What is Health? What Determines Health Status?

If I were to rewind back to my high school days, back when I applied to nursing school, my perception of the profession revolved around caring for "Sick" individuals. At that time, my understanding of "Sick" was limited to physical ailments—broken bones, tumors, infections, and the like. What I overlooked were the dimensions of mental and social well-being, along with the promotion of overall wellness.

The definition of health can be a relative, and intricate concept, varying from person to person and even from one culture to another (Brook, 2017). This complexity prompts the question: what constitutes the most accurate definition of health? And how can we validate health across all its dimensions? For clarity, let's examine the word "Health" as an adjective describing a state or status.

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A quick Google search for the definition states: "The state of being free from illness or injury." A secondary definition includes mental health by stating: "A person's mental or physical condition." It is interesting that the World Health Organization's (WHO) definition, introduced in 1948, incorporates a much more holistic definition than one of the most up-to-date proficient English search engines. The WHO defines health as "A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

During my quest for a fitting definition of health, I posed questions inspired by my readings. Would I be considered healthy? Is it possible to be entirely healthy across all dimensions? I asked this after seeing the word “Complete,” inserted in the WHO’s definition. The status of complete health is controversial, and impossible to measure when considering an aging population (Oleribe et al, 2018). Are the tools and standards used to gauge health universally applicable? These questions prove challenging to answer due to the intricate variables at play from person to person. Values differ and tolerating these differences should be considered a determinant of health (Brook, 2017). Is a person with a chronic lung disease requiring oxygen healthier than an adolescent experiencing suicidal ideation? Given these complexities, I genuinely believe the most suitable definition of health is "The ability to adapt and self-manage," created by the Health Council of Netherlands (Huber, 2011) This definition accommodates interpretation and dismisses the static notion of health. Whether one faces social, physical, or mental barriers, the elements of health lie in the capacity to adapt to life's ups and downs.

One might raise the issue of terminal and chronic illnesses and their physical impacts, asking how one can adapt to those conditions. Rest assured, when the definition is dynamic, it can still account for all three elements (Oleribe et al, 2018). Consider a homeless individual who adapts their social status by working with community resources, maintains physical hygiene, and cares for their mental well-being. Conversely, think of someone who fractures their hip and becomes secluded and depressed while awaiting rehabilitation. The latter is not adapting well, resulting in an unhealthy state. This dynamic approach leans on the individual’s integrity and sense of wellbeing (Huber, 2011).

Another definition suggests health as "A satisfactory and acceptable state of physical, mental, emotional, economic, and social well-being," (Oleribe et al, 2018). Notably, the key word here is "Acceptable," implying that what constitutes acceptability is a mutual agreement between the individual and society. While this definition introduces five determinants of health, it may appear somewhat unclear. However, it aligns closely with Canada's social determinants of health, which encompass personal, social, economic, and environmental factors (Government of Canada, 2020).

I favor the dynamic adaptive definition because it accommodates some determinants of health including the many inequalities people face (Government of Canada, 2020). With this definition, someone experiencing inequality is not inherently deemed unhealthy but is evaluated based on their response to these challenges. Individual variability, ongoing changing circumstances, societal influences, and advancements in healthcare all underscore the need for a dynamic definition.

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I acknowledge that this definition is not without its imperfections. Self-management alone may not suffice to define someone as healthy. For example, an individual deemed overweight according to a validated tool like the Body Mass Index (BMI) may manage well by engaging in physical activity, maintaining a social life, and experiencing no self-image concerns. However, this does not negate the potential high risk for conditions like Coronary Artery Disease (CAD) or diabetes. Existing validation tools should continue to be part of the decision-making process to determine one's state of health along with categorizing them in the determinants of health with an emphasis on a dynamic definition.

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