Rethinking Healthy: From Static Definitions to Dynamic Adaptation

A recent article by Krahn et al. (2021) presents an interesting redefinition of health: "Health is the dynamic balance of physical, mental, social, and existential well-being in adapting to conditions of life and the environment." The authors argue that this definition advances contemporary thinking, drawing on the direct experiences of people with disabilities. One notable feature of their work is a table (see below) outlining the evolving views on health definitions. What stands out are the use of terms like "dynamic" and "adaptation," which didn’t appear until the 2000s. Prior to this, terms like "balance," "whole," and "complete" were more commonly used. 

The WHO’s definition of health, “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”, faces several modern critiques. Krahn describes how this definition began right after the world was emerging from warfare, 76 years ago. The causes of mortality and when describing someone as unhealthy were things like infectious diseases, cardiac conditions and cancers (Taylor et al., 1998).  They had not yet witnessed issues like chronic conditions, social determinants of health, racial disparities, obesity and changes due to technology as we are today.  In 2009 the scientific editors of the Lancet replaced the words “a complete state” with the word’s adaptation. Huber (2011) also argued that if we require a person to meet this "complete" standard in all three areas physical, mental, and social well-being, to be considered healthy, we overlook important factors like early diagnoses, which modern technology now makes possible. Such a rigid definition could unfairly label individuals as unhealthy, even if they are effectively managing and coping with a condition. Krahn also suggeted, and I agree, that we need a health definition that better accounts for an individual’s ability to adapt to and self-manage health challenges, including those related to aging. Their definition reflects current health realities, including the rise of chronic conditions, increasing mental health awareness, and the impact of early diagnosis. Both Krahn and Huber propose a dynamic, capacity-based model of health that focuses on an individual’s ability to cope with disease, rather than adhering to an unrealistic standard of "completeness."

I find Krahn and colleagues' definition particularly relevant today. It highlights key concepts like a dynamic approach and adaptation, which will remain important in the decades to come. Additionally, it views health as a continuum. They further promote their definition by emphasizing the inclusion of existential well-being alongside physical, mental, and social well-being, referring to a person's subjective state of well-being in relation to dimensions such as quality of life. They describe this aspect as "spiritual integrity." Krahn and colleagues also suggest that good health can exist even in the presence of limitations, challenging the WHO's focus on health as a measure of function. Instead, Krahn argues that their definition will enable policymakers to better promote health for individuals with disabilities, moving away from the idea that disability equates to poor health. As we continue to evolve and face new challenges, this definition is likely to remain a valuable framework.

Lastly, the definition considers the social, political, and physical aspects of the environment. By this, Krahn and colleagues highlight the importance of social and policy strategies aimed at improving health both at the individual and population levels. Including a political lens is needed for influencing government decisions and advocating for policy change. This definition also stresses the need for ongoing adaptation, from managing disabilities to coping with chronic conditions, and recognizing the health inequities faced by marginalized groups in society.

Table

References

Huber, M. (2011). Health: How should we define it? British Medical Journal,

343(7817), 235-237. https://doi.org/10.1136/bmj.d4163

Krahn, G. L., Robinson, A., Murray, A. J., & Havercamp, S. M. (2021). It’s time to reconsider how

we define health: Perspective from disability and chronic condition. Disability and Health

Journal, 14, 101129. https://doi.org/10.1016/j.dhjo.2021.101129

Taylor R, Lewis M, Powles J. The Australian mortality decline: cause-specific mortality 1907-

1990. Aust N Z J Publ Health. 1998;22(1):37e44.

https://doi.org/10.1111/j.1467-842X.1998.tb01142.x.