The World Health Organization (WHO) constitution, which came into force in 1948, defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

This definition was expanded in 1986 as “To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realise aspirations, to satisfy needs and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities.” But not many in the medical fraternity took to this depiction of health. The earlier definition therefore continues to be widely used even today.

But since 1948 when the definition of health came into being, global health has undergone a transformation. Disease patterns have changed. Our ability to diagnose and manage diseases has improved. Complications can be avoided or delayed. Public awareness about health and disease has increased. Many potentially life-threatening communicable diseases are now prevented by immunization. Life expectancy has increased and consequently the number of people living with a noncommunicable disease (NCD) has increased. This is the age of personalised medicine, also called precision medicine.

We have become less insular as far as health is concerned. In the past few years, the concept of “One health” has been gradually making inroads into the way we perceive health. It is an acknowledgement that the health of people, animals, plants and the environment are interdependent, a fact that has been emphatically brought home to us by the ongoing pandemic.

While the WHO incorporates the dimensions of mental and social well-being, as per the definition being healthy requires having no disease.

There has been criticism that this definition has failed to adapt to the changed scenario and hence it is time for a change to make it more relevant to the present times.

We have attempted to modify the WHO definition of health and at the same time tried to retain its essence. We came up with the following version: “Health is a sustainable state of optimized physical, mental and social wellbeing, and not merely the absence of acute disease or infirmity.”¹

The word “complete” in the original definition seems utopian and has a chimeral hint to it. In its place, we have used the word “sustainable” meaning “a situation which can be maintained, or defended, at a certain rate or level”. Simply put, this alludes to long-term maintenance of health.

While everyone is entitled to healthcare, not everybody has access to healthcare. Resources are scarce in many parts of the world, which have an impact on the quality of healthcare delivered. Hence, the use of the word “optimization” in our definition, which implies “best or most effective use of a situation or resources”.

A well-controlled disease, through interventions such as lifestyle modification, drugs and devices, allows an individual to lead an active and healthy life, the disease notwithstanding.

Also, health cannot be only assessed at any one given point of time as the health needs of a person keep on changing during the lifetime. Therefore, our definition allows for people living with a disease condition and “suggests that health is a dynamic, long-term process as well as goal, instead of a static point-of-contact definition.” It also takes into consideration the inequities in health.

What do you think about this new definition of health?

Reference

1. Kalra S, Arora V, Verma M, Kumar V. A novel definition of health: Crafting a contemporary classic. J Pak Med Assoc. 2021 November;71(11):2490-1.

Authors

Dr Sanjay Kalra, DM (AIIMS); President-elect, SAFES, Bharti Hospital, Karnal, India 

Dr Varun Arora, Department of Community Medicine, Pt BDS PGIMS, Rohtak, India;

Dr Madhur Verma, Department of Family Medicine and Community Medicine, AIIMS, Bathinda, India;

Dr Vijay Kumar, Department of Geriatric Medicine, AIIMS, New Delhi, India.