> *** Interesting debate going on on another listserv. Michel O'Neill. ***
>
> >Mime-Version: 1.0
> >Date:         Tue, 17 Feb 1998 09:20:48 +0100
> >Reply-To: "Health Promotion & Disease Prevention Researchers."
> >              <[log in to unmask]>
> >Sender: "Health Promotion & Disease Prevention Researchers."
> >              <[log in to unmask]>
> >From: Ilona Kickbusch <[log in to unmask]>
> >Subject:      WHo definition of health
> >To: Multiple recipients of list HEALTH-PROMOTION
> >              <[log in to unmask]>
> >
> >     You might be interested to know that as part of the process of "Review
> >     of the Constitution of the World Health Organization" the Exectutive
> >     Board of WHO has proposed to propose the following definition of
> >     health to the World Health Assembly in May 1998:
> >
> >     "Health is a dynamic state of complete physical, mental, spiritual and
> >     social well-being and not merely the absence of disease or infirmity."
> >
> >     Ilona Kickbusch


Dear All

I tried to reply to the other list but without success.  I hope I'm
not alone in my concern about this.  Here's what I tried to post:

Dear Colleagues

Excuse me butting in like this but I came across the following
message posted on another health promotion listserve:

> >     You might be interested to know that as part of the process of "Review
> >     of the Constitution of the World Health Organization" the Exectutive
> >     Board of WHO has proposed to propose the following definition of
> >     health to the World Health Assembly in May 1998:
> >
> >     "Health is a dynamic state of complete physical, mental, spiritual and
> >     social well-being and not merely the absence of disease or infirmity."
> >
> >     Ilona Kickbusch
>

I wonder if this is meant seriously?  If it is then I find it very
hard to believe that the 'Executive Board', after years of
intelligent debate by thoughtful health promoters about this
supremely important notion, can come up with something so plainly
vacuuous.

The definition in the WHO Constitution 1948 has been
extensively criticised, as everyone knows.  Does the WHO intend to
ignore this criticism and the many accompanying constructive
suggestions altogether?  This is not a trivial matter.  A definition
of health is not something that one can 'knock together', nor is it
something that should emerge as part of a political process (this
would be like asking a mathematician to compromise about a proof
because Arthur or Albert is unhappy).  The WHO's definition of health
asserts - or at least ought to assert - the purpose of the
organisation.  But what do we have?

The only change to the 1948 effort is the addition of 'dynamic'.
I must say I didn't think it possible to make the 1948 version _more_
meaningless, but I was wrong.  So:

"Health is a dynamic state of complete physical, mental, spiritual and
social well-being and not merely the absence of disease or
infirmity."

What does this mean?  If health is dynamic then it is changing.  If
something is changing it cannot at the same time be complete in the
way indicated here.  The definition irrevocably confuses the ideas of
process (the dynamic bit) and end (the state) bit.

The 'definition' has limitless meaning and is therefore useless as a
practical guide to health promoters.  What does 'spritiual
well-being' mean for instance?  Obviously it depends what one means
by 'spiritual'.  If you read the literature on spirituality you will
find a host of different meanings in use - many of them incompatible
with each other.  What does 'social well-being' mean?  Everyone knows
that this is a contested notion - different societies, different
cultures think of this idea in often widely divergent ways - social
well-being to the nomad may not be social well-being to the arable
farmer, or the greedy business woman, or the nun .....  Isn't this
just obvious?  Any decent definition must at least explain what
'social well-being' is taken to mean - if it is supposed to mean
whatever different communities say it means then we should be told
(and we should perhaps begin to think what we should so if 'their'
idea is not 'ours').  If it is supposed to be a universal notion then
we should be told its content (which would be fun, wouldn't it?).

I could go on, of course, but any point I could make is very
well-known already - at least outside the walls of the Executive Board
committee room.

It boils down to this.  Health promotion is a Magpie Profession
which borrows ideas and methods from here there and everywhere, and
which tries to welcome people with many different points of view.
Given this there is an obvious - though superficial - advantage in
having 'catch all' definitions - who cannot be initially attracted by
definitions of limitless meaning after all?

The trouble is that this cannot go on forever.  If health promotion
is to become a profession or a serious discipline it has to start to
develop intelligent theories about what it is, what it isn't, what
it is alright to do and what is beyond its remit (nothing is beyond
its remit on the latest definition by the way).

Health promotion urgently needs to work out theories about itself -
at the very least to help offer guidance to fieldworkers who can only
be confused by the WHO's nebulous pronouncements.  How much longer
are health promoters expected to put up with this nonsense?

Sincerely



David Seedhouse
Auckland University
New Zealand


Any thoughts?