Discussions on the World Health Organizations definition of the word "health" and how it can be adapted to meet the needs of today's healthcare systems.
The World Health Organization (WHO) defined health in 1948 as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” and although amended, the definition has not changed since that time. Since then the complexities of health care in the Canada have expanded and our societal knowledge of global health has become increasingly prevalent. For these reasons it has become essential for those involved in providing healthcare to reconsider what we consider the definition of health to be. By incorporating the concepts of potential and systemic support proposed by Bircher (2005) and Badash et al (2017) respectively, a more comprehensive definition of health can be considered.
The Government of Canada uses the WHO definition of health as a platform but expands their definition to include the notion that “an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment” (Government of Canada, 2008). This expansion of ideas to include a focus on social well being and aspirations of health is in line with a theory proposed by Bircher (2005). His theory defines health as
“a dynamic state of wellbeing characterized by a physical,
mental and social potential which satisfies the demands of
a life commensurate with age, culture and personal responsibility.
If the potential is insufficient to satisfy these demands the
state is disease” (Bircher, 2005)
Bircher uses the term potential to define the opportunities for health in the future, in the same way that the Government of Canada includes the concept of an individual’s aspirations in its definition of health. Potential is further defined as having 2 separate components; the biological competent that is comprised of a person’s genetic makeup which is unchangeable and acquired potential that is developed physically, socially and spiritually as we age (Bircher, 2005). The third element that Bircher proposes effects health are the demands of life (2005). As stated in his theory, when the demands (physically, socially, spiritually, socially or financially) exceed a person’s potential (biologically or acquired) to cope, the state which a person is in is disease (Bircher, 2005). By including this concept of potential into the definition of health, it highlights the importance of social and preventative medicine and could ultimately save healthcare dollars by limiting care to those who truly need it (Bircher, 2005). The WHO definition of health considers “complete physical, mental and social well-being” (WHO, 1948) in everyone, which seems unrealistic in terms of fiscal and material resources.
As outlined in the Canada Health Act the role of the Canadian Government in healthcare is “to protect, promote and restore the physical and mental well-being of residents of Canada” (Government of Canada, 2017). By adopting a broader definition of the term health that includes the requirement of an effective healthcare delivery system governments could further assess and manage the needs of their communities. Badash et al (2017) proposes a theory of health that can directly assist governments in meeting societal needs. The definition of health proposed by Badash et al is
“holistic state of physical, mental, emotional, and social wellness
supported by an integrated and technologically sophisticated
healthcare delivery system tailored to meet the entirety of a patient’s
medical needs, including disease prevention and management
of undesirable conditions, comorbidities, complications, and unique
patient circumstances” (2017)
This theory directly addresses the need for healthcare systems to address disease prevention and to use technology to meet needs identified by the patient (Badash et al, 2017). This theory is similar to the WHO theory that it incorporates physical, mental and social wellbeing, however it expands to include the ideas that health care be centered around the needs of the patients and prevention of illness in the future through the use of efficient and sophisticated healthcare systems (Badash et al, 2017).
In the definition of health outlined by the World Health Organization in 1948 there is no regard given to the concepts of an individual’s potential for wellbeing and growth and does not address the complex needs of modern healthcare systems. By including the concept of investment in developing acquired potential and preventing illness (Bircher, 2005) and including the concepts of technology and tailored healthcare delivery systems (Badash et al, 2017) the WHO could develop a more comprehensive definition of the word health that would be better suited for complex needs of those involved in planning healthcare in todays world.
References
Badash, I., Kleinman, N. P., Barr, S., Jang, J., Rahman, S., & Wu, B. W. (2017). Redefining Health: The Evolution of Health Ideas from Antiquity to the Era of Value-Based Care. Cureus, 9(2), e1018. http://doi.org/10.7759/cureus.1018
Bircher, J. (2005). Towards a dynamic definition of health and disease. Medicine, Health Care and Philosophy, 8(335). https://doi.org/10.1007/s11019-005-0538-y
Government of Canada. (2008). What is Health? Retrieved May 29, 2018 from https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-approach/what-is-health.html
Government of Canada. (2017). Canada Health Act. Retrieved May 29, 2018 from https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html
World Health Organization. (1948). Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948
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