How should we define health?
How should we define health?
The WHO definition of health as complete wellbeing is no longer fit for purpose given the rise of chronic disease. Machteld Huber and colleagues propose changing the emphasis towards the ability to adapt and self manage in the face of social, physical, and emotional challenges Machteld Huber senior researcher1, J André Knottnerus president, Scientific Council for Government Policy 2, Lawrence Green editor in chief, Oxford Bibliographies Online—public health 3, Henriëtte van der Horst head 4, Alejandro R Jadad professor5, Daan Kromhout vice president, Health Council of the Netherlands 6, Brian Leonard professor 7, Kate Lorig professor 8, Maria Isabel Loureiro coordinator for health promotion and protection9, Jos W M van der Meer professor10, Paul Schnabel director 11, Richard Smith director 12, Chris van Weel head 13, Henk Smid director 14
1Louis Bolk Institute, Department of Healthcare and Nutrition, Hoofdstraat 24, NL-3972 LA Driebergen, Netherlands; 2Department of General Practice, Maastricht University, Scientific Council for Government Policy, Postbus 20004, NL-2500 EA The Hague, Netherlands; 3Department of Epidemiology and Biostatistics, School of Medicine, University of California at San Francisco, USA; 4Department of General Practice, VU Medical Center, Amsterdam, Netherlands; 5Centre for Global eHealth Innovation, Toronto General Hospital, Toronto, Canada; 6Department of Public Health Research, Wageningen University, The Hague, Netherlands; 7Pharmacology Department, National University of Ireland, Galway, Ireland; 8Stanford Patient Education Research Center, Palo Alto, CA, USA; 9National School of Public Health/New University of Lisbon, Portugal; 10General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; 11Netherlands Institute for Social Research, The Hague, Netherlands; 12UnitedHealth Chronic Disease Initiative, London, UK; 13Department of Primary and Community Care, Radboud University Nijmegen Medical Centre; 14Netherlands Organisation for Health Research and Development, The Hague, Netherlands
The current WHO definition of health, formulated in 1948, describes health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”1 At that time this formulation was groundbreaking because of its breadth and ambition. It overcame the negative definition of health as absence of disease and included the physical, mental, and social domains. Although the definition has been criticised over the past 60 years, it has never been adapted. Criticism is now intensifying,2-5 and as populations age and the pattern of illnesses changes the definition may even be counterproductive. The paper summarises the limitations of the WHO definition and describes the proposals for making it more useful that were developed at a conference of international health experts held in the Netherlands.6
Limitations of WHO definition
Most criticism of the WHO definition concerns the absoluteness of the word “complete” in relation to wellb
