On examination, health can be defined and evaluated through various lenses; individuals, communities, cultures, occupations, or governments. Each offers a unique perspective on what it means to be “healthy” and demonstrate differing values and priorities in relation to good health. As Canada’s health system continues to evolve, so should our definition of health and our understanding of how health practitioners can play a role in the advancement of understanding and supporting health in Canada.
The definition of health has, historically, been poorly defined. The evolution of this definition from the World Health Organization (WHO) can be interpreted with continued rigidity and lacking in the pragmatism of daily living. Since 1948, WHO states “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” with the latter serving as an original depiction of health (WHO, 2020). Global and national views of health have shifted through the years, and while the inclusions of mental and social well-being are welcomed, the WHO definition remains absolute by the choice of the word “complete”. This unyielding term hinders the ability to view health as an ever-evolving spectrum, with continuous compromise. Huber proposes the definition of health should be formulated in such a way to include the “ability to adapt and to self manage” (2011). The WHO definition also lacks individualistic approaches and understanding of health, such as that of a specific group of peoples.
A more current definition of health, developed by the Ottawa Charter for Health Promotion, in an expansion of the WHO definition, states, “To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment” (1986). This broader depiction of health opens up the definition to interpretation from specific groups. Instead of offering the definition of health as a “complete state of well-being”, it suggests that groups can individualize the components and priorities and that health can change with time and environments.
In an exploration of the definition of health, I would like to examine it through the lens of population health, as it empowers groups to include unique characteristics, specific values, and to create tools of measurement that are appropriate and relevant. For example, The Arctic Institute Center for Circumpolar Security Studies highlights that, while there has been increased health care and research engagement in Indigenous communities, there “remains a need for health care models that are born from Indigenous perspectives on wellness”(Healey, 2017). Similar to Huber’s recommendation of applying a framework as opposed to a rigid definition (2011), The International Journal of Environmental Research and Public Health considered “Indicators of Indigenous Community Health” through an examination of the effectiveness of health assessments in Indigenous populations. They state “health assessments may be too narrow in scope (e.g., only focus physiological health, leaving out cultural, emotional and environmental health and interconnections), limited in scale (e.g, only focus on individuals rather than family or community), or are unable to find and utilize indicators that depict the “intangible” aspects of Indigenous health (e.g., importance of ceremonies, relations with inanimate objects such as mountains or water” (Donatuto, Campbell, & Gregory, 2016). This examination rightfully indicates that health definitions and assessments need “to reflect an understanding of the key values and priorities of the people in questions and…must be driven and refined by the people in question for use in their own communities, reflecting their own unique histories and place-based uses of resources” (2016). In a publication by Richmond, Ross, and Bernier, exploring Indigenous concepts of health, they state “because such sizable disparities exist between Indigenous and non-Indigenous populations…it is arguable that these kinds of comparisons are irrelevant because Indigenous and non-Indigenous concepts of health are shaped by distinct world views and cultures of experience, which are undeniably different between two populations” (2007). The Canadian Institute for Health Information (CIHI, 2016) provides a video describing various sets of health indicators used widely in Canada (i.e. Long term care, hospitals, or national) and clarifies that indicators or measurements of health designed for a specific setting or population are required to ensure you are “comparing apples to apples” (CIHI). This further demonstrates the need for a population-specific approach to ensure that “you are measuring what you say you are measuring” (CIHI, 2016).
Another shortfall of the World Health Organization's definition of health is in the lack of acknowledgment with regards to others’ perceptions of one’s health. The unilateral definition focuses on the singular view of the individual in question – it does not take into account prejudice, racism, or externally perceived state of health. In an article by Lauren Howe, a Ph.D. candidate in Social Psychology, she criticizes the WHO definition to this point. She states, “Overweight people face social disapproval, such as being seen as lazy, weak-willed, or worthless” (2016). Attitudes such as systemic racism or prejudice will affect the context in which an individual or community can be considered healthy, and the WHO definition falls short to identify this concern.
While the WHO definition of health presents a simplified concept of health, there are population-specific frameworks and resources that are more capable of providing an understanding of health. Examples are frameworks such as the Social Determinants of Health (WHO, 2017) or the Indigenous Health Indicators (Donatuto, Campbell, & Gregory, 2016), which are more suitable for use when evaluating the health of individuals or populations, such as Canada’s Indigenous and Inuit population. They provide a more detailed analysis and depict population-specific limitations or barriers. I welcome the shift from a definition-based to a framework-based depiction of health and support the use of population-specific tools as a more valuable approach to understanding.
References
Canadian Institute for Health Information. (July 13, 2016). Getting to know health indicators [Video]. Youtube.https://www.youtube.com/watch?v=hxPUSluTJcM
Howe, L. (2016, January 29). Character & Context: Creating a new definition of what it means to be healthy. Retrieved June 07, 2020, from http://www.spsp.org/news-center/blog/what-it-means-to-be-healthy
Donatuto, J., Campbell, L., & Gregory, R. (2016, September 9). Developing Responsive Indicators of Indigenous Community Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036732/
Healey, G. (2017, June 20). What if our health care systems embodied the values of our communities? A reflection from Nunavut. Retrieved from https://www.thearcticinstitute.org/health-care-systems-values-communities-nunavut/
Huber, M. (2011). Health: How should we define it? British Medical Journal, 343,(7817), 235-237. https://doi.org/10.1136/bmj.d4163
Richmond, Chantelle A.M.; Ross, Nancy A.; and Bernier, Julie, "Exploring Indigenous Concepts of Health: The Dimensions of Métis and Inuit Health" (2007). Aboriginal Policy Research Consortium International (APRCi). 115. Retrieved from https://ir.lib.uwo.ca/aprci/115
World Health Organization. (2017, September 25). About social determinants of health. Retrieved from https://www.who.int/social_determinants/sdh_definition/en/
World Health Organization. (2020, 06 03). Who Are We / Constitution. Retrieved from World Health Organization: https://www.who.int/about/who-we-are/constitution
World Health Organization. (1986). Ottawa Charter for Health Promotion. Retrieved from https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf
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