Understanding Health and Its Determinants

What is health? Multiple definitions of health exist, ranging from a precise biomedical or physical definition such as the absence of negative biologic circumstances (altered DNA, abnormal physiologic states, abnormal anatomy, disease, disability, or death) to the broad definition of the World Health Organization: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (WHO, 1994). The former definition offers the advantages of easy measurement and relatively clarity of the causal connections between the medical and public health care systems and the measured outcomes. The latter definition views health more broadly but risks assigning to the "health" system full responsibility for the economic and social welfare of members of society. Neither definition explicitly takes account of how individuals experience disease. Individuals can feel ill in the absence of disease and vary dramatically in their responses to a disease. Indeed, what matters to individuals is not simply the absence of disease, disability, or death, but also their responses to symptoms or diagnoses; their capacity to participate in work, family, and community; and their sense of well-being in many spheres (e.g., physical, psychosocial, spiritual).