In my thinking and writing about health, I have often found myself leaning on the preamble to the World Health Organization (WHO) constitution, which says, "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."
In truth, I have referred to this quote so often that it can sometimes feel a bit hackneyed. But I continue to lean on it because it reflects an accurate understanding of health.
Our world is unhealthy if it can treat a range of diseases but cannot prevent them. It is unhealthy if it invests in healthcare alone while neglecting the foundational drivers of health.
When I ponder this approach to health and the many varieties of health that may exist within the basic framework I have long accepted, the question naturally emerges of what is to be done to calibrate our pursuit of health to support health in all its varieties.
This reflects an “outcome-driven approach,” one that starts from the goal—living a good life however we might define it—and works backward to the means—health—to that goal. Toward this goal, three thoughts emerge that shape, or at least challenge, my thinking about what health is and how we might achieve it, especially as we look to advance approaches that maximize health for all, supporting each of our visions of what health means to us.
First, our view of what living a good, full life means, and our capacity to achieve this aspiration, is determined significantly by the world in which we live. Rather than any universal law, our present context decides whether our attributes constitute a barrier to “perfect” health or are easily dealt with inconveniences.
For example, I am Maltese, born and raised on a small Mediterranean island. And yet, I get terribly seasick when I step on a boat. I have no doubt that was I born a few hundred years earlier, I would have been weeded quickly out of the family as utterly useless in a culture that depended on fishing and all manner of seafaring for its survival.
The inability to travel via water would be a substantially limiting factor at that time for my ability to live a fully realized life. Having the good fortune to live when and where I do, my seasickness is immaterial to my life: I avoid boats, and all is well.
What would have been regarded at one time as a significant imperfection becomes, in the present moment, a mere quirk.
Once we understand that the ability to live a full life is determined by the context in which we live, our notion of what is healthy changes. Hence, I am not so sure anymore that we can even define health without recognizing that this definition is largely determined by the world we build.
We can choose to build a world in which our definition of health limits fewer people in their efforts to live the lives they want. This has implications, for example, for our efforts to create a better world for people with a disability. While we have taken steps to make life easier for this population, we still live in a world where much of what we consider “disability” acts as a barrier to many of the pursuits we define as core to a full life.
What if we were to create a world that is different, and better, for this population? As I have written previously, creating a world “where disability is not merely accommodated but uplifted” could serve as an example of how, by changing context, we can radically change the implications of what we might previously have defined as imperfect health.
Second, when we recognize that health is more of a social construct than a biological absolute, an enormously slippery slope can lead to paternalism bred from good intentions, which describes what health is based on the social constructs of the moment. We may, for example, find ourselves, in our efforts to improve the world for populations whose context imposes limits on their health, inadvertently reinforcing the health gaps created by these limits.
This is not to say that we should not work toward accommodations for all of us who may need them. Still, we should not do so at the expense of imagining new contexts for health, where what may function as imperfections in the present moment no longer need to interfere with pursuing a full life.
It then becomes incumbent on us to create a world that opens up space for as many people as possible to be “healthy” because they can live their lives more fully in ways that align with their visions of what health means.
Third, all of this comes down to the values that animate what we do, what we prioritize, and why. Perhaps what is at issue is not so much our capacity to be healthier in some one-size-fits-all way as what it will take for people to live their lives in ways that align with their vision of health.
If so, we must collectively establish values around what this means for us. How can we create a world that supports the health of all, generally, while supporting the health of you and me, specifically, in keeping with our visions for a healthy life? I have argued before, and reassert here, that what should rise to the top of our priority list is ensuring that everyone can live a life with dignity and have opportunities to realize their potential.
The world should be structured so that everyone can lead full, dignified lives and also so that everyone can do all they wish to do—everything that means health for them.
A version of this piece appeared on Substack.