaceuticals, without addressing underlying factors that may be causing the symptoms in the first place (e.g. smoking, poor diet). This approach can lead to medical dependencies within the population and reduce an individual's ability to modify and manage their changing health status; attributes that are not present within the current WHO definition.

Time for a change

With these criticisms in mind, I believe the WHO definition of health; albeit innovative in the 1940’s, should be updated to align with global population changes, modern health promotion strategies and people’s ability to holistically manage and regulate their own health.

References

Brook. R. H. (2017). Should the definition of health include a measure of tolerance? JAMA, 317 (6), 585-586. doi:10.1001/jama.2016.14372 (link https://0-jamanetwork-com.aupac.lib.athabascau.ca/journals/jama/fullarticle/2601506)

Definition of HEALTH. (n.d.). Merriam-webster.com. Retrieved October 9, 2023, from https://www.merriam-webster.com/dictionary/health

Felman, A. (2020, April 20). What is health?: Defining and preserving good health. Medicalnewstoday.com. https://www.medicalnewstoday.com/articles/150999

Huber, M. (2011). Health: How should we define it? British Medical Journal (Clinical Research Ed.), 343(7817), 235–237. http://www.jstor.org/stable/23051314

Institute of Medicine (US) Committee on Using Performance Monitoring to Improve Community Health, Durch, J. S., Bailey, L. A., & Stoto, M. A. (1997). Understanding health and its determinants. National Academies Press

Larsen, L. T. (2022). Not merely the absence of disease: A genealogy of the WHO’s positive health definition. History of the Human Sciences, 35(1), 111–131. https://doi.org/10.1177/0952695121995355

Saadati, F., & Nadrian, H. (2023). “Health promotion governance”: A framework for operationalizing the Ottawa charter mechanisms in health system governance. World Medical & Health Policy. https://doi.org/10.1002/wmh3.583