What is health? Less a state, more a capacity

Try this at your next team meeting: ask everyone to answer, in one line: what is health? The answers will differ. For some it means not being sick; for others, living a long life; and someone will almost always quote the World Health Organization. That we struggle to define what we say we care for is not an academic detail. What we mean by health decides what we measure, what we fund and whom we serve first.

The definition everyone quotes

The WHO Constitution, adopted in 1946, says that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” It was a huge step: it took health out of the hospital and into people’s lives.

But one word causes trouble: complete. Almost no one lives in a state of complete well-being. With aging populations and the weight of chronic disease, most people would be, by that definition, unhealthy. And there is a practical paradox: although the definition speaks of well-being, health systems are still organized around disease. They act once the damage is done, in a way that is more corrective than preventive.

So what is health? A capacity

In 2011, a group of experts convened by Machteld Huber proposed in the BMJ another definition of health, and with it another answer to what is health: the ability to adapt and to self-manage in the face of physical, emotional and social challenges.

The shift looks small, but it moves the focus. Picture two people. One lives with well-controlled type 2 diabetes: she works, looks after her family and makes decisions about her treatment. The other has no diagnosis, but lives isolated, far from any service, under stress that does not let up. By the 1946 definition, neither is healthy. By the idea of capacity, the first has far more health than her diagnosis suggests, and the second less than his medical record shows.

Being healthy is not the absence of problems. It is having what you need to face them.

Capacity does not live in the person alone

This is the core idea at MedicalPoints. If health is a capacity, that capacity does not depend only on each person’s biology. It also depends on where they live, the services within reach, their time, the people who support them, and the choices their surroundings make easy or hard.

It is not a new idea. In 1974, Canada’s Lalonde report described health as a field with four components: human biology, environment, lifestyle and the organization of services. In 1986, the Ottawa Charter named the prerequisites for health (peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity) and defined health promotion as the process of enabling people to increase control over, and to improve, their health.

In our words: people decide; their surroundings tilt the odds. The same person, with the same condition, does not have the same capacity to manage it if the clinic is twenty minutes away or two hours away, or if their work shift overlaps with clinic hours. That is why we say health is not a variable: it is a network of relationships in motion. We tell that story in How health happens.

The big picture and its close-ups

If health depends on context, a population’s health cannot be understood with a single number. You need to look at two things at once: the big picture of the whole population, and its close-ups, the groups and places where things happen differently.

A simple example: the same air quality index does not play out the same way in children, young adults and older people. An indicator that describes a whole city can hide exactly the people who matter most. That is why population health analytics starts by asking who your population is and which groups fall outside the average.

What changes for a health team

Measure capacity, not only disease. Alongside diagnoses, look at function, autonomy, support and access: the things that tell you whether a person can manage life with what they have.
Look at context before blaming motivation. When someone drops out of a program, the reason is often not a lack of will, but surroundings that make it hard to stay.
Design for your real population. Most health strategies are designed for an average person who doesn’t exist. Your population isn’t an average.
Place the problem before choosing the tool. Strengthening a population’s capacity usually combines different types of problems. We explain how in Not every health problem needs the same approach.

This does not discard the WHO definition or the value of diagnosing and treating disease. The capacity view has its critics too: on its own it is not a measurement tool, and measuring the ability to adapt requires indicators validated in each population. What it does suggest is looking beyond the diagnosis.

Understanding how health happens starts with knowing what we are looking at. If you have a question about your population that your data should be able to answer, let’s talk.