A critical question for doctors: What is health?

Recently I went to a physician and left pondering the question: “What is health anyway?”

This is an interesting question, especially one for a doctor to ask.

But it’s important because if we don’t know what health is, how do we know if we’ve got it? If we don’t know what health is, how do we know we’ve improved?

As a doctor and medical writer, I’m finding it more and more difficult to write about health without really being able to say what it is and how you know if you have it. I’ve been looking for a way to see health differently – if for no other reason than to better empower people in managing their own health.

So more than an interesting question for a doctor to ask, it’s a critical question for a doctor to ask. But it’s not as easy to answer as it looks.

What does health mean to you?

Take a moment to think about what health means to you, and how you might define it to someone else.

Tricky isn’t it? Because, somehow, whatever words we use don’t quite capture the whole concept that we have in our heads.

We might think that health is something we feel. Right now I feel healthy. I feel great. But despite this, the doctor wan’t quite so enthusiastic after considering my age and the things doctors like to look at. Yes I know I need to lose some weight, eat better, exercise more.

But all these things must be done for problems I might have in the future. I have no illnesses now, but I do have some risk factors now. Does that make me unhealthy? Or does it mean I’m healthy but I’ve made some unhealthy choices recently that can be improved with a small turn back towards healthier choices?

And what about the people who persistently make unhealthy choices, yet all their numbers proclaim health? What about them I wonder: Are they healthy or not? Or maybe they are just lucky for now.

Or we might think being healthy means not having any diseases, or illnesses. So that would mean people who have a chronic condition like diabetes, depression or asthma must be unhealthy? After all people with a chronic condition have a disease that they will usually have for life that needs long-term treatment or medication.

But for many illnesses it’s now possible to manage it in the long-term to the point where a person lives their life around their condition. They function well, have meaning in life and can achieve many wonderful things. So maybe people with a chronic disease are healthier than we think?

What do the experts say?

The experts, of course, have a lot to say about health. The most widely used definition of health is the World Health Organization definition from 1948: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

While there are some really great points about this, in thinking of health as bigger than the absence of disease, it is static and inflexible. It’s health as a noun: something we have, or something we don’t have. And who really has complete physical, mental and social well-being on a permanent basis? Surely physical, mental and social well-being are more fluid that states we move in and out of, from day-to-day and week-to-week?

The Ottawa Charter for Health Promotion attempted to address this in 1986 saying: Health is a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.

I love that this thinks about why we want health in first place, or what health allows us to do. Health allows us to live our lives, function the way we want and pursue our dreams. So it gives health meaning beyond the idolization of health for its own sake. But it is still a noun, and still static. It still doesn’t allow us to say who is healthy beyond the default that we must have health if we are living the way we want to.

Active health

I have been thinking for a while that it might be better to think about health as a verb, rather than as a noun. As something active and dynamic as a mindset rather than as state of being. It’s kind of anti-logical yet it makes sense to me in my quest to empower people to turn towards health, because it is solution-focused and something you do rather than something you are or have.

So I was really excited to come across a paper from a conference of international health experts in 2011 who proposed a formulation, or paradigm, that sees health as, “dynamic … [and] based on the resilience or capacity to cope and maintain and restore one’s integrity, equilibrium, and sense of well-being … the ability to adapt and to self manage.”

“The ability to adapt and to self manage” was like music to my ears. Suddenly here was a view of health that holds within it concepts from positive psychology like hope, optimism, agency and self-efficacy. Suddenly here was a picture of active health, that is available to choose by anyone at anytime in whatever illness or chronic condition they face, and in whatever domain is required – physical, mental or social.

Like all concepts this one has inadequacies, but it moves us well past the static view of health as something you have or not, and allows us to think of health as something we can move towards. And that I find empowering and compelling … and hopefully useful.

Jocelyn Lowinger is a physician in Australia who blogs at Snap: Connect: Inspire.  She can be reached on Twitter @DrJoLow.

Comments are moderated before they are published. Please read the comment policy.

  • Kristy Sokoloski

    This was an excellent article. I also think it’s a question that patients and the rest of the public in general need to ask themselves as well. Because what patients and the public in general define “health” to be is different from the way that doctors define the same word.

  • buzzkillerjsmith

    It’s really not that critical of a question because it is so easy to answer. Health is the absence of disease. The WHOs 1948 definition is garbage, known to be so.

    Next case.