Definition of Health - Is it time to move past a 1948 concept?

Card versus the World Health Organization

There are many opinions around the definition presented by the WHO in 1948. One alternate definition of health is presented by A.J Card, in his paper “Moving Beyond the WHO Definition of Health: A New Perspective for an aging World and the Emerging Era of Value-Based Care.” Card (2017) states, “Health is the experience of physical and psychological well-being. Good health and poor health do not occur as a dichotomy, but as a continuum.  The absence of disease or disability is neither sufficient nor necessary to produce a state of good health” (p.131). As compared to the WHO’s (1948) definition, “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. 

The WHO’s original definition was created to consider a comprehensive approach to health care (Schramme, 2023).  So also does Card recognize the importance of mind and body wellbeing. (Card, 2017). However, there are a few significant differences. First is the WHO supposition that a person cannot be healthy unless they are completely well, “with no disease or infirmity” (WHO, 1948).  Compared to the belief that a person can be healthy despite having a diagnosis or an impairment (Card, 2017). Card opposes that a person has to be in perfect psychological and physiological condition to be considered well.  Rather,  an individual can experience wellbeing even if they have a disability or illness (Card, 2017). This is evidenced when Card (2017) states, “the presence of some degree of disease or disability is not disqualifying”(p.131).  Overall, the experience of health is not defined by perfection, rather based on the individual's experience (Card, 2017). In addition, there is a difference in the consideration of social determinants. The WHO contends that social determinants are also important in the total view of health (Schramme, 2023; WHO 1948). Jadad & O’Grady (2008) indicate, "this definition invites nations to expand the conceptual framework of their health systems beyond the traditional boundaries set by the physical condition of individuals and their disease” (p1363).  Whereas Card considers each person may be impacted by social factors but can find ways to allow for a lived experience of health despite circumstance Card, 2017).  

Overall, the idea of holistic health is present in both definitions. However, one indicates a person must be perfect in all situations to be healthy, over the experience of health within disease or disability (Card, 2017). And finally, the social determinants are considered as an influence of Card, rather than a strict measure for the WHO.  

Why is the New Definition Helpful 

Card’s definition is helpful because it allows every person to attain regardless of their physical or mental status. By allowing the person to set realistic, attainable goals. Their own personal idea of health. Rather than a definition that makes people strive for perfection in physical, mental, and social aspects of their life. 

Other thoughts about the WHO 

Defining health by addressing individual, social, and environmental determinants: New opportunities for health care and public health. By Bircher and Kuruvilla. 

  • “It contributes to medicalization of the society, it is inadequate for chronic diseases, and it is neither operational nor measurable” (p.365) 

  • Individuals with disabilities or non-communicable and chronic conditions may subjectively feel healthy, even though by this definition they might not be considered as such” (p.365). 

Health as Complete Well-Being: The WHO Definition and Beyond. By Scramme. 

  • “An alleged confusion of health with happiness, which then purportedly leads to a form of medicalization of human life” (p.210). 

  • “I argue that a holistic concept of health is better suited for the purposes of the WHO and more generally for political and economic agendas” (p.211) 

  • “Someone who is sad, following the WHO constitution, they apparently have a justified claim to be made healthy, that is, happy, potentially by using mood-enhancing drugs or other medicalization” (p.211) 

The WHO’s definition of health: a baby to be retrieved from the bathwater? By Armitage. 

  • “The WHO’s definition of health … would render a major proportion of the world’s population unhealthy despite them feeling entirely, or at least sufficiently, well.” 

The WHO definition of ‘Health.’ By Callahan. 

  • “The cultural tendency to define all social problems, from war to crime in the streets, as “health” problems; the blurring of lines of responsibility between and among the professions, and between the medical professional and political order” (p.78) 

  • “The denial of human freedom which results when failures to achieve social well-being are defined as forms of ‘sickness” (p.78). 

  • “The WHO Constitution says that “the health of all peoples is fundamental to the attainment of peace and security…Why is this fundamental” (p.80) 

Should the Definition of Health Include a Measure of Tolerance? By Brook. 

  • “I believe it is time to expand the WHO’s definition of Health to include acceptance and tolerance” (p.6). 

  • “No community or nation should be considered healthy if hatred is pervasive” (p.6). 


The World Health Organization Needs to Reconsider its Definition of Health. By Saracci 

  • “Widening health to the psychological and the social dimension was a major advance, but although it was conceptually important, it had no direct operational value” (p.1409). 

  • “The conflict between health needs and resources has become of paramount concern, nationally and internationally. In fact, a state of complete physical, mental, and social wellbeing corresponds much more closely to happiness than to health” (p.1409). 


References


Armitage, R. (2022). The WHO;s definition of health:a baby to be retrieved from the bathwater? BJGP life. https://doi.org/10.3399/bjgp23X731841


Bircher, J., & Kuruvilla, S.(2014). Defining health by addressing individual, social, and environmental determinants:New opportunities for health care and public health. Journal of PUblic Health Policy, 25(3), 363-386.https://www.jstor.org/stable/43288035


Brook, R, H. (2018) Should the definition of health include a measure of tolerance? JAMA, 317(6), 585-586. https://doi.1001/jama.2016.14372


Callahan, D. (1973). The WHO definition of ‘Health’. The Hastings Centre Studies 1(3), 77-87. https://www.jstor.org/stable/3527467


Card, A.(2017). Moving beyond the WHO definition of health: A new perspective for an aging world and the emerging era of value based care. World Medical and Health Policy, 127-137.


Saracci, R. (1977). The world health organisation needs to reconsider its definition of health. British Medical Journal 314(7091), 1409-1410.https://wwwljstor.org/stable/25174539


Schramme, T. (2023). Health as complete well-being: The WHO definition and beyond. Public Health Ethic, 16(3) 210-218. https://doi.org/10.1093/phe/phad017


World Health Organization (1948). Definition of Health https://www.who.int/about/governance/constitution

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