People use the word “health” in a wide variety of ways, from the sense of relief that comes with being cured of a severe illness to the feeling of well-being that comes when we meet someone who seems full of life. We can also describe the health of a family, an institution, or a country. But what is health exactly? Multiple definitions exist, ranging from a narrow biomedical or physical definition to the World Health Organization’s broad definition that “health is a state of complete mental and social well-being and not merely the absence of disease or infirmity.” The latter offers advantages in terms of ease of measurement and clarity of causal connections between medical and public health care systems and measured outcomes. However, it risks attributing to the health system full responsibility for the economic and social welfare of members of society.
A new generation of scholars has called for a new definition of health that reflects our current understanding of genomics, the environment, and planetary health. Inspired by the work of Canguilhem, they have promoted a dynamic view of health that replaces perfection with adaptation. They have also advocated a more holistic approach that shifts the focus from the physician as the arbiter of what is healthy to the patient as a partner in defining their individual health needs.
This new definition invites a wider array of targets for intervention in research, clinical practice, and health policy. The traditional targets for these interventions have largely been specific diseases and behaviors, which is in part the result of categorical funding streams that encourage this approach. Moreover, the field model of the determinants of health promotes consideration of a wider array of targets, such as education and the preservation of the family.
These targets will inevitably affect the way we measure health outcomes. For example, measures that rely on biological metrics will require sufficient sensitivity to detect change at the individual level. But measurements based on subjective questions will need to have enough breadth and depth to reflect the range of aspects of health that matter to individuals, such as how they feel about their lives and their ability to cope with challenges.
The broader focus on generating health rather than simply focusing on sick-ness may also lead to greater attention to the local environment in which individuals strive to become healthy. The quality of school and business environments, the safety of neighborhoods, the extent to which communities are integrated and supported by their families, and many other factors have a direct impact on an individual’s perception of health. And a community’s ability to function effectively and make progress toward its societal goals depends on the health of its residents.