“Am I healthy?” It sounds like a simple question. But try answering it.
Is it having no illness? Feeling good most days? Passing your check-ups? What if you take a tablet every morning for blood pressure but still walk, work and enjoy life with your family? Are you healthy then?
Most of us spend a lot of time learning about illness: what causes it, how to spot it, how to treat it. But before we can understand illness, or know how to improve our health, we need to answer a more basic question: what is health? Once you know what good health really looks like, you are better able to look after your own.
The answer has changed over thousands of years. Today, people are living longer than ever before, and more of us are living with long-term conditions such as diabetes, asthma or arthritis. So does the definition of health the world agreed on in 1948 still fit the way we live now? Or do we need a new way of thinking about health, one that’s more meaningful for today and easier to measure?
To answer that, let’s go back to the beginning.
Long before microscopes and blood tests, people in ancient India and Greece saw health as harmony. They believed the body held a balance of natural forces, which the Greeks called “humours”. When that balance was upset, illness followed. For many cultures, being healthy meant being at peace with yourself, your community and the world around you [1].
For centuries, that idea held. Then science changed everything.
Around the start of the 1900s, the discovery that germs cause many diseases transformed medicine. Doctors began to see the body almost like a machine: if a part broke, their job was to find it and fix it. Health came to mean simply having no disease [1].
This way of thinking brought remarkable success: vaccines, antibiotics and modern surgery saved millions of lives. But it had a blind spot. It struggled with problems such as poor nutrition, addiction, mental illness and long-term disease, where there was often no single germ to blame [1].
So people began to look wider. Some noticed that health depends on how well we adapt to the world around us: the air we breathe, the food we eat, the homes we live in. Others showed that our minds, our relationships, our money and our culture shape our health too. Slowly, a bigger picture formed. Health meant a sound mind, in a sound body, in a sound family, in a sound environment [1].
After the Second World War, countries came together to form the World Health Organization (WHO). In its founding document, which came into force in 1948, the world agreed for the first time on what health means:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” [2]
It was a bold step. Health now officially included your body, your mind and your social life, and WHO declared it a basic human right for everyone [2].
But a definition on paper is one thing; using it with real patients is another. In 1977, an American doctor named George Engel argued that medicine still focused so much on the body that it left little room for the psychological and social sides of illness [3]. He suggested that every patient should be understood in three ways: their body, their thoughts and feelings, and their family, work and home life. He called this the biopsychosocial approach. It’s the reason your doctor today may ask about your sleep, your stress or your job, not just your symptoms.
Less than ten years later, WHO added another thought: health is not the goal of life, but a resource for everyday living [4]. In other words, health is what allows you to do the things that matter to you.
As the years passed, medicine kept improving and people lived longer. But living longer also meant that more people lived with long-term conditions. And that raised an awkward question: if health means complete well-being, is anyone truly healthy? [5]
In 2011, a Dutch doctor and researcher, Machteld Huber, and an international group of experts offered a new way of thinking. Health, they suggested, could be seen as the ability to adapt and manage your own life when you face physical, emotional or social challenges [5].
When her team later asked patients what health meant to them, the answers were broad: their body, their mood, having meaning in life, enjoying life, taking part in society and managing daily tasks. Doctors, on the other hand, tended to think mainly about the body [6].
So where does that leave us?
Over thousands of years, our idea of health has grown from balance, to no disease, to body, mind and social life together, and more recently to how well we cope with life’s challenges. Each idea added something important, and none of them has the final word. The WHO definition still gives us an ideal to aim for. But as people live longer and more of us live with long-term conditions, many experts are asking whether we also need a definition that’s more realistic and easier to measure [5].
Which brings us back to where we started, and to a question that matters to millions of people:
If you take a tablet every morning for blood pressure or diabetes, but still walk, work and enjoy life with your family, are you healthy?
That’s what we’ll explore in the next part of this series.
References
- Park K. Park’s Textbook of Preventive and Social Medicine. 23rd ed. Jabalpur: Banarsidas Bhanot; 2015. Chapter: Concept of Health and Disease.
- World Health Organization. Constitution of the World Health Organization. Signed 1946; in force 7 April 1948.
- Engel GL. The need for a new medical model: a challenge for biomedicine. Science 1977;196:129–36.
- World Health Organization. Ottawa Charter for Health Promotion. 1986.
- Huber M, Knottnerus JA, Green L, et al. How should we define health? BMJ 2011;343:d4163.
- Huber M, van Vliet M, Giezenberg M, et al. Towards a ‘patient-centred’ operationalisation of the new dynamic concept of health. BMJ Open 2016;6:e010091.