Defining Health

  • Joachim P. Sturmberg


We all seem to know what health is, and we all seem to know how our health changes over time. It may thus sound counter-intuitive to even ask the question—what is health?

Many definitions of health have been proposed since the time of antiquity. None has been universally accepted, but all have one thing in common—all describe health as a subjective experience. A pragmatic definition of health defines health as the personal state of feeling whole.

What contributes to our health experience? The literature has identified four broad domains that contribute to our health:
  • Our bodily experiences

  • Our emotional experiences

  • Our social experiences

  • Our ability to make sense of our life experiences

When we feel healthy, these four domains are in a state of balance. We are at ease whereas disturbances in any domain results in the experience of dis-ease.
  • The colloquial term “disease” refers to the presence of pathological changes that can be identified by health professionals. However, much of the experience of dis-ease is not associated with identifiable pathology, and even if pathology is identifiable, most people still experience “good health”.

  • Being able to accept and adapt to the inevitable onset of some form of disease across one’s life is another defining characteristic of health.

  • Most of us are healthy—or at least healthy enough—most of the time to not perceive a need to seek care from a health professional.

  • It is now clear that, over a lifetime, dis-ease is a major contributor to the development of many common diseases and substantially effects our longevity.

  • Unsurprisingly, the question “How do you rate your health on a scale of excellent - very good - good - fair - or poor” is the single most predictive indicator of
    • future health,

    • the use of healthcare services and

    • mortality.

  • The ways how the subjective experience of health and dis-ease impacts on the development of disease have been untangled, but so far, these understandings have not been implemented in everyday clinical care.

Understand health and dis-ease as personal experiences, i.e. the focus on personal well-being, have important implications for the redesign of health systems.
  • “Health systems” need to be distinguished from “healthcare systems”. At present those responsible for the health system predominantly focus on the object of disease, hence a more accurate characterisation of the prevailing system would be “disease management” system.

  • Understanding the patient’s dis-ease, regardless of its underlying cause, is essential to identify the most effective means to allow him to regain his state of ease. This is especially important when there is no disease associated with the experience of dis-ease; the medical literature somewhat disparagingly refer to these constellations as somatisation.

  • Given the epidemiology of health and disease, the health system needs to allocate a larger proportion of resources towards “health supporting services” and “community development”.

Successful health system redesign would firmly focus on the interdependent environmental, personal and biological factors that contribute to health as a whole person experience.


  1. 1.
    Sturmberg JP (2009) The personal nature of health. J Eval Clin Pract 15(4):766–769CrossRefPubMedGoogle Scholar
  2. 2.
    Huber M, Knottnerus JA, Green L, Horst Hvd, Jadad AR, Kromhout D et al (2011) How should we define health? Br Med J 343:d4163CrossRefGoogle Scholar
  3. 3.
    Sturmberg JP (2013) Health: a personal complex-adaptive state. In: Sturmberg JP, Martin CM (eds) Handbook of systems and complexity in health. Springer, New York, pp 231–242CrossRefGoogle Scholar
  4. 4.
    Lakoff G, Johnsen M (2003) Metaphors we live by. The University of Chicago Press, LondonCrossRefGoogle Scholar
  5. 5.
    Idler EL, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38(1):21–37CrossRefPubMedGoogle Scholar
  6. 6.
    Jylhä M (2009) What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med 69(3):307–316CrossRefPubMedGoogle Scholar
  7. 7.
    Benyamini Y (2011) Why does self-rated health predict mortality? An update on current knowledge and a research agenda for psychologists. Psychol Health 26(11):1407–1413CrossRefPubMedGoogle Scholar
  8. 8.
    Egnew TR (2005) The meaning of healing: transcending suffering. Ann Fam Med 3(3): 255–262CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    McWhinney IR (1989) An acquaintance with particulars. …’. Fam Med 21(4):296–298PubMedGoogle Scholar
  10. 10.
    Mitchell D (2014) Philosophy at the bedside - phenomenology, complexity and virtue in the care of patients. J Eval Clin Pract 20(6):970–974CrossRefPubMedGoogle Scholar
  11. 11.
    Scott JG, Cohen D, DiCicco-Bloom B, Miller WL, Stange KC, Crabtree BF (2008) Understanding healing relationships in primary care. Ann Fam Med 6(4):315–322CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Uexküll Tv, Pauli HG (1986) The mind-body problem in medicine. Adv J Inst Adv Health 3(4):158–174Google Scholar
  13. 13.
    Macklem PT, Seely A (2010) Towards a definition of life. Perspect Biol Med 53(3):330–340CrossRefPubMedGoogle Scholar
  14. 14.
    Bircher J (2005) Towards a dynamic definition of health and disease. Med Health Care Philos 8(3):335–341CrossRefPubMedGoogle Scholar
  15. 15.
    Bircher H, Kuruvilla S (2014) Defining health by addressing individual, social, and environmental determinants: new opportunities for health care and public health. J Public Health Policy 35(3):363–386CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Sturmberg JP (2014) Emergent properties define the subjective nature of health and dis-ease. J Public Health Policy 35(3):414–419CrossRefPubMedGoogle Scholar
  17. 17.
    Pellegrino E, Thomasma D (1981) A philosophical basis of medical practice. Towards a philosophy and ethic of the healing professions. Oxford University Press, New York/OxfordGoogle Scholar
  18. 18.
    Picard M, Juster R, Sabiston C (2013) Is the whole greater than the sum of the parts? Self-rated health and transdisciplinarity. Health Aff 5(12A):24–30CrossRefGoogle Scholar
  19. 19.
    Vogt H, Ulvestad E, Eriksen TE, Getz L (2014) Getting personal: can systems medicine integrate scientific and humanistic conceptions of the patient? J Eval Clin Pract 20(6): 942–952CrossRefPubMedGoogle Scholar
  20. 20.
    WHO - Western Pacific Region (2007) People at the centre of health care. Harmonizing mind and body, people and systems. WHO Western Pacific Region, GenevaGoogle Scholar
  21. 21.
    Illich I (1976) Limits to medicine. Medical nemesis: the expropriation of health. Marion Boyars Book, LondonGoogle Scholar
  22. 22.
    Husserl E (2006) The basic problems of phenomenology: from the lectures. Winter Semester, 1910–1911. Springer, DordrechtGoogle Scholar
  23. 23.
    Antonovsky A (1979) Health, stress and coping. Jossey-Bass, San FranciscoGoogle Scholar
  24. 24.
    Ingstad B, Fugelli P (2006) “Our health was better in the time of Queen Elizabeth”: the importance of land to the health perception of the Botswana San. In: Hitchcock RK, Ikeya K, Lee RB, Biesele M (eds) Updating the San: image and reality of an African people in the 21st century (Senri Ethnological Studies No 70). Senri; National Museum of Ethnology, OsakaGoogle Scholar
  25. 25.
    Engel GL (1977) The need for a new medical model: a challenge for biomedicine. Science 196(4286): 129–136CrossRefPubMedGoogle Scholar
  26. 26.
    Moes M (2001) Plato’s conception of the relationship between moral philosophy and medicine. Perspect Biol Med 44(3):353–367CrossRefPubMedGoogle Scholar
  27. 27.
    WHO (1978) Declaration of Alma-Ata. International conference on primary health care, Alma-Ata, USSR, 6–12 Sept 1978. World Health Organisation, GenevaGoogle Scholar
  28. 28.
    Parsons T (1951) The social system. Free Press, GlencoeGoogle Scholar
  29. 29.
    Dubos R (1960) The mirage of health. Allen and Unwin, LondonGoogle Scholar
  30. 30.
    Maslow HA (1968) Toward a psychology of being. Van Nostrand Reinhold Company, New YorkGoogle Scholar
  31. 31.
    Tissue T (1972) Another look at self-rated health among the elderly. J Gerontol 27(1):91–94CrossRefPubMedGoogle Scholar
  32. 32.
    Kehlman S (1975) The social nature of the definition problem in health. Int J Health Serv 5(4):625–642CrossRefGoogle Scholar
  33. 33.
    Reid J (1984) Body, land and spirit. Queensland University Press, St LuciaGoogle Scholar
  34. 34.
    Seedhouse D (1986) Health: the foundations for achievement. Wiley, New YorkGoogle Scholar
  35. 35.
    WHO (1986) Ottawa charter for health promotion. First international conference on health promotion. Ottawa, 21 Nov 1986: WHO/HPR/HEP/95.1. Available at:
  36. 36.
    Sturmberg JP (2007) The foundations of primary care. Daring to be different. Radcliffe Medical Press/Oxford San FranciscoGoogle Scholar
  37. 37.
    WHO Commission on Social Determinants of Health (2007) Globalization, global governance and the social determinants of health: a review of the linkages and agenda for action.
  38. 38.
    Pourbohloul B, Kieny M-P (2011) Complex systems analysis: towards holistic approaches to health systems planning and policy. World Health Organ Bull World Health Organ 89(4):242CrossRefPubMedGoogle Scholar
  39. 39.
    Rosenberg CE (1989) Disease in history: frames and framers. Milbank Q 67(Suppl1):1–15CrossRefPubMedGoogle Scholar
  40. 40.
    Rosenberg CE (2003) What is disease? In memory of Owsei Temkin. Bull Hist Med 77(3): 491–505CrossRefPubMedGoogle Scholar
  41. 41.
    Sturmberg JP, Martin CM (2016) Diagnosis - the limiting focus of taxonomy. J Eval Clin Pract 22(1):103–111CrossRefPubMedGoogle Scholar
  42. 42.
    Australian Institute of Health and Welfare (2014) Australia’s welfare 2014. Australian Institute of Health and Welfare, Canberra. Contract No.: Cat. no. AUS 178. Available at:
  43. 43.
    Pârvan A (2016) Monistic dualism and the body electric: sn ontology of disease, patient and clinician for person-centred healthcare. J Eval Clin Pract 22(4):530–538CrossRefPubMedGoogle Scholar
  44. 44.
    Dantzer R (2001) Cytokine-induced sickness behavior: where do we stand? Brain Behav Immun 15(1):7–24CrossRefPubMedGoogle Scholar
  45. 45.
    Goh K-I, Cusick ME, Valle D, Childs B, Vidal M, Barabási A-L (2007) The human disease network. Proc Natl Acad Sci 104(21):8685–8690CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Tracey KJ (2007) Physiology and immunology of the cholinergic antiinflammatory pathway. J Clin Invest 117(2):289–296CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Glaser R, Kiecolt-Glaser JK (2005) Stress-induced immune dysfunction: implications for health. Nat Rev Immunol 5(3):243–251CrossRefPubMedGoogle Scholar
  48. 48.
    Cole SW (2013) Social regulation of human gene expression: mechanisms and implications for public health. Am J Public Health 103(S1):S84–S92CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Picard M, Juster RP, McEwen BS (2014) Mitochondrial allostatic load puts the ‘gluc’ back in glucocorticoids. Nat Rev Endocrinol 10(5):303–310CrossRefPubMedGoogle Scholar
  50. 50.
    Wallace DC (2013) A mitochondrial bioenergetic etiology of disease. J Clin Investig 123(4):1405–1412CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Loscalzo J, Kohane I, Barabási A-L (2007) Human disease classification in the postgenomic era: a complex systems approach to human pathobiology. Mol Syst Biol 3(1):124PubMedPubMedCentralGoogle Scholar
  52. 52.
    Barabási A-L (2007) Network medicine - from obesity to the “Diseasome”. N Engl J Med 357(4): 404–407CrossRefPubMedGoogle Scholar
  53. 53.
    Sturmberg JP, Bennett JM, Picard M, Seely AJE (2015) The trajectory of life. Decreasing physiological network complexity through changing fractal patterns. Front Physiol 6:169Google Scholar
  54. 54.
    Sturmberg JP, Bennett JM, Martin CM, Picard M (2017) “Multimorbidity” as the manifestation of network disturbances. Implications for whole person care. J Eval Clin Pract 23(1):199–208CrossRefPubMedGoogle Scholar
  55. 55.
    Sturmberg JP, Botelho RJ, Kissling B (2016) Integrated multimorbidity management in primary care: why, what, how, and how to? J Comorbidity 6(2):114–119CrossRefGoogle Scholar
  56. 56.
    Hutchinson AF, Graco M, Rasekaba TM, Parikh S, Berlowitz DJ, Lim WK (2015) Relationship between health-related quality of life, comorbidities and acute health care utilisation, in adults with chronic conditions. Health Qual Life Outcomes 13:69CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    White K, Williams F, Greenberg B (1961) The ecology of medical care. N Engl J Med 265(18):885–892CrossRefPubMedGoogle Scholar
  58. 58.
    Green L, Fryer G, Yawn B, Lanier D, Dovey S (2001) The ecology of medical care revisited. N Engl J Med 344(26):2021–2025CrossRefPubMedGoogle Scholar
  59. 59.
    Johansen ME, Kircher SM, Huerta TR (2016) Reexamining the ecology of medical care. N Engl J Med 374(5):495–496CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Joachim P. Sturmberg
    • 1
  1. 1.University of NewcastleWamberalAustralia

Personalised recommendations