How Health is influenced by the Determinants of Health: WHO vs Leonardi’s definition

Since 1948 the World Health Organization has defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Official Records of WHO, no. 2, p. 100). Although this definition is still one of the leading definitions of health, it doesn’t reflect the advances that the medical field and society have made. Leonardi breaks down the WHO definition to show the flaws in the 21st century (2018); beginning with the complete wellbeing aspect. When looking at complete wellbeing it is problematic in the fact that the average person can not achieve this as Leonardi implies that this would “involve the absence of any risk factor of any disease” (2018). Leonardi also explores how the WHO definition is not measurable so can not be utilized to develop useful health standards (2018). Although Leonardi discusses the political and medicalization influences of society on health, this I don’t agree is helpful in defining health (2018). One aspect that Leonardi described as “an important exception; the WHO definition assumes that well-being is always linked to health” (2018); this is something I have considered over my years of frontline care. I find one’s well-being maybe be influenced by health, for example when dealing with the loss of a loved one, one may feel sad but has not actually had a loss of health per say. This feeling of sadness is a moment in time and does not always equate to not being healthy. Leonardi final point with WHO definition is that it “assumes that physical, psychological, and social well-being always have a positive correlation among them…” (2018); this is where I feel determinants of health support how fluid a health definition can be. Leonardi’s “newly proposed definition configures health as the capability to cope with and to manage one’s own malaise and well-being conditions” (2018). Although this isn’t a fully encompassing definition in my opinion, it is more modernized in the aspect it does not focus on the absence of disease/illness but the ability to cope in daily life with conditions one must face.

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What influences one’s ability to cope?

As each definition hints at, health has many domains to it. “At every stage of life, health is determined by complex interactions between social and economic factors, the physical environment and individual behaviour” (Simcoe Muskoka Health Unit, n.d.). These factors lead to the social determinants of health. As seen in the image below from Amit (2020) article, there are 12 core determinants of health.

If we take into account the determinants of health and Leonardi’s (2018) definition of “health as the capability to cope with and to manage one’s own malaise and well-being conditions”; we see how these overlap each other. One’s ability to cope or manage a medical condition could be influenced by income, ability to work, and social support network. If I am wheelchair bound due to a medical condition and require assistance to get up to the chair in the morning but after that I am independent, does that mean I am unhealthy? If we look at Leonardi’s definition, I could be healthy if I have all the supports in place to manage this. What if I live in a rural community with limited social support, and have no income to private hire as I am unable to drive and can not hold a job as I can not get to a place of work without relying on public transit that does not go by my home; does this mean I can’t cope with my condition?

As we can see social determinants of health have influences on each other. Because of this it is hard to define health as one definitive concept. More over health should be seen as a fluid concept that can be subjective to an individual. Although the definition of health maybe subjective to an individual, it is also need in a more broad concept to influence policy change to address the social determinants of health as proactive over reactive to health conditions.

References

Amit, S. (2020). What are the Determinants of Health? Colleaga. https://www.colleaga.org/article/what-are-determinants-health.

Leonardi, F. (2018). The definition of health: towards a new perspective. Internal Journal of Health Services, 48(4), 735-748. https:doi:10.1177/0020731418782653

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July, 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April, 1948.

Simcoe Muskoka Health Unit. (n.d.). Determinants of Health. Determinants Of Health. https://www.simcoemuskokahealthstats.org/topics/determinants-of-health.