Is the current definition of health enough?


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When thinking about what being healthy means and how to transmit the importance of certain health practices to communities, we healthcare professionals tend to pass our ideas and concepts and transform those into health policies. We overlook that health, illness and even life are concepts with such vast, possible interpretations by different people and populations, which shapes their adherence to our strategies.

 

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Several studies have provided evidence that the way in which we interpret health may be linked to our engagement to health enhancement behaviours 1. People with a more holistic view of health tend to adopt more of these. On the other hand, individuals with a more biological insight into what being healthy means are more prone to experience a feeling of not having control and power over their own health, given the having the knowledge of inherent biological degradation and, consequently, express less adherence to healthy practices.

As such, defining health and what being healthy means to different people might be an overlooked field when developing public health measures targeting different communities or even when dealing with a specific patient.

The concept of health has evolved as we have. Ancient Greeks attributed a divine meaning and responsibility to being healthy and to develop personal habits to promote such a state 2. The first records of the word “health” in old English appear in approximately 1000 A.D. and they included, besides bodily functions, moral, ethical and spiritual wholeness.

In more recent times, three major currents of possible interpretations of the idea of health have evolved. The more traditional approach relies on a dichotomy between health and illness and stands for health merely being the absence of disease, incapacity or symptom. In contrast, on the 7th of April of 1948, in the aftermath of World War II, the World Health Organization created the now most widely accepted definition of health as “a state of complete physical, mental and social well-being” 3. This very holistic definition presents itself as a utopic and unreachable state, almost impossible to operationalise and consequently measure. It also fails to include the possibility of a harmonious co-existence with disease or disability. Despite these flaws, it remains the most recognised and quoted definition of health and represents a revolutionary moment and thought a shift in the practice of Medicine 4.

In the 1960s and 1970s, more dynamic notions of health appeared, trying to find a balance between illness, adaptation mechanisms and environment 5. Health started to be looked upon as a dimension of our human experience, regardless of the presence of disease. The real focus became one’s ability to carry out responsibilities, self-manage and live happily. For the first time, people are more than their diseases, fighting stigma and discrimination. A disease is just a part of us.

A recent study in the Netherlands tried to evaluate the acceptance of this dynamic approach by different segments of the population 1. All considered bodily functions to be very related to health. However, there was a disparity with other concepts, suggested as health indicators: mental and spiritual dimensions, quality of life, social and societal engagement within a community and daily life. Both policymakers and medical doctors put an emphasis on organic functions, while patients placed less value in the body and more in the spiritual dimension.

As healthcare professionals, when developing public health strategies we should take into account the people we are addressing. Imposing our concept of why the importance of being healthy and the behaviours to achieve such a state sometimes does not work, precisely because it is based on imposing and not listening. As a medical doctor, I also believe this is easier said than done. What should be my role as a doctor then? For us, clinicians, I believe incorporating these values might change a lot in us and in how we educate and see ourselves and healthcare. However, since it is so clear that we as individuals are so different from each other and our belief systems are not the same, why should our concepts of health and illness and the dimensions behind those be? What this study shows is, if we want to achieve more success in healthcare policies and to develop a healthcare system that is truly patient-centered and based on shared decision-making, we need to listen to patients. We might learn that a lot of the time, our mainly scientific and objective perspective is not the most important thing we can give to them and to the community we work in.

 

References:

  1. 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, no. 5. Available from: <http://bmjopen.bmj.com/content/bmjopen/6/1/e010091.full.pdf>.
  2. Tountas, Y. (2009). The historical origins of the basic concepts of health promotion and education: the role of ancient Greek philosophy and medicine. Health promotion international, 24(2).
  3. World Health Organization. Constitution of WHO principles. Available from: <http://www.who.int/about/mission/en/>.
  4. Saracci, R. (1997). The World Health Organisation needs to reconsider its definition of health. BMJ, 314(7091), 1409-10.
  5. Alonso, Y (2004). The biopsychosocial model in medical research: the evolution of the health concept over the last two decades. Patient Education and Counseling, 53(2), 239-244.

 

Margarida Paixao

Margarida Paixão is a medical doctor, currently doing an MSc in Public Health in the London School of Hygiene & Tropical Medicine. She previously worked as a Public Health resident in Portugal. She attended NOVA Medical School in Lisboa and besides her medical work, she has an interest in Human Rights.

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