The concept and definition of health is a personal one for me. I have always considered myself a healthy person. To me this meant a balance of eating well and exercising regularly alongside a good dose of fun, relaxation and the occasional bag of candy or chips. I had been healthy for the better part of thirty six years when everything changed. I was diagnosed with Type 1 diabetes in my thirties (unusual yes, but not unheard of). As you can imagine this was shocking, devastating and very scary. Suddenly the health I thought I had was gone. Although I don't know that I could have articulated it at the time, but it's clear I equated my own health with an active lifestyle and the absence of disease.
In the weeks after my diagnosis, I was sent to a Rapid Access Clinic to see a specialist. I was first assessed by a resident doctor. During the assessment, he was surprised to learn that I participated in many "healthy" activities as part of my usual routines. Later the specialist entered and in the first few moments of meeting me she said, "after assessing you this doctor described you as previously healthy and I had to correct him. You are healthy and we are going to work together to keep you that way." This statement changed the way I viewed my health in the face of a chronic illness diagnosis. It has shaped the way I choose to live with and manage my disease. It was an impactful and empowering statement.
So what is health and who is healthy? The World Health Organization (WHO) defines health as a "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (1948). Although this definition may seem progressive with a move beyond the absence of disease and the inclusion of domains beyond the physical body, the word complete in essence excludes anyone with a physical or mental disability from being healthy. One might argue that I do not hold complete physical health given my pancreas is close to non-functional despite the fact that I live a rich and productive life with no health complications.
Huber (2011) on the other hand describes a much more fitting definition (for me anyway) where health is defined as the ability to adapt and self manage. This idea is more dynamic in nature and measures resilience, quality of life and functional status (is my OT background showing?). Under this definition of health, someone living with a chronic illness or disability may have opportunity to be healthy.
Interestingly, Nazi (2012) discussed the idea of health with persons with physical disabilities who largely described health as the absence of illness. The people interviewed, considered themselves healthy despite living with a physical disability (Nazi, 2012). Nazi found that when talking about recovering from illness, a return to health was equated to returning to the activities of daily life however that looked for them.
The Lancet (2009) discusses a view of health described by George Canguilhem (1943) which is a combination of what Huber (2011) and Nazi (2012) outline. Canguilhem as cited in the Lancet, describes a state of health as the ability to adapt to one's environment, where health is not the same for all but "varies for every individual, depending on their circumstances." (The Lancet, 2009, pg. 781). The definition of health described by Canguilhem takes the physical, mental and social aspects of life and includes the persons relationship with the environment. This definition is much more fluid then the WHO's definition and allows health to be defined by the patient. The role of the physician or health practitioner is to work alongside the patient to help the patient adapt to their specific set of circumstances in the context of his or her environment. It recognizes the patient as partner. This definition of health recognizes that one definition of health does not fit all. Thinking about this, let me share another personal experience. Early in learning to manage my diabetes I was reviewing my blood sugars with the my specialist. I'd had an incidence of high blood sugar on the previous Saturday night. I shared with her that I had watched a hockey game and eaten ripple chips and had a few beers. I was nervous telling her, thinking she may judge my unhealthy Saturday night. Instead of judging me, she said "okay, let's figure out how to manage your blood sugar when watching hockey, eating chips and drinking beer. " Her ability to help me learn to manage a chronic illness within the context of my own varied life activities has ultimately led to better blood sugar control and better long term health.
In closing, it is evident that health does not mean the same thing to everyone and that health is so much more than the absence of disease. An individuals health is influenced by their environment and unique circumstances. As in my personal example, the concept of health could prove to be a meaningful and empowering wellness tool. In a world where people are living longer, living with chronic illness and disability it would be prudent to expand the definition of health beyond the 1948 WHO definition. Finding a definition that resonates with everyone will likely prove difficult so why not leave the patient to define what health looks like for them?
Huber, M., André Knottnerus, J., Green, L., Van Der Horst, H., Jadad, A. R., Kromhout, D.,
Leonard, B., Lorig, K., Loureiro, M. I., Van Der Meer, J. W. M., Schnabel, P., Smith, R.,
Van Weel, C., & Smid, H. (2011). How should we define health? BMJ (Online), 343(7817).
Nazli, A. (2012). “I’m Healthy”: Construction of health in disability. Disability and Health Journal, 5(4),
What is health? The ability to adapt. (2009). Lancet (London, England), 373(9666), 781.
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