The word “health” is generally viewed as much more than a state of merely not being sick. Health is a holistic concept that incorporates an individual’s mental, physical and social well-being. It is the ability to manage one’s life, including coping with change and adversity. Ultimately, this is what makes someone healthy and able to live their best lives.
In 1948, the World Health Organization defined health as a state of “complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition was revolutionary at that time because it was the first to recognize that health is more than just the lack of pathology.
Since that time, medical science has made significant strides in understanding how diseases work and discovering new ways to prevent or treat them. But this progress has also led to the recognition that an entirely pathology-free existence may not be possible. In the face of this growing awareness, how is it now possible to conceive of a healthier, more resilient and productive human being?
For many years, efforts to improve health have focused on modifying behavior. In fact, the term “health promotion” was coined to highlight this emphasis on the behavioral aspects of health. While this remains a valuable and important goal, it should be expanded to encompass a greater range of targets.
The field model of the determinants of health encourages consideration of a wider array of goals for interventions, including those that affect the broader environment and the capacity of individuals to adapt to changing circumstances. For example, if unintended pregnancies, drug abuse and crime among teenagers are to be reduced, then a community-level approach is needed that addresses these underlying issues. It could include the provision of youth sports programs, increased parental support and mentoring, a reduction in teen alienation, better opportunities for education and careers, and more family-centered support services.
This broader definition of health, akin to Canguilhem’s notion of normality, is what the committee has adopted as its broadest and most inclusive definition for health improvement. It allows improvement efforts to focus not only on reducing disease, disability and death, but on improving people’s ability to cope with their illnesses; their perceptions of and responses to those illnesses; and their functional capacity both now and in the future.
Of course, not everyone will be able to take on these challenges immediately or in full. Some factors, such as genetic makeup and environmental conditions are nearly impossible to change; others, like dietary habits or levels of physical activity, are amenable to changes in individual behaviors. But the point is that, if we are to improve global health, then all of these determinants need to be addressed. The future of our children and grandchildren depends on it.