Redefining Health and Well-Being – How the WHO has it wrong

What is health? Nutritious food and exercise quickly come to mind.  Being healthy makes us think of doing something. We have a healthy diet, lead a healthy lifestyle, have healthy relationships. “Healthy”, the adjective, is easily understood as a good way of doing something. It’s more difficult to define “health”, the noun. Presumably doing healthy things brings us health. Why else would we do healthy things? The reasons, and hence the “health” being sought, differ from person to person. Enter “well-being” and the subjectivity amplifies. The two are intimately linked. Perhaps not in the way we’ve been sold.

Let’s start with a definition. I know, I am breaking 10th grade English dogma – don’t start your introduction with a definition! My purpose is to show you how a widely accepted definition is not only wrong but is not actionable. The World Health Organization definition of “health”:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

I appreciate the inclusion of “physical, mental and social” as necessary components of health. The utility of this definition ends there for me. Starting with the second clause the WHO suggests that the presence of “disease or infirmity” (read: disability) negates the achievement of a state of health. Can one not have health while living with chronic disease or disability? Rhetoric aside, I don’t think I need to expand further.

Back to the first clause, “Health is a state of complete […] well-being”. I’ve removed the part I like to reveal the absolute nature of this statement. If you broadly apply the WHO’s definition of health, you would be hard pressed to find any human being who meets the criteria of clause one alone. Let’s give the WHO the benefit of the doubt – their definition is aspirational. It’s meant to inspire nations and their policy-makers to reach the highest possible heights of health, equity, and productivity. I’m skewering their definition to make the point that health, to the individual, must be cast in a different light. What of well-being?

In the philosophical sense, well-being is how well your life is going for you. There is debate about how to quantify this. One has to know the constituents of well-being and how to determine what makes them good for the individual. There are three leading theories, Hedonism (balance of pleasure over pain), Desire-satisfaction (fulfillment of desires), and Objective list (constituents of well-being outside of pleasure and desires). I will not dive into these here, suffice it to say that each has its limitations. Given the theoretical equipoise, I feel I have license to propose my own definition, albeit leaning in the direction of Objective list theory. Let’s first address the relationship between health and well-being.

According to the WHO, health cannot be achieved until you have well-being. For those policy-makers trying to bring health to their people, the problem of defining well-being becomes eminently vexing. If defining health is the Mona Lisa, defining well-being is the ceiling of the Sistine Chapel. My main contention, however, is against the assertion that health is secondary to well-being. I argue that the opposite is true.

Argument from First Principles

You are a biological being. You have physiologic systems that require inputs and produce outputs. An ideal state of health, then, could be considered providing the precise quantity and rate of inputs your systems need to perform effectively and efficiently. Nothing more, nothing less. Inputs may include nutrition, sleep, physical activity, mental stimulation, and so on.

Now imagine a scenario where someone has completely engineered your life for you. They have designed a way to provide all inputs, tailored to your biological and genetic profile – proper food, eight hours of sleep per night, physical training, exemplary education, even socialization. Everything is controlled. Even though you could be in perfect physical and mental health, you would not be surprised to find yourself completely miserable.

How can this be so? Because whatever we do to be healthy is ultimately being done to prepare us for something else. That something else is conscious experience. I do not wish to invoke any arguments about dualism here. Regardless of how you think about the nature of consciousness, its existence is undeniable.

Consciousness presents the world to us. It is within consciousness that we do or do not achieve well-being. An ideal state of health gives us our best chance to achieve well-being but does not guarantee it. Well-being is achieved when our consciousness perceives that our internal and external states are aligned and complimentary. If I am in pain and I do not think I should be in pain, I am suffering, and my well-being is under attack. If I have a set of beliefs but others are forcing theirs upon me, there is conflict, and my well-being is under attack. If I love the natural world and have time to go for long hikes (and the physical health to do so), I feel fulfilled, and my well-being is sustained.

Argument from Evolution

From an evolutionary standpoint the healthiest, strongest, fittest people had an advantage. This includes mental health and intelligence, requirements to succeed in a group. In a hunter-gatherer tribe, most waking hours would be spent on activities to promote survival. Good health would allow individuals to contribute more and pass on their genes. Well-being doesn’t emerge as something with which one has to be concerned until you can do something more than simply survive.

Well-being requires time, with which one can turn their attention to or think about whatever they choose. It requires time to experience a sense that what you’re doing is worthwhile.

Well-being became possible once we had larger societies with economies and adequate resources. Once you can purchase or trade for what you otherwise would have spent your time acquiring, you have time to learn, travel, care, volunteer, socialize, play, and more. These are things with which we associate meaning or purpose. Plato and Aristotle were able to think extensively about well-being, virtue, and the like, because they lived in a society that valued knowledge and was able to support a number of citizens who did not contribute to the production of physical resources.

One could point out that we would not be able to conceptualize or experience well-being were we not adapted for it. While true, this does not negate my argument. Before modernity the major selective pressures would have primarily favoured characteristics that promoted survival. In keeping with the story of evolution, it is generally only known what characteristics conferred an advantage in hindsight. The emergence of consciousness and ability to reason are clear evolutionary advantages, allowing ancient peoples to develop language and band together in complex societies. These events needed to occur prior to the ability to articulate and reflect on what is now being considered as well-being. Hence, I contend that the notion of well-being is an interesting development that came along for the ride while humans evolved to become the primary dominant species that we now are.

Conclusion and New Definitions

To bring this full circle, two questions help underscore the fact that health precedes well-being and not the converse:

Can you have good health without well-being? Yes, without a doubt.

Can you have well-being without good health? Unlikely.

Notice I haven’t answered ‘No’ to question two. Health is an important (likely the most important), but not sole component leading to well-being. If you are a Buddhist Dzogchen master and have become enlightened, unencumbered by a sense of self, you could have well-being without good health, because there is no self that requires it. You would still require some degree of health, though, to hold the body upright and have clarity of mind enough to meditate.

Also note that within my questions ‘good health’ does not ascribe to the WHO’s “absence of disease or infirmity”. Health is a product of the individual within whom is resides. With that said, here are my suggested new definitions for health and well-being:

Health:            A state of optimal physical, mental and social functioning that gives one the best opportunity to live well.

Well-being:     A state of consciousness in which one’s internal and external experiences are aligned to create feelings of happiness, fulfillment, meaning and/or satisfaction, over the course of one’s lifetime.

Within the definition of health, I have used the word “optimal”. This allows anyone to optimize their physical, mental and social functions to fit their current state, be it free of disease and disability, or not. The definition also tells us that health is a foundational state. If we have health, we are on solid ground. Health is the jumping-off point for us to live our best lives.

Well-being is less tangible. While not the only route, health is the major conduit to well-being. As the definition states, your internal and external states must align. This means that your physical, mental and social functioning, as well as your environment, occupation, goal structure, expectations, and more, must converge to create the feeling of fulfillment. By its nature, well-being is transient, but can be kept closer at hand with deliberate attention.

As a final thought, I have designed the definitions to be actionable. Getting to an optimized state, modifying, and optimizing some more, is achievable. Getting to “complete […] well-being” is not. Reflecting on your internal and external experiences to assess their alignment can also be done. Keep these definitions close at hand as we continue to explore ways to empower your pursuit of health & well-being.

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