The World Health Organization’s (WHO) Constitution defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Constitution of WHO). Established shortly after the end of World War II in 1948, this definition has not changed for seventy years. While acknowledging the multifaceted nature of health, its use of the term “complete” make it challenging to see this definition as helpful or relevant to today. Criticisms of the WHO’s definition include that it medicalizes society, does not reflect advances in healthcare for those aging with chronic disease, and poses problems for application and measurement (Huber).
When one uses the term “complete” it implies that anything less than a perfection in any one of these areas is a perpetual state of unhealthy (Jadad). In turn, this supports the advancements of pre-illness technologies. While this might increase detection of illness in a few individuals, it subjects large numbers of the population to testing where the risks may outweigh the benefits (Huber). This is a concept that percolates into all areas of healthcare, including obstetrics. As advancements were made in fetal monitoring, one the goals became to reduce the number of cases of Cerebral Palsy (CP). Over time, it evolved that electronic continuous fetal monitoring (EFM) became the standard of care for all labouring women, regardless of identified risk factors.. As with any testing, EFM has a predetermined sensitivity and specificity. The consequence of the universal application of EFM, was the increase in emergent cesarean delivery of many “well” babies who were at low risk of CP. The functionality of “complete” health in terms of fetal wellbeing meant assuming the risks of cesarean delivery. In current practice the recommendation is for EFM in cases with increased risk of issues with maternal-placental perfusion. Intermittent Auscultation is the standard for all others.
Current definitions of health attempt to shift thinking by addressing some of the concerns illustrated by Huber. The Ottawa Charter states that in order for an individual to fulfill the definition set out by the WHO they must also “be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment” (Ottawa Charter). This reinforces the individuals role within their own health, and focuses on resources and capabilities (Ottawa Charter). This definition varies from the WHO, because it allows individuals who are not “complete” to still experience health. Similarly, the Health Council of Netherlands acknowledges that health should be viewed as a “balance or equilibrium of different aspects, homeostasis, allostasis, resilience, and it should also be related to age” (Report Invitational Conference). I feel this more adequately represents individuals aging with chronic illness, and creates provisions for measurable components.
The WHO definition from 1948 may persist, but the discussion around this definition challenges us to thinking critically about how the language we use at an organizational level impacts the daily care of patients, and our societal view of health. As we search for more dynamic definitions, we acknowledge that health is an ever evolving concept that reflects the impacts of applied technology, the changes in our aging populations, and the need for more tools to adequately measure #whatishealth.
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)
Health Council of the Netherlands. (2010). Report Invitational Conference ‘Is health a state or an ability? Towards a dynamic concept of health’ (Publication No. A10/04E). The Hague: Health Council of the Netherlands. https://www.gezondheidsraad.nl/en/task-and-procedure/areas-of-activity/prevention/report-invitational-conference-is-health-a-state-or
Huber, M. (2011). Health: How should we define it? British Medical Journal, 343,(7817), 235-237. https://doi.org/10.1136/bmj.d4163 (link http://www.jstor.org/stable/23051314)
International Conference on Health Promotion. (1986). Ottawa Charter for Health Promotion(Publication). Public Health Agency of Canada. https://www.canada.ca/en/public-health/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion.html
Jadad AR, O’Grady L. (2008). How should health be defined. British Medical Journal, 337 (a2900).
World Health Organization. (2016, September 01). Constitution of WHO: Principles. Retrieved from http://www.who.int/about/mission/en/