by Morgan Wills, MD, FACP
This simple yet sweeping definition of health was the first principle of the Constitution of the World Health Organization (WHO) upon its founding in 1946. Since that time, this ideal has had profound impact—directly and indirectly, for good and ill—on the well-being of individuals and whole populations worldwide. It is referred to formally in the setting of medical education and policymaking, and it also echoes more implicitly in the cultural rhetoric of advertising, industry, and the blogosphere worldwide.
Yet what should we make of this view of health? Should we as Christians embrace it? In this essay, I will consider the significance, background, and implications of this definition. I will argue that, although tantalizingly promising, it is dangerously utopian. What is needed is an explicitly human understanding of health to underlie our decisions about healthcare and the good of society.
This classic definition of health has much to commend itself. Conceived as a broader alternative to the reductionist biomedical model, it helpfully and explicitly validates the positive role of subjective well being and the interconnectedness of individual and community factors in health.2 As a core principle of WHO, it invited nations to expand the conceptual framework of their health systems beyond traditional boundaries and “to pay attention to what we now call the social determinants of health,” and likewise “opened the door for public accountability” for health related institutions.3
Yet this definition of health is not unproblematic. On a purely practical level, the definition has been criticized for its lack of operational value in a world where budgets are allocated based on strictly measurable goals.”4 The biggest conceptual problem with WHO’s core principle, however, is its conflation of health with happiness. These are distinct experiences whose relationship is neither fixed nor constant. As Sigmund Freud once observed after stopping smoking cigars, “I learned that health was to be had at a certain cost… Thus I am now better than I was, but not happier.”5 Once this distinction is blurred, the stage is set for a cascade of unintended consequences.
First, any diminishment of happiness can be seen as a health problem. We see this most explicitly in the field of psychopharmacology, where breakthroughs in medications for depression and anxiety, funneled through the vortex of direct-to-consumer advertising, have driven the creation of whole new categories of “disease”—such as social affective disorder (excessive shyness). This has induced the phenomenon of “personality sculpting” by normally functioning consumers who simply prefer the way they feel on an SSRI medication.6
Second, because the thirst for happiness in a fallen world is essentially unlimited, so too, is the thirst for such “health.” The exploding demand in North America for cosmetic surgery, the massive expenditures on dietary and nutritional supplements, and even the growing use of hormonal and surgical treatments for gender identity disorders all attest that the proverbial camel’s nose is well under the tent. Here in the U.S. the medical profession and its technologies are seen increasingly as the gatekeepers of the “American dream.” Meanwhile, resources and attention are diverted away from the more basic physical health needs of countless but less affluent patients both here and in the developing world.
The third corollary of this definition is one of its natural historical consequences: the “tyranny of health.” That is, health per se begins to be drained of practical meaning and instead progressively implies the projected desire of those in power. This may begin innocently enough—with well-intentioned seat belt laws, for instance. But it can eventually take the form of enforced family planning via abortion (as in a communist state such as China) or more subtle but indirect and pernicious new norms for body size and image (as in Western consumer culture). As Daniel Callahan writes, health assumes “the cultural clout which morality once had” and becomes a normative concept for all of life which trumps personal freedom and individual responsibility. When all human disorders—from war to crime to cultural unrest—are seen as forms of illness, “health is no longer an optional matter, but the golden key to the relief of human misery. We must be well…”7
This tyranny of health is bolstered by another, synergistic idea. According to the second principle of the WHO Constitution: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”8 The question of whether health itself is a human right is not the subject of this article. But suffice it to say that such a mindset makes it all the more critical to understand the proper meaning of “health.”
In this scenario, it is essentially incumbent upon government authorities to provide for our happiness as much as possible. Interestingly, many current advocates for health as a human right justify it as the alternative to a consumerist, health-as-commodity approach. Consider this “talking point” from Amnesty USA’s campaign for healthcare reform: “Approaching health as a human right is preferable to using a consumer approach because doing so suggests that care is a good that each of us must purchase at market rates.”9
There is definitely something to this fear. Indeed, even modern Western medical missionary efforts can fall into this trap. By introducing powerful, heavily subsidized new therapies and healing modalities into another culture, it is very easy to create a sense among patients of “health” as something that others deliver, rather than something intrinsic to their own community that should be cultivated. The subsequent cycle of dependence can actually leave such societies sicker after missionary contact than before they arrived.10
Ironically, though, construing health as a human right may contribute to a similar type of commodification in our own culture—with government supplying the goods instead of the missionary (or marketplace). As Dr. Valery Elverton Dixon summarizes in a piece for Jim Wallis’ God’s Politics blog, “We ought to decide if health is a public good, and if it is, there is an obligation of government to provide it.”11 In either paradigm, the tendency is for the patient to become a consumer of health “goods.”
So we are in a conundrum. How else could health be defined? Many minds greater than mine have fallen short of defining health in a satisfactory way. As Callahan quips, “It seems simply impossible to devise a concept of health which is rich enough to be nutritious and yet not so rich as to be indigestible.”12
The testimony of Scripture is helpful but not definitive. The primary insight is the concept of wholeness or integrity of being. This idea is introduced in Genesis 2:7: “then the Lord God formed the man of dust from the ground and breathed into his nostrils the breath of life, and the man became a living creature.” This last word—alternatively translated “soul” (KJV) or “being” (NIV, NASB)—comes from the Hebrew nephesh, suggesting one who hungers or yearns. It does not refer either to man’s physical body or spiritual nature alone, but rather to “the whole self, a unity of flesh, will, and vitality.”13
The closest approximation to the health of this creature that the Hebrew Scriptures offer is shalom—the state of peace, harmony, and rightness that the human being longs for in all of his relations (with God, himself, other people, and the rest of Creation).
The New Testament uses several different words for the act of healing, usually personified by Jesus. Most of these notably the Greek verb sozo—refer both to physical and spiritual healings, and can address social reconciliation as well. One could argue that the multidimensional WHO definition of health comes very close to the biblical mark. Yet there is one major caveat. The WHO conception makes no reference to the human being whose health is being discussed. If the subject of “complete well-being” is the multidimensional but finite creature of the biblical account, many of the pitfalls we have observed do not necessarily follow. However, by leaving ambiguity on such a critical starting point, the definition is ripe for misuse.
Theologian Jurgen Moltmann reminds us, “the modern cult of health,” because it offers no transcendent perspective or narrative, “produces precisely what it wants to overcome: fear of illness.” The WHO’s definition “is open to such misunderstanding because it talks only about illness and infirmity, but not about death. But without the remembrance of dying, every definition of health is illusory.”14
And so we conclude that it is unwise—and potentially dangerous—to attempt to define health without first clarifying what it means to be human. As former missionary surgeon and health development expert Dr. Daniel Fountain writes:
“Health cannot be defined. It is not simply an object for analysis. To render it such is to think secularly about health. Health is life, a gift we receive, an endowment we are to develop, and a journey we are to pursue. We can observe and analyze much along the way. We can manipulate and improve certain aspects of health and life. But we can never comprehend the whole.”15
In the absence of public consensus about what it means to be human, a more minimalist definition of health may be more helpful for shaping policy and reigning in budgetary priorities. Dr. Leon Kass, for instance, suggests understanding health as a kind of mean rather than an ideal: “the well-working of the [physical] organism as a whole.”16 With proper clarification, such an approach would not preclude attention to mental health (the locus of which is the body after all), and it would minimize the inevitable misunderstandings inherent to “complete…social well-being.”
Meanwhile, the Christian community is left with the task of articulating and embodying a biblical and humane approach to multidimensional health that may yet transform the view of the public at large. This health—located in the body but reflecting the quality of all man’s relationships—is a temporary gift of which we are only stewards, which we are called to cultivate both individually and corporately. And yet it is also necessarily limited.
Thus, a “healthy” approach to health will embrace irreparable disability, infirmity, and even mortality because its hope lies beyond itself. Ultimately we will give an account for it—and receive a transformed and everlasting version of it—from the One who called himself “the Resurrection and the Life.”17
1 Constitution of the World Health Organization, 2006, available from http://www.who.int/governance/eb/who_constitution_en.pdf. 23 February 2010
2 Rodolfo Saracci, “The World Health Organization Needs to Reconsider Its Definition of Health,” BMJ 314 (1997): 1409.
3 Alejandro R Jadad and Laura O’Grady, “How Should Health be Defined?” BMJ 337 (2008): a2900.
5 Saracci, “WHO Needs to Reconsider.”
6 A seminal treatment of the phenomenon may be found in Listening to Prozac by Peter Kramer, M.D. (NY: Penguin, 1993).
7 Daniel Callahan, “The WHO Definition of ‘Health,’” in On Moral Medicine: Theological Perspectives in Medical Ethics, ed. Stephen E. Lammers and Allen Verhey (Grand Rapids: Eerdmans, 1998), 2:257.
8 WHO Constitution.
9 “Health as a Human Right” (communications memo), available from http://www.amnestyusa.org. 26 February 2010
10 In addition to recognizing this from my own experience, I am indebted to the insights of Dr. Brian Riedel and Dr. Dan Fountain in this regard.
11 Dr. Valery Elverton Dixon, “Health Care: Human Right, Civil Right, Privilege, or Market Commodity,” Oct. 6, 2009, available from http://blog.sojo.net/. 26 February 2010
12 Callahan, “The WHO Definition”, 254.
13 Theological Wordbook of the Old Testament.
14 Jurgen Moltmann, God in Creation (Minneapolis: Fortress Press, 1993), 274.
15 Daniel Fountain, Health, the Bible, and the Church (Wheaton, IL: The Billy Graham Center, 1989), 52.
16 Callahan, “The WHO Definition”, 251.
17 John 11:25 (ESV)