Defining Health

Abstract

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.