1.2 What is health?
What do the words ‘health’ and ‘healthy’ mean or imply? Superficially this seems a fairly straightforward question: for example, you may recognise that a house plant does not look too healthy. Does this mean it is diseased or is going to die, or that it requires some attention?
When applied to humans the term ‘healthy’ is often associated with a variety of other, more elaborate concepts. For example, it may mean that a person looks ‘well’, as a result of being fit (doing regular exercise), or feeling content with life (being emotionally robust). Older people with mobility difficulties may have different perspectives of ‘healthy’, compared with an athlete or a young person struggling to make ends meet. Health is a subjective determination – in other words, your own definition of health depends on your cultural background, personal aspirations, physical and mental condition, and situation in life. As life is a course and not static, these aspects fluctuate and the meaning of ‘health’ is constantly reassessed and re-formed.
Activity 1: Defining health
In 1946 the World Health Organization (WHO) proposed the following definition of health:
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
Consider this definition of health and then answer the following questions.
Do you think this is a useful definition?
Does this definition provide a useful framework for how you think about your own health?
In what ways does the WHO definition tally with and/or contrast with your beliefs about your own health?
You might disagree with the WHO's definition and view health as being the absence of disease; or you may believe health includes emotional and spiritual wellbeing, social functioning, satisfaction, and work/life balance. According to the WHO definition, very few people would describe themselves as completely healthy. It represents an ideal state, and you might not expect to achieve this level of optimum functioning all the time. You probably recognise that most people experience fluctuating levels of health and do not necessarily seek professional help for every episode of illness. You may have considered whether you view health as your responsibility and whether you attempt to self-manage health issues. Certainly, the WHO definition of health seems to envisage an aspirational level of health that goes beyond what the National Health Service (NHS) provides treatment for.
Despite the practical and resource implications of the WHO definition, its vision of health is still valuable, capturing a broader understanding that many people experience about their own health: namely, health is a holistic notion that goes far beyond reductionist explanations of disease. However, this definition has limitations, particularly in relation to measuring health outcomes (Bowling, 1991). To date, health indicators have been primarily mortality and morbidity rates, rates of health service uptake, and subjective indicators, which might include self-reported or collected data about behaviour (such as consulting CAM practitioners, or lifestyle indicators such as smoking). Collecting such data is fraught with difficulties, as health may be seen at one end of the spectrum and death at the other (Bowling, 1991). It is important to note that there is no universal agreement about the meaning of the terms ‘health’, ‘illness’ and ‘disease’ and that these terms are contested (see Helman, 2001). For the purposes of this extract, illness is the subjective state – the behavioural response to which may be noticed by other people – whereas disease is the pathological condition identified by biomedical strategies (the ‘clinical gaze’) or technology such as blood tests.