Definition of health includes social well-being

by Emily P. Walker

I was covering an FDA tobacco meeting a while back when I heard a Howard Koh, MD, assistant secretary of health at the Department of Health and Human Services (HHS) start his speech with the World Health Organization’s definition of health.

“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

That was the first time I’d heard the definition, and I immediately decided I liked it.

Health is what is, rather than what is not.

I know many people who would consider themselves healthy because they don’t have a disease or obvious illness (in many cases, these people are young, and the effects of a sedentary lifestyle have yet to catch up with them).

And Dr. Koh’s statement was particularly relevant at a meeting on tobacco because many younger smokers have no clear health ailments, but obviously are not living a “healthy” lifestyle by choosing to inhale a substance that causes lung cancer and a litany of other diseases.

Personally, if I’m having a week where I’m not moving around much, have missed my workouts, consumed an embarrassing amount of cheese, and a slightly less embarrassing amount of wine and whiskey, I do not feel healthy even though I have no clear “disease or infirmity.”

I also like the WHO definition for its inclusion of “social” health as a key component of overall health, because it promotes a well-rounded lifestyle. Also, there has been some evidence that shows elderly people might delay cognitive decline by being socially engaged.

Including “social” struck me as very progressive, so I was surprised when I looked at the WHO’s website and learned that the group has had the same definition for health since it was established in 1948.

Upon a bit of further research, I discovered not everyone is as pleased with WHO’s definition as I am.

In a 1997 article in the British Medical Journal, Rodolfo Saracci of the National Research Council in Pisa, Italy argued that the WHO’s definition, while inspirational, is not practical and that it “corresponds much more closely to happiness than to health.”

He shared an example illustrating that health and happiness may not always go hand-in-hand.

“Sigmund Freud, an appropriate reference in psychological matters, saw it clearly when, after stopping smoking cigars for health reasons, he wrote: ‘I learned that health was to be had at a certain cost. … Thus I am now better than I was, but not happier.'” Saracci wrote.

(A particularly apt example for its relation to the FDA’s new authority over regulating tobacco products aimed at improving the health of Americans).

Happiness is strictly subjective, Saracci argues, and is not necessarily linked to health.

I see his point, and agree that the WHO definition of health could also double as a definition for “happiness.”

But with so many government agencies and health groups offering hyper-clinical guidelines and definitions, I kind of like a simple, somewhat existential, definition that promotes happiness as an integral part of health.

Emily Walker is a MedPage Today Washington Correspondent  and blogs at In Other Words, the MedPage Today staff blog.

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