Traditionally, health has been defined as the absence of disease or infirmity. While this definition reflects the importance of disease control, it overlooks other aspects of health that are fundamental to our well-being.
Health includes both an individual’s physical and mental well-being and his or her ability to function in the face of life’s challenges. To achieve optimal health, individuals need a supportive social context and access to resources that promote adaptation and resilience. This perspective is particularly important for people with disabilities or chronic health conditions.
When asked about what makes them healthy, most people will list their family history and personal lifestyle choices such as whether they smoke, how often they exercise, and what foods they eat. These factors have a direct impact on health and can be changed by choice, but they do not capture the full complexity of what it means to be healthy.
The traditional view of health, based on a biomedical framework, emphasizes the role of the medical and public health care systems in improving health outcomes. This approach has the advantages of easy measurement and the clarity of its causal connections to measured outcomes. But it may also miss the importance of other influences on health, such as the condition of the community’s working and living environments, its safety, the educational level of its citizens, and other environmental factors.
In the field model, the origins of health are seen as a dynamic process that involves interactions among a multitude of forces. While some of these factors, such as genetic endowment, are not amenable to change, others, such as dietary habits, are more flexible and can be modified by choice. The field model also places more emphasis on the need for individuals to be resilient and able to adapt to changing circumstances.
This approach is most evident in the response to the COVID-19 pandemic, where a focus on a variety of community-level factors, such as family support, housing assistance, and job opportunities, has led to improved community health. In contrast, the traditional approach to health may be more prone to rigidity and inflexibility, especially when it is based on a prescriptive definition of health that focuses exclusively on disease and disability.
The new definition of health will help individuals, researchers, and policymakers develop strategies to facilitate adaptation across all dimensions of health throughout the lifespan. This commentary was developed as part of a Rehabilitation Research and Training Center (RRTC) on Health and Functioning, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research under grant number 90RTHF0002-01-00. This commentary is also supported by a Center for Excellence in Disability and Rehabilitation grant to The Ohio State University Nisonger Center from the Administration on Community Living, Department of Health and Human Services, Office of Special Education and Rehabilitative Services. (NIDILRR project number 90RTHF0002-01-000). The views expressed herein do not necessarily reflect the opinions of NIDILRR or the Department of Health and Human Services.