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As with WHO's 'complete state...' this is an aspirational concept of health which draws attention to the avoidably unequal world we all live in. I wouldn't scour the world for examples of good health: my preference is rather, to seek the means to change it.

William Morris wrote, in 1884, '...at least I know this, that if a man is overworked in any degree he cannot enjoy the sort of health I am speaking of; nor can he if he is continually chained to one dull round of mechanical work, with no hope at the other end of it; nor if he lives in continual sordid anxiety for his livelihood, nor if he is ill housed, nor if he is deprived of all enjoyment of the natural beauty of the world, nor if he has no amusement to quicken the flow of his spirits from time to time: all these things, which touch more or less directly on his bodily condition, are born of the claim I make to live in good health'

William Morris. How we live and how we might live (1884). (In) AL Morton, ed. Political Writings of William Morris. Lawrence and Wishart, 1973

125 years on, few if any can even claim the good health he so clearly understood. We remain subject to the inequalities he perceived. But this doesn't mean we should accept them as inevitable

All best, Alex



On 15/08/2011 20:59, Daniel Shaw wrote:
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Dear Alex,

Thank you for sharing this.

I'd be interested to hear from you on examples in which you believe health as you define it has been attained.

Best wishes,

Daniel Shaw

Date: Mon, 15 Aug 2011 16:31:21 +0100
From: [log in to unmask]
Subject: Defining health as if society mattered
To: [log in to unmask]

You may find this BMJ rapid response of interest, as it proposes a new definition of health - this in response to a recent BMJ article (see foot of this e-mail) which proposed a (very individualistic) replacement for the 1948 WHO definition; and to an earlier rapid response which is mentioned in my letter


Defining health as if society mattered

http://www.bmj.com/content/343/bmj.d4163.full/reply#bmj_el_268624

Alex Scott-Samuel, Clinical senior lecturer in public health,Department of Public Health and Policy, University of Liverpool

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.

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: None declared

Published 15 August 2011

ORIGINAL ARTICLE

Huber M, et al. How should we define health? BMJ 2011;343:doi:10.1136/bmj.d4163 [Extract] 



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Dr Alex Scott-Samuel 
EQUAL (Equity in Health Research and Development Unit) 
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