Defining health as if society mattered
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I would propose instead a (thus far unpublished) definition of health coined in 1996 by Jane Wills, Nigel Watson and myself: 'Health is a condition in which people achieve control over their lives due to the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]