Even medical practitioners " doctors" can’t reportedly define ‘health’

The official and universally recognized definition of ‘health’ is the one formulated by the World Health Organization [WHO] in 1948. This UN agency defines ‘health’ as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. In one of our editions, we attempted to define ‘health’ in simple terms as the state of enjoying life free of not only diseases but also all factors leading to diseases and other conditions causing a person to suffer, while promoting all conditions fully supporting health. But, we also then provided the definition created by the WHO. Yet, in our last article we paused to reflect on our definition of health and that of the WHO.

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This reflection informed us that our definition contains two elements not clearly covered in the WHO definition. ?This article concentrates on what should be the full definition of ‘health’. Meanwhile, the WHO constitutes the leading global public health organization dedicated to promoting global health and well-being. It’s been established to provide leadership on global health matters and help countries, particularly developing countries, to attain their health goals. WHO is assigned to directing and coordinating international efforts to improve global health. This signifies that the definition of ‘health’ to be officially followed globally till now is the one formulated by this UN agency in charge of health in the world. Is the definition complete or inflexible? The question is among key issues to be answered by the article.

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We and Dr. Alistair Tulloch argue that this definition is incomplete for reasons we are going to give. Besides, the definition isn’t inflexible. It can be changed or adapted, to accommodate the real context, yet still it the WHO that is entitled to adjust the definition. In other words, it is the agency that holds the right to initiate the process of modifying the definition, if it deems it right. Meantime, each and every field has to be completely defined, also for reasons which we are also going to furnish in this article.

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Who is Dr. Tulloch?

He was born and raised in Scotland and trained as a doctor at Aberdeen University before undertaking his two-year National Service in the Royal Air Force [RAF]. RAF is the United Kingdom’s air force.? The university- the fifth oldest University in the UK- features among the most powerful higher learning institutions globally. It is ranked the 208th among the best universities across the world in 2024.

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Dr. Tulloch retired in 1987, aged 61. He qualified as a GP in 1950. GPs, general practitioners, handle a range of health problems and are usually the first persons that patients turn to for help. They are general experts in the whole field of medicine, attending to both children and adults. He wrote the book ‘Medicine and Other Topics’ which is an autobiography from someone steeped in the values of the National Health Service [NHS]. The NHS is the publicly funded healthcare system in England, and one of the four National Health Service systems in the United Kingdom. The NHS stands as the second largest single-payer healthcare system in the world after the Brazilian one.

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What should be the complete definition of ‘health’?

Dr. Tulloch’s arguments will contribute to showing what the complete definition of health ought to be. The arguments lie in his document entitled “What do we mean by health?” It was published by the National Institutes of Health [NIH], the National Library of Medicine [NLM] and the National Center for Biotechnology Information [NCBI] on 1st April2005. The NIH is the primary agency of the United States government responsible for biomedical and public health research. The United States NLM, operated by the United States federal government, is the world's largest medical library. The NCBI constitutes a component of the NLM, a branch of the NIH.

Dr. Tulloch starts, saying “The main objective of the doctor's work, in whatever field he or she functions, is ultimately the restoration and maintenance of health. Yet, as Smith pointed out some time ago, disease and health are ‘slippery concepts’ that we have not been able to define clearly hitherto. The difficulty of defining health was clearly illustrated when the distinguished figures of the World Health Organisation (WHO) were asked to undertake this task in 1948. Their response was that ‘health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.”

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Dr. Tulloch doesn’t identify with this definition. He indicates that no other credible source furnishes the satisfactory definition of ‘health’ either. “Now, a definition should define clearly the nature of a subject as it is or by what effect it has; that is, what it does. In addition, in the fields of science and medicine, it should indicate how the subject is produced and enable it to be measured. The WHO definition did none of these things — it merely took one vague entity ‘health’ and defined it in terms of another equally obscure concept, ‘wellbeing’. It did, however, point out that there was more to health than simply the absence of disease, but this was not really a definition at all, being merely a rather vague description.

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The waters remained as muddy as ever and the measurement of health was in no way facilitated. Incidentally, the Oxford English Dictionary is no more precise on this subject. It offers a number of meanings including ‘soundness of body, that condition in which functions are duly discharged, spiritual, moral or mental soundness, salvation, well-being, safety and deliverance’ — all parts of the picture, but a real definition is still some way off.”

He underlines a certain interesting thing. This is that, according to him, physicians fail to define ‘health’ while this forms their field. He doesn’t nevertheless blame them, for a reason which he furnishes. “Now one does not have to be Wittgenstein to recognise the absurdity of the situation in which doctors regard health as the main currency of their work, despite the fact that they cannot define exactly what they mean by the term.

Indeed, they may even take refuge in the belief that ‘health’ is impossible to define. Even more remarkably this extraordinary fact seems of little concern to the medical profession. It certainly did not concern me in any way throughout my entire career. After all, we seemed to manage reasonably well with the current vague concept of what we mean by the term ‘health’. Is this complacency justified? In retirement I have come to think that it is not.”

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In the meanwhile, ‘health’ like all other fields needs to be explained perfectly or fully for people to completely understand it. This complete understanding of ‘health’ permits people to perfectly execute the right actions to perfectly ensure it.

Different personalities with whom we completely concur point out that it can be hard for people to apply a concept/field which they don’t comprehend. Oshadhi Herath from the Department of Philosophy at the University of Kelaniya in Srilanka is one of them. He has also underlined that it can be difficult for people to operationalize a concept, if they’re not enlightened on it. While contributing to defining ‘peace’, he has said “If[a] person defines something vague, it will be difficult to put [it] into practice.”

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A field not fully defined will create room for limitations and this is observed in the medical field. As we agree upon it with Tulloch, the current official definition of ‘health’ lacks certain key aspects. This generates room for doctors not to intervene massively in those key aspects. The definition doesn’t incorporate external/environmental factors and doesn’t suggest anything about approaches/mechanism or actions to assure health. However, the definition of a science field like health ought to indicate action to take so as to promote or support the field as even implied by Tulloch.

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He points out “In this context, the task of the doctor is primarily (and prior to the start of the 20th century was almost exclusively) the identification and management of disease presented to them by their patients. Of course there were pioneers like Edward Jenner and John Snow in the 18th and 19th centuries who drew attention to the importance of preventive measures and control of environmental forces. However, the profession was slow to learn from them and it was not until the 20th century that preventive care programmes focused on disease, accidents and a variety of other environmental factors likely to affect health.”

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He adds that this form of prophylaxis has been developed very slowly and tends to be seen even as a supplementary back-up service. "Thus, disease is the main focus of the doctor's work and the background to disease does not enjoy the same attention, which is why occupational health has only established itself very slowly across the last 50 years while the specialty of rehabilitation has an even shorter lifespan.

By contrast, clinical care of diseases and accidents goes back thousands of years. So, I am suggesting that our failure to define health may well have been more influential in the evolution of our philosophy of medical care than, perhaps, we recognised in the past. Philosophers, who claim to be seeking ‘the ultimate nature of reality’, would no doubt point out to doctors that this is precisely what they are failing to do and that their patients are paying the price as a result.”

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In fact, with the WHO definition of health, we understand that the focus is only placed upon fighting diseases, but without considering the context of diseases.

The definition doesn’t reflect other factors like those in the physical environment which create or can create diseases. Health as defined by the WHO needs to be enormously supported by favorable external/environmental conditions and behaviors, for it to materialize as exactly as defined by this organization.

Nonetheless, the definition doesn’t conspicuously address these conditions. Tulloch suggests it in these words “Supposing, instead of the conventional model, the starting point of our thinking was that men and women live day-by-day in an alien environment subject to a variety of hostile forces, which constantly threaten and sometimes damage them.

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Their response has been one that enables them- with the assistance of better hygiene, sanitation, diets, health education and medical care in most cases- to adapt to these forces and function normally in the community most of the time — in advanced Western societies at least. Thus, we have a simple definition of ‘health’ as the capacity to make this adaptation, while ‘ill-health’ can be defined as failure to adapt to environmental forces and function normally in society.”

Dr. Tulloch adds that the alien forces referred to above are several and varied. Some of the most serious ones include accidents, infections, other physical disorders, psychological factors, lack of exercise, poverty, social deprivation, inadequate diet, obesity, poor quality or unsuitable accommodation (including poor heating) and lack of sanitation. “To this can be added poor working conditions, inappropriate social behaviour (for example, smoking and drug abuse), ageing, weather conditions, foreign travel, inadequate medical care (either from poor provision or low standards) and the most hazardous sporting or recreational activities.

These environmental forces are mainly external but can occasionally be internal when, for example, they take the form of congenital or autoimmune disease”.

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Tulloch encourages a broad view toward the sector of health and we agree with him without any reservations. “I would contend that the planning of health care today could be facilitated by the medical profession taking much more account of the context of disease than at present and there are many instances in which this is important. For example, doctors in the UK do far less than they should to halt the carnage on the roads. A significant minority of the general public are all too often indifferent to this heavy loss of life, as witnessed by their hostility to the introduction of cameras on the roadside that expose their excessive speeding and save lives. The profession should therefore be pressurising the government much more vigorously to take more action in this field.”

“So, if human health is to be seen as a process of adaptation which, with the help of medical care, is improving slowly generation by generation, what is the best way for it to be developed? Surely by making people better equipped to adapt to these hostile environmental forces which, in turn, need to be much better controlled to reduce their harmful effects on human beings. Or, put another way, by the highest standards of clinical care associated with better health education and environmental control.”

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Tulloch recommends that people ought to be protected from environmental hazards to which they are exposed day by day, as they go about their lives. “This different perspective on health defines its nature and suggests the need for more emphasis on the context of disease than at present, while, at the same time, maintaining the highest standards of clinical care.”

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Our definition of health tallies with Tulloch’s comments. We try to define ‘health’ as the state of enjoying life free of diseases but also all factors leading to diseases and other conditions causing a person to suffer, while promoting all conditions fully supporting health. But, here, we don’t intend to maintain that our definition is perfect. That’s not our purpose. Our purpose is instead to argue that the current definition of health ought to be amended, adding those key areas still lacking in it. In our opinion, the amendment shouldn’t remove anything from the current definition; it should only conspicuously include the two aspects lacking in.

The two aspects involve (1) dealing with all factors/conditions leading to diseases and (2) promoting all conditions fully supporting health which includes health education. You can argue that these aspects are also carried out. We will concur on it, but reply to you that these areas aren’t clearly covered in the current definition and that this represents a limitation.

As even highlighted by Dr. Tulloch, if these aspects are reflected in the definition, healthcare practitioners will include them in their primary tasks and it will yield more considerable results by far. Yet, today it can cause them to feel that it doesn’t behoove them to intervene significantly in those areas.

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Thus, as we have begun it with this article, we will carry advocacy on so as for the current definition of health to be revised.

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By Jean Baptiste Ndabananiye- Media, Empowerment& MBA.

Management and Journalism Professional with a demonstrated history/experience of involvement in women’s empowerment, project/program management, peace-building/conflict transformation, training, public awareness campaigns, governance and budget transparency, advocacy, documentation, the broadcast media industry, and community justice, among others.

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He is skilled, among others, in English and French, Project& Program Management, Media Production, Peace-building, Leadership, Advocacy, and Kinyarwanda- English-French Translation, and Mind-Body Connection and its Link with Health through extensive reading and investigation about these two fields as well as Health Reporting and Communication. Strong management, media and communication professional with a Bachelor's and Master's focused in Journalism& Communication and MBA-Project Management respectively from University of Rwanda and Mount Kenya University.

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