Definition of Health

by

Lawrence W. Green

Introduction

The definition of health has evolved with the changing conditions of societies, with the changing technologies for identifying abnormalities at finer tissue and molecular levels and at earlier stages of disease, and with the redefinition of conditions as health problems that were previously considered within the range of normality or at least outside the realm of medicine, sickness, and health. Some refer to these drifts in the definition of health as the medicalization of everything organic and emotional that bothers people; some worry that societies are letting technology define health for them. For public health, the need exists to define health with some consensus and concreteness for the purpose of measuring the health of populations. Measuring the health of populations requires the collection of data on large numbers of people, at considerable expense, to monitor trends in population health, detect outbreaks of ill health, trace causes or sources of such outbreaks or epidemics, and to evaluate the progress and achievements of programs directed at protecting or promoting health.

General Overviews

The first recorded break from divine notions of health requiring prayers and sacrifices to the gods is variously attributed to Hippocrates or the Hippocratic School of medicine on the Mediterranean island of Cos in the centuries surrounding the Christian era. Although the name Hippocrates is more frequently associated with medicine, the approach to health associated with Hippocratic teaching had a decidedly public health emphasis on environmental sanitation, personal hygiene, and nutrition, as discussed in Üstün and Jakob 2005. Debates over the definition of health have ranged from the strictly empirical, for which the Hippocratic school of medicine is the usual touchstone, to the idealistic in World Health Organization 1948; to humanistic philosophical critiques of the pursuit of technological fixes for health in Dubos 1959; to psychological in Justice 1987, Kessener 1982, and Maslow 1968, to cultural in Airhihenbuwa 1995; to patient self-determination and autonomy as central values in defining health for practitioners in Young and Hayes 2002; to sociopolitical national policy debates in O’Neill, et al. 2007.

• Airhihenbuwa, Collins. 1995. Health and culture: Beyond the Western paradigm. Thousand Oaks, CA: SAGE.

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  Extends the postmodern, postcolonial, feminist, and anthropological discourses and theories on health to an examination of health as “cultural production.” Rather than Western social scientists speaking about and for people of other cultures, it incorporates the voices of those cultures. Religion, magic, and superstition and their resulting concepts of health are based in rationality that can best be understood from the locally interpreted historical experience of those cultures.

• Dubos, René. 1959. Mirage of health. New York: Harper & Row.

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  In his humanist challenge to the technological view that health can be achieved by technological means or by individuals acting alone, Dubos defines health as “the expression of the extent to which the individual and the social body maintain in readiness the resources required to meet the exigencies of the future.”

• Justice, Blair. 1987. Who gets sick: Thinking and health. Houston, TX: Peak Press.

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  One of the first books to compile and weave together the varied influences of pessimistic thinking, love, faith, attitudes, beliefs, moods, feelings of helplessness, social ties, and thoughts on health, thereby redefining the scope of definitions of health in the growing tradition of mind-body relationships. Chapter titles include “Germs and Stress,” “Neurotransmitters,” “Coping,” “Vulnerability,” and “Self-repair.”

• Kessener, A. W. 1982. Gezondheidszorg, fictie of realiteit? Medisch Contact 37:335–338.

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  This paper on “Health Care: Fiction or Reality” staked out the more extreme nonmedical position that personal perception of well-being should be what defines health, not biological opposites or absences of disease or disability. If people perceive themselves as healthy, they can be said to be healthy.

• Maslow, Abraham H. 1968. Towards a psychology of being. New York: Van Nostrand Reinhold.

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  Maslow’s hierarchy of individual needs has been widely used as a way of interpreting the World Health Organization’s definition of health as a state of physical, social, and mental wellbeing. His hierarchy posits physiological needs such as thirst, food, and rest as the base of a pyramid of motivation to satisfy physical needs, followed by safety needs, then love needs, then esteem needs, and finally self-actualization needs.

• O’Neill, Michael, Ann Pederson, Sophie Dupéré, and Irving Rootman. 2007. Health promotion in Canada: Critical Perspectives. 2d ed. Toronto: Canadian Scholars’ Press.

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  Canada provides a national case study in the rise and decline of health promotion as a rallying point for social and political perspectives on a “new public health.” Following Canada’s landmark Lalonde report and the International Ottawa Charter on Health Promotion, which became global touchstones, health promotion has struggled nationally. This book examines Canada’s national struggle and international influence. Also available in French: La promotion de la santé au Canada et au Québec: perspectives critiques (Quebec: Presses de l’Université Laval).

• Üstün B., and R. Jakob. 2005. Calling a spade a spade: meaningful definitions of health conditions. Bulletin of the World Health Organization 83:802.

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  This review of the debates on re-defining health casts a historical perspective on the still prevailing divine notions of health in the world religions and the struggle within health and social sciences to come to a more humanistic and adaptable definition that takes into account variations dependent on age, culture, and the balancing of personal and community responsibility.

• World Health Organization. 1948. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946 and entered into force on 7 April 1948. Geneva: World Health Organization.

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  The first lines of the Preamble declare, “in conformity with the Charter of the United Nations, that . . . [h]ealth is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition has become a lightning rod for academic and political debate over the past half century.

• Young, Lynne E., and Virginia Hayes. 2002. Transforming health promotion practice: Concepts, issues, and applications. Philadelphia: F. A. Davis.

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  Directed particularly at health promotion practiced in nursing, this book takes a postmodern approach to the broader need, in the authors’ and some of the contributors’ views, for an interdisciplinary approach to health that increases patients’ or clients’ control over their health and their lives.