Huber et al in BMJ
Reviewed by Josefien Van Olmen
Although this publication has appeared several months ago, we found it too relevant not to discuss it. The group of experts publishing this paper discussed the relevance of the WHO definition of ‘health’ and proposals for its adaptation. The 1948 definition of health as state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” was been important because of its with and ambition. However, the authors argue, in today’s (western) contexts, where ageing with chronic illnesses has become the norm, chronic diseases account for most of the health care expenditures, putting pressure on its sustainability, the WHO definition becomes counterproductive as it declares people with chronic diseases and disabilities definitively ill. Instead, the authors plea for a more dynamic formulation based on the resilience or capacity to cope and maintain and restore one’s integrity, equilibrium, and sense of wellbeing of a person. The preferred view on health was “the ability to adapt and to self-manage.” Indeed, this proposal fits very well into the of paradigm of people living with chronic lifelong conditions. And it articulates well with the growing attention for the role and responsibility of people themselves in their own health. However, the authors seem to jump from 1946 to 2011 as if only Ottawa happened in between. What about Alma Ata, the 1978 conference on Primary Health Care? I think the WHO definition implicitly includes the adjective ‘as much as possible’. The Alma Ata declaration speaks of an “acceptable level of health for all the people”. What Alma Ata also advocated for was enough resources, both from people themselves and from governments, to ensure support systems to reach this goal. Self-management is crucial, but should not be a substitute for professional resources. In this regard, the mentioning of sustainability and rationing is dangerous.