Health is a complex concept and has long been defined in different ways. One definition states that health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Other definitions have emphasized that a person’s sense of wellbeing can only be understood in relation to his or her environment.
A third definition emphasizes that people strive to adapt to life circumstances in order to maintain or regain their sense of balance and health. This definition also focuses on the importance of environmental contexts and support systems.
The new definition of health brings attention to the role of society in generating policies, programs and research that facilitate successful adaptation across all dimensions of health throughout the lifespan, especially for people with disabilities and chronic conditions. It also reframes the emphasis on removing diseases and diminishing risk factors to focus on building healthy individuals whose sense of health is disconnected from their limitations.
This broader perspective of health has important implications for patients, caregivers and healthcare providers. For patients and their families, embracing a broad understanding of health can help them manage their own health more effectively by preventing illness and maximizing their quality of life. It can also empower them to engage with their healthcare providers in a more productive and meaningful way.
For healthcare professionals, the new definition of health can inspire a shift in practice and policy. Traditionally, targets for intervention have focused on specific diseases or behaviors, and categorical funding streams for both research and the delivery of services encourage this approach. The field model of the determinants of health invites consideration of a wider array of targets, including education on lifestyle choices and their impact on health, the development of community-based resources that provide adolescents with a sense of belonging and purpose, the reduction of teenage suicide, unintended pregnancies, alcohol and drug abuse, crime, and school dropout rates, and the expansion of accessible healthcare.
Embracing a broad view of health can lead to innovative assessment strategies and new approaches to measuring outcomes. In individual clinical contexts, it may require assessments of symptoms and biological metrics with sufficient sensitivity to detect change in the presence of disease or disability. In population monitoring, it will require the use of survey instruments with enough flexibility to accommodate a wide range of settings and life situations. This broader vision of health can open the door to an unprecedented opportunity for innovation in rehabilitation, especially for persons with disabilities and chronic conditions. This Commentary is adapted from a paper presented at the 2019 National Rehabilitation Conference sponsored by the Center on Independence and Quality of Life (CIQOL) at The Ohio State University Nisonger Center, through a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research, U.S. Department of Health and Human Services, (NIDILRR No. 90RTHF0002-01-00). The authors would like to thank the NIDILRR and the ACL for their generous support of this work.