How should we define health?
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4163 (Published 26 July 2011) Cite this as: BMJ 2011;343:d4163
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In the not-so-recent article (July 2011) by Huber et al., entitled "Health: How Should We Define It?" the authors present some interesting alternatives to the WHO definition of health. They argue that health is more an ability to "adapt and self-manage" than a state of "complete physical, mental and social well-being." Such an alternative conceptual framework is useful because it makes the health care system more realistic in terms of spending money on states of ill-health, among other reasons.
Wisely, Huber et al. do not try to overturn the old WHO definition, which was established in 1946. That definition is figuratively set in concrete. This attempt to redefine health is useful because it reminds us that health is something which is felt internally, as well as being something that others assess externally in clinical settings. We have "social assessment" of our health by health professionals, family members and friends, and then we have the "self assessment" of health, which is defined by how we "feel" and look to ourselves. There will always be some agreement between these two ways of defining our health, but often there will be important differences which affect whether or not we seek professional help. As we age, we may be plagued with a whole variety of minor complaints, but if we feel good, and are able to function without much pain, there is no reason to see a doctor. "Social assessment" may creep into our perception of health, but ultimately the "self assessment" will trump anything but overwhelming pressure from others to seek help. Ultimately, health should be defined, even by the WHO, to include these two elements.
Competing interests: No competing interests
Huber and colleagues bring needed attention to the WHO definition of health. Their suggestions are to move the definition toward adaptation and self-management in the face of challenges. (1) However, since challenges to be faced in life can never be known until they occur, their suggestion would encourage reactive instead of proactive actions by individuals and professionals. This author suggests it is necessary to define health, as WHO has done, in a way that inspires the desire to improve physical, mental and social well-being for its own sake. By doing this, abilities to adapt and self-manage are improved as a better life is created. (2-5)
Improved health provides an opportunity to manifest a better life. Health is a dynamic, not static state that one must work to continuously generate. Health is not something that can be achieved by reacting to current circumstances. The WHO definition provides an ideal state to work toward by defining health as a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity (6).
Humans have a unique, innate ability and desire to adapt and continually improve their state of well-being. Health is not as much an end point as it is an enabling capacity to facilitate progress toward a desired life. Huber and colleagues’ commentary suggests that the WHO definition would consider most individuals to be unhealthy or definitively ill most of the time and that this would then lead to the undesired outcome of increased medicalization. (1) This interpretation is correct if health is understood to be the absence of disease and infirmity and not as the presence of well-being.
WHO explains that health is the PRESENCE of physical, mental and social well-being and not merely the ABSENCE of disease and infirmity. (6) Only conscious action can create these desired states of well-being. Seeing health as the absence of disease and infirmity is narrow and incomplete. Instead of defining health as a higher state to be created and continually achieved, Huber and colleagues suggested redefinition would seem to encourage a return to a predetermined baseline instead of a move toward a higher state of well-being. Putting a focus on the precursors to achievement, accomplishment and thriving, something required with the current definition, inspires action to enhance physical, mental, and social well-being.
Though we are pulled to the status quo or maintenance by the endowment effect, (7) it does not inspire. Furthermore, passive reactionary stances and maintenance of the status quo through "…the ability to adapt and to self-manage" would be encouraged if this redefinition were accepted. Accomplishment and achievement of one’s desires, on the other hand, inspires action. The current WHO definition inspires action to create a dynamic and improving state of health that can be measured by determining engagement in health promoting actions. Results document that the more people engage in health promoting actions, the greater their well-being, satisfaction, and performance and the lower their incidence of symptoms and problems associated with disease and infirmity because of a better ability to adapt and self-manage in the face of challenges. (8,9)
(1) Huber M, Knottnerus JA, Green L, Horst H, Jadad AR, Kromhout D, et al. How should we define health? BMJ 2011;343.
(2) Breslow L. A quantitative approach to the World Health Organization definition of health: physical, mental and social well-being. Int J Epidemiol 1972 Winter;1(4):347-355.
(3) Breslow L. From disease prevention to health promotion. JAMA 1999 Mar 17;281(11):1030-1033.
(4) Antonovsky A. Unraveling the mystery of health : how people manage stress and stay well. 1st ed. San Francisco: Jossey-Bass; 1987.
(5) Becker C, Glascoff M, Felts W. Salutogenesis 30 Years Later: Where do we go from here? International Electronic Journal of Health Education 2010;13:25-32.
(6) World Health Organization. World Health Organization Constitution. Dublin: Stationery Off; 1948
(7) Ariely D. The upside of irrationality : the unexpected benefits of defying logic at work and at home. New York, NY: Harper; 2010.
(8) Becker CM, Whetstone L, Glascoff M, Moore J. Evaluation of the Reliability and Validity of an Adult Version of the Salutogenic Wellness Promotion Scale (SWPS). Am J Health Educ 2008;39(6):322-328.
(9) Becker CM, Dolbier CL, Durham T, Glascoff MA, Adams TB. Development and Preliminary Evaluation of the Validity and Reliability of a Positive Health Scale. Am J Health Educ 2008;39(1):34-41.
Competing interests: No competing interests
The definition of health as the "ability to adapt and to self manage" is an important step toward a full comprehension of health and disease. In fact, the question about the nature of health is overwhelming. To answer it, we have to ask: When do we not feel healthy? We can easily answer: When we cannot do something that we used to or something that people commonly do. For instance, when we can no longer run as swiftly as we used to, or when a disease inhibits eating food that people commonly eat. To drink, to walk, to eat ice cream, to read a good book; to restore breathing if our nose is obstructed, to restore sight if we are blind or to kill pain if we have a headache - to be healthy is to realize this. The awareness that our desires are being realized is what we call well-being: in other words, the awareness of health. It is important to affirm that, even in the case of chronic diseases, health is possible, first because many disabled people show how to be healthy despite their disability (e.g. Paralympic champions or world famous blind singers such as Andrea Bocelli or Ray Charles); second, because precluding disabled people from health to is relegating them to a second-class personhood.
The only flaw I see in this paper's definition of health is that it highlights only the active aspect of an healthy person, while even when dependent on others a human being maintains his/her dignity and therefore his/her possibility of health: the opposite of health is not the lack of autonomy, but the lack of hope.
References:
Bellieni CV, Buonocore G: Pleasing Desires or Pleasing Wishes? A New Approach to Health Definition. Ethics and Medicine 2009;25(1):7
Carlo V. Bellieni
Pontifical Academy for Life
University Hospital, Siena (Italy)
Competing interests: No competing interests
The proposed new definition for health risks further blurring of the
health - disease transitions and possibly would lead to an oxymoronic
state of 'healthy disease'. Would a single mum in a poor country working
during her bout of flu be termed healthy since she is able to adapt and
self manage whereas a young adult in a rich country who is 'off sick from
work' with flu might be termed as unhealthy.(1).
The general public would define health as absence of disease. The
problem lies with definition of diseases not with definition of health.
Ever expanding pre-disease categories and risk factors are increasingly
viewed as physical disease. (2). 'Normal life events' are increasingly
categorised as mental health problems. (3).
The availability of rapid genome wide sequencing might detect low
penetrant disease risk genes in practically most of us and this
potentially can put most of us in some pre-disease categories.(4).
Hence there is an urgent need to define disease before we define
health. Otherwise concept of 'health' risks becoming a philosophical
concept discussed along with 'meaning of life'!
References:
1. Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D
et al. How should we define health? BMJ. 2011 Jul 26;343:d4163. doi:
10.1136/bmj.d4163.
2. Moynihan R. Medicalization. A new deal on disease definition.
BMJ. 2011 May 3;342:d2548. doi: 10.1136/bmj.d2548.
3. Frances A. The first draft of DSM-V. BMJ. 2010 Mar 2;340:c1168.
doi: 10.1136/bmj.c1168
4. Cirulli ET, Goldstein DB. Uncovering the roles of rare variants
in common disease through whole-genome sequencing. Nat Rev Genet.
2010.Jun; 11(6): 415-25.
Competing interests: No competing interests
Dear Editor,
Re: Huber et. Al. How should we define health?
As a participant at the international conference referred to in the
above paper (my contributions to these debates is acknowledged by the
authors) I would like to make three comments on the ideas they present.
1. The authors fail to appreciate what for many is the key strength of the
WHO definition which paradoxically is a weakness of the approach they are
proposing. The WHO definition is 'aspirational' aiming to guide national
and global health governance not to provide a conceptual framework for
operationalising 'health' in a narrow technical sense.
2. The WHO definition was the product of an inclusive dialogue involving
'lay' and professional/medical experts. If there is to be a change in
the way that international health governance agencies define health then
it surely is not acceptable in the 21st century for this to be done
without wide-ranging engagement beyond the esoteric world of academia and
the pragmatic world of policy. Civil society should have a voice.
3. The authors' new definition of 'health' places undue emphasis on
individuals and their "ability to adapt and to self manage" irrespective
of their context. If one accepts that it is worthwhile to pursue a new
definition amenable to operationalisation - and I am not convinced of this
- then this process needs to attend to the implications of the burgeoning
literatures on:
a. the complex concepts of capability, capacity and resilience where
research points to the importance of conceptualising these as
characteristics of the relationship between individuals and the socio-political systems in which they are embedded (or even as characteristics
of these systems themselves) rather than as located with individuals.
b. The role of collective social dynamics and/or relationships in the
genesis, promotion, management and sustainability of health, wellbeing and
functioning
c. Lay/patient generated measures of health and health outcomes (e.g
patient reported outcome measures) which allow individuals to identify the
domains of health, wellbeing and social functioning that are important to
them.
The authors argue that the "formulation of health as the ability to
adapt and to self manage... could be a starting point for a fresh, 21st
century way of conceptualising human health and that discussion with other
stakeholders should continue. Indeed it should. I fear that the
approach proposed by Huber et. al. results in a narrowly individualistic
psycho-social definition of health. The social determinants approach,
emphasising political, economic, social and cultural pathways to health
and health inequalities provides a more appropriate 21st century framework
to underpin national and global health governance.
Competing interests: I participated in discussions at the workshop that the authors Huber et. al. draw on for their article.
We certainly agree with the recommendation by Machteld Huber et al,
resulting from a recent meeting of experts at a Dutch conference, that WHO
update their definition of health and place 'emphasis towards the ability
to adapt and self manage in the face of social, physical, and emotional
challenges.'1. We appreciate the concept of 'dynamic balance between
opportunities and limitations' in the social domain.
However we are concerned that the proposed definition's emphasis on
personal and community responsibility for adaptation and self-management
denies the reality that some social determinants may preclude the ability
of individuals and communities to adapt to their circumstances.
We believe that the authors and WHO would benefit from applying a
much wider lens to the etiology of health, and therefore increase the
recommendations to support maximum health around the world. The physical,
mental, emotional and spiritual health of individuals and communities
depends on numerous general factors including political conflict and war,
literacy, education, employment, adequate housing, poverty reduction and
reducing the income gap within countries - in addition to 'good nutrition,
hygiene, sanitation and health care interventions'. This means that WHO
must partner with other international organisations with many different
mandates to promote health. It should also encourage countries to adopt
health policies that make it possible for individuals and communities to
self-manage; as has occurred with smallpox and polio prevention, iodine
supplementation and, in some jurisdictions, smoking and seatbelt usage.
We also recommend that future writings should lessen the focus on
'doctors in their daily communication with patients.' The majority of the
world receives health care from other health professionals, community
leaders, traditional healers or those with additional knowledge in health,
as well as family caregivers,
Finally, we are delighted that this article recommends involving
other stakeholders - and recommend that these should be widened past
'patients and lay members of the public' to include community leaders,
health organisations and policy makers.
1. Huber M, Knottnerus JA, Green LW et al. How should we define
health?
BMJ 2011;343:d4163
Competing interests: No competing interests
We believe that the WHO definition of health is wonderful, and we
need to be careful before trying to change it.
We began thinking about this definition this when we asked our eight
MPH students with prior medical degrees if they knew any definition of
health. Only two did, and it was the WHO definition. It seemed unusual
that medical doctors enrolled in public health program did not know what
health was, at least from standpoint of standard definition. Just this
week our Supercourse project (www.pitt.edu/~super1) is likely to reach
over 1 million faculty and students world wide with the definition of
health in various formats, including poster. We shared the definition of
health with 50,000 members of the Global Health Network Supercourse
network and we provided a poster, that can be distributed electronically,
and printed out
http://www.pitt.edu/~super1/globalhealth/What%20is%20Health.htm
Anyone
can distribute this poster, add a link to your website, or print out.
There are several reasons we like the WHO definition.
1. WHO Constitution: The definition of health is in the body of the
preamble of the WHO constitution giving it credibility. It is like: "We
the People of the United States, in Order to form a more perfect Union,
establish Justice, insure domestic Tranquility, provide for the common
defence, promote the general Welfare, and secure the Blessings of Liberty
to ourselves and our Posterity, do ordain and establish this Constitution
for the United States of America". This obviously is vague, and could
have been changed every few years, but it upholds a very important
concept, as does the WHO Definition
2. Definition compared to oath: In many ways the WHO definition
is an oath or a pledge of allegiance to health. If we use the Hippocratic
oath as a framework, despite some aspects being wrong, or hopelessly
outdated e.g. "I swear by Apollo, the healer, Asclepius, Hygieia, and
Panacea, and I take to witness all the gods, all the goddesses, to keep
according to my ability and my judgment, the following Oath and agreement:"
Despite being outdated, it serves as a pledge to "do no harm" We think
the WHO Definition is also an "Oath", pledging the allegiance to
improving health and public health.
3. Ten years: We want our students to remember in 10 years that they
were taught the definition of health. In our experience at the University
of Pittsburgh Graduate School of Public Health, most students remember the
WHO definition. BMJ just published a nice paper by Machteld Huber who
argued that the definition of health as the "ability to adapt and to self
manage". http://www.bmj.com/content/343/bmj.d4163.full
While Dr. Huber
provides an excellent overview to make their case, we doubt that this new
definition will be easy to remember
4. Early to bed, early to rise, makes one healthy, wealthy and wise.
A litmus test for a definition is to see if we can substitute the
definition into health quotes to see if they make sense. If we have
correct definition of health, should be usable in different contexts.
Existing definition of health is understandable and easy to remember.
Should we really try to change it?
We think the WHO definition of health has relevance to the individual
and community. The WHO definition, is short, punchy, almost lyrical
poetry, with credibility and a wonderful history and sounds much like a
pledge. It is an oath to be taken for health and public health. The WHO
definition health has stood well for 60 years, as the Hippocrates oath has
done the same for 1000s of years. Also, it is like a slogan, "just do
it", or "you deserve a break today", that reminds us that we must think of
health and physicians should think of prevention. To us, the WHO
definition appears to be ideally suited for mass marketing of health.
So this is our rationale. We are driven to the WHO definition of
health because of what we want to do, teach all health students about
health.
Faina Linkov, Ph.D.
Ronald LaPorte, Ph.D.
University of Pittsburgh Pittsburgh, PA USA
Competing interests: No competing interests
Re: How should we define health? Huber et al. BMJ 2011;343:d4163
Huber et al. have proposed to reformulate health as the ability to
adapt and self manage. We support the new definition of health with
arguments from the fields of occupational health and positive psychology.
However, the question is whether or not our health system is able to
broaden its scope and get less problem orientated?
As science and technology advance Huber et al. argument that patients
with diseases should be helped to adapt and to self manage with their
physical, mental and social health. We favor this view from our
experiences in the field of occupational health. In the Netherlands
occupational physicians not only explore the medical status, but also the
disease cognitions, contextual work factors and private life of employees.
This helps employees and employers to cope with disease and impairments.
One of the key findings is that functioning helps employees to recover
from illness, whereas postponing return to work results in reduced health
(1). Employees who have difficulties to adapt and manage their diseases
and health complaints have high rates of sickness absence, which is of
major importance for society (2). Our impression is that employers and the
health care system can do more to help employees with chronic illness (3).
Physicians are trained to recognize symptoms of disease and health
risks. From the health perspective, it would be worthwhile to pay
attention to what makes people healthy. Salutogenesis is the term for
studies (4) how people stay well. However, this approach is not very
popular in medicine. The same is true for the field of positive
psychology. The traditional focus of psychology is on people's weaknesses
and malfunctioning, whereas positive psychology proposes a shift towards
human strengths and optimal functioning (5). The healthcare system and
science are mainly focused on negative prognostic factors. An example of
the contrary is that optimism protects against cardiovascular death (6).
Another example is engagement; regarding health this is a remarkable
determinant of mental health: it protects against burnout and contributes
to well being and productivity (7) and is therefore of importance for
society. If salutogenesis, optimism and engagement have such health
benefits, why not giving positive states a greater role in our health care
system?
In the physical, mental and social dimensions of health mentioned by
Huber al., we miss the spiritual aspect. They mentioned 'sense of
coherence' as a factor for successful coping, which includes enhancing,
comprehensibility, manageability and meaningfulness of a stressful
situation. This should be worked out. There are studies (8) which show
that spirituality, seen in its broad meaning and overlapping with positive
psychology, contributes to a sense of mastery and to physical and mental
health. Japanese studies (9,10) state that 'ikigai', a Japanese concept
meaning something worth living for, contributes to reduced risk of all-
cause and cardiovascular death.
Of great importance in developing and implementing this vision, is
the ability of the health care system and health care professionals to
adapt their clinical outlook. Our difficulties in helping patients with
medically unexplained physical symptoms (MUPS), which can only be
understood in biopsychosocial context, shows how difficult it is to
broaden our scope (11). Evidence (12) from the treatment of patients with
longstanding MUPS shows that these patients want to be taken seriously,
explanations they understand and this asks other competences, longer but
less frequent consultations and that this will result in less medical
consumption and better functioning.
To conclude, we acclaim that health should be seen as a ability of
patients to self manage disease within their social context, rather than
being free of disease or complaints.
References
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Anema JR. Effect of integrated care for sick listed patients with chronic
low back pain: economic evaluation alongside a rondomised controlled
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2 Marmot M, Feeney A, Shipley M, North F, Syme SL. Sickness absence as a
measure of health status and functioning: from the Whitehall II Study. J
Epidemiol Community Health 2007;1995:49:124-130.
3 Munir F, Randall F, Yarker J, Nielsen K. The influence of employer
support on employee management of chronic health conditions at work. J
Occup Rehab 2009;19:333-344.
4 Davies P. In praise of salutogenesis: the missing component of most
public health work. J Epidemiol Community Health 2008;62:572.
5 Myers DG. The funds, friends, and faith of happy people. Am Psychol
2000;55:56-67.
6 Das S, O'Keefe JH. Behavorial cardiology: recognizing and addressing
the profound impact of psychosocial stress on cardiovascular health. Curr
Atheroscler Rep 2006;8:111-118.
7 Schaufeli WB, Bakker AB, Van Rhenen W. How changes in job demands and
Resources predict burnout, work engagement, and sickness absenteeism. J
Organ Behav 2009;30:893-917.
8 Tanyi RA, McKenzie M, Chapek C. How family practice physicians, nurse
practitioners, and physician assistants incorporate spiritual care in
practice. J Am Acad Nurse Pract 2009;21:690-697.
9 Tanno K, Sakata K, Ohsawa M, Onoda T, Itai K, Yaegashi Y, Tamakoshi A.
Associations of ikigai as a positive factor with all-cause mortality and
cause-specific mortality among middle-aged and elderly Japanes people:
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10 Koizumi M, Ito H, Kaneko Y, Motohashi Y. Effect of having a sense of
purpose of life on the risk of death from cardiovascular diseases. J
Epidemiol 2008;18:191-196.
11 Ring A, Dowrick CF, Humphris G, Salmon P. What do general practice
patients want when they present their medically unexplained symptoms, and
why do their general practioners feel pressurized? J Psychosom Res
2005;59:255-260.
12 Hoedeman R, Blankenstein AH, Van der Feltz-Cornelis CM, Krol B, Stewart
RE, Groothoff JW. Consultation letters for medically unexplained physical
symptoms. Cochrane Database of Sytematic Reviews. 2010 Dec 8: CD006524.
Review.
Competing interests: No competing interests
While the response(1) of Shilton et al from the International Union
for Health Promotion and Education is correct in pointing out that health
is a social product rather than an individual attribute, their proposed
definition is unhelpful - its final part is a tautology, which makes the
meaningless claim that 'Health is created when... (people's) needs and
rights are supported by systems... conducive to better health'. Like the
WHO Commission on Social Determinants of Health(2), they also fail to
point out that the inequity which as they say, rations global access to
health, is a systematic product of the neoliberal capitalism which so
dominates global public policies and international relations. We must
engage with these realities if we wish to create better health in the
world.
I would propose instead a (thus far unpublished) definition of health
coined in 1996 by Jane Wills, Nigel Watson and myself: 'Health is a
condition in which people achieve control over their lives due to the
equitable distribution of power and resources. Health is thus a collective
value; my health cannot be at the expense of others, nor through the
excessive use of natural resources.' This definition is more in keeping
with the WHO's prerequisites for health for all(3) - equal opportunities
for all, satisfaction of basic needs (adequate food and income, basic
education, safe water and sanitation, decent housing, secure work, a
satisfying role in society), peace and freedom from fear of war - and with
current perspectives on sustainability.
e-mail: alexss@liverpool.ac.uk
References
1 Shilton TR, Sparks M, McQueen D, Lamarre M-C, Jackson S. The
meaning of health - we differ. BMJ rapid response, 8 August 2011.
2 Commission on Social Determinants of Health. Closing the gap in a
generation: health equity through action on the social determinants of
health. Geneva: World Health Organization, 2008.
3 World Health Organisation. _targets for Health for All. Copenhagen:
WHO Regional Office for Europe, 1985
Competing interests: No competing interests
Re: How should we define health?
Dear Editor,
We read, with great interest, the paper of Huber et al., as published in the BMJ 2011;343:d4163. Huber and colleagues attempted to enhance the classic WHO definition, by approaching health as “the ability to adapt and to self-manage”, (1) while conceptualising health as a dynamic, not static state, along with measurable dimensions and indicators.
In addition to this publication, there are numerous theories and conceptual frameworks that have attempted to enrich the WHO definition, the social determinants’ model or develop new approaches to health, happiness and wellbeing. Most of these theories (ecohealth theory, health behavior theory and the economic determinants of happiness) focus on specific aspects of health and support the role of economy, environment, behavior and social networks in “good” health, respectively.(2-7)
However, the unequal distribution of health and socioeconomic prosperity in many cases broadens disparities even in terms of human rights. This has an impact on the definition and notion of health. The concept of health determinants seem to be a more robust approach to the current health needs; according to the WHO “this unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements, and bad politics”.(8,9) The current societal and economic challenges, as well as the refugees/migrants crisis, have identified the need for a more tailored definition of the individual's and societies’ needs, including that of wellbeing and wellness.
It seems interesting to revisit the ancient Greek term “eudaimonia” that was originally mentioned by several Ancient Greek philosophers including Aristotle and Epicurus and others. Aristotle (384–322 BC) assessed “eudaimonia” as a designate end of life, through a dynamic process of “eu zên” (“living well”) during a lifetime. Aristotle suggested that virtue and its continuous exercise is the most important constituent in “eudaimonia”, but also acknowledged the importance of external goods such as health, wealth, and beauty. According to Epicurus (341–270 B.C.E.), “eudaimonia” was what we currently conceive as happiness; it is not simply a neutral or private condition but rather a form of pleasure in its own right (what Epicurus called catastematic or “static” as opposed to “kinetic” pleasure). Etymologically, the term “eudaimonia” consists of the words "eu" ("good") and "daimōn" ("spirit"). Thus, it defines a contented dynamic process of wellbeing, happiness, health, prosperity, physical/mental independence and active community membership.
Based on the above, we suggest that the international health community should introduce the concept of “eudaimonia” and discuss its adoption as a more reliable and holistic approach for conceptualising health, wellbeing and prosperity. The authors have already attempted to define “eudaimonia” and its dimensions through a systematic literature review and an expert panel. The expert panel has agreed on a new consensus-based definition that describes this concept, by highlighting its dimensionality and dynamic “nature”, as follows: “Eudaimonia is the dynamic ability of an individual to evolve and adjust him/herself in time changes and living environment, while maintaining a balance between his/her intellectual independence, health, social relations and the external environment; through reasonable decision making and interpretation of events.” (10) More specifically, the word “ability” defines the “eudaimonia” by referring to an optimum or positive or privileged dynamic process of an individual’s (or group of people's) life. They words “dynamic” and “evolve” capture the constantly changing nature of humans, in terms of biology, psychology, lifestyle, external environment, societies, etc. The word “balance” is vital in this definition and is based on Aristotle’s theory of balanced life, subjective and objective happiness.(11) Furthermore, the reference to intellectual independence and reasonable decision making, adds to the WHO definition and Huber’s approach, while it stresses the significance of individual characteristics that have to do with ingenuity, perception, spirit and rationale.
We strongly consider that this novel approach towards “eudaimonia” introduces a dynamic process/progress of claiming a better life of a non-utopic balanced future, rather than the end point of an ideal state of complete physical, mental and social well-being. This approach encourages more proactive actions rather than reactive actions that are indicated by the Huber and colleagues approach. Perhaps is the time, by utilising “Eudaimonia”, to see health within the context of the universal dynamic society system that affects, is affected and interacts with individuals.(9,11)
References
(1) Huber M, Knottnerus JA, Green L, Horst H, Jadad AR, Kromhout D, et al. How should we define health? BMJ 2011;343:d4163.
(2) Leung Z, Middleton D, Morrison K. One Health and EcoHealth in Ontario: a qualitative study exploring how holistic and integrative approaches are shaping public health practice in Ontario. BMC Public Health 2012;16(12):358.
(3) Di Tella R, McCulloch RJ. Gross national happiness as an answer to the Easterlin Paradox? J Dev Econ 2008;86:22–42.
(4) Phelan JC, Link BG, Diez-Roux A, Kawachi I, Levin B. “Fundamental causes” of social inequalities in mortality: A test of the theory. J Health Soc Behav 2004;45(3):265–285.
(5) Parkes M, Panelli R, Weinstein P. Converging Paradigms for Environmental Health Theory and Practice. Environ Health Perspect 2003;111(5):669–675.
(6) Jadad AR, O'Grady L. A global conversation on defining health , BMJ, 2008. Available at: http://blogs.bmj.com/bmj/2008/12/10/alex-jadad-on-defining-health/. Accessed 12 April 2015.
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Competing interests: No competing interests