Should I change the Definition of Health by WHO?

The current health definition of WHO, stated in 1948, describes health as "a state of complete physical, mental and social, not merely the absence of disease or infirmity." At that time, this statement was innovative for its breadth and ambition. Overcame the negative definition of health as absence of disease and included the physical, mental and social. Although the definition has been criticized over the past 60 years, never adapted it. The criticism now being intensified and as populations age and disease patterns change this definition can even be counterproductive.Limitations of the WHO definitionMost of the criticism of the WHO definition are on the absoluteness of the word "complete" in relation to welfare. The first problem is unwittingly contributing to the medication of society. The requirement of complete would leave most often in poor health. It therefore supports the trends in the pharmaceutical and medical technology, in partnership with professional organizations to redefine disease and extend the possibilities of the health system.The new screening technologies that detect alterations to levels perhaps never cause illness and drug companies produce drugs for conditions not previously considered health problems. The thresholds for intervention tend to fall, for example, blood pressure, lipids and glucose. The persistent emphasis on complete physical that could generate large groups of people meet the requirements for screening tests or costly interventions, producing greater and greater risks medical unit.The second problem is that since 1948 the demography of populations and the nature of the disease have changed considerably. At that time represented the acute disease burden of disease and chronic diseases leading to the premature death. Since then, the disease patterns changed, with sanitary measures such as better nutrition, hygiene and sanitation and better health care interventions. The number of people living with chronic diseases for decades is increasing worldwide.The current standard is to age with chronic illnesses. They are responsible for most of the cost of health systems, and put pressure on the sustainability of the same. In this context, the WHO definition becomes counterproductive because it believes people sick with chronic illnesses and disabilities. Minimizes the importance of human capacity to deal autonomously physical challenges, emotional and social life and to work with sense of accomplishment and well even with a chronic illness or disability.The third problem is the ope-rationalization of the definition.WHO established several systems to classify diseases and describe aspects of health, disability, functioning and quality of life. However, because the reference to a state of complete, the definition is impractical, because "full" is not operational or measurable. " A reformulation needThere have been various proposals to adapt the definition of health. The best known is the Ottawa Charter, which emphasizes social and personal resources as well as physical ability. However, WHO does not take any of these proposals and the limitations of the current definition are increasingly affecting health policy. For example, preventive programs and health care determines the definition of health outcome parameters: the years of survival may be less important than participation in society and the increased ability to cope may be more important and realistic full recovery.Redefining health is an ambitious and complex, it must consider many aspects, refer to many stakeholders, reflect many cultures, as well as scientific and technological future. The experts attending the conference gave ample Dutch support for changing the definition to a more dynamic based on the resilience and coping capacity and to maintain and restore its own integrity, balance and sense of wellbeing. The preferred formulation of health was "resilience and self-management."Participants chose to replace a static definition of a conceptual framework on health. But operational definitions are necessary for practical life and to make measurements.The first step in using the concept of health as "resilience and self-management" is to identify and characterize this concept to the three areas of health: physical, mental and social.Physical HealthIn the physical realm the healthy organism is capable of "allostasis," ie maintaining physiological homeostasis through changing circumstances. Versus physiological stress, the healthy organism can organize a protective response to reduce the possibility of damage and restore balance (adaptation). If this strategy is unsuccessful confrontation physiological damage (or "allostatic load") continues and eventually can cause disease.Mental HealthIn the mental sphere Antonovsky mentioned the "sense of coherence" as the factor that contributes to the ability of engagement, a strong recovery from psychological stress and preventing stress disorder post-traumatic. The sense of coherence includes the subjective faculties which enhance comprehensibility, manageability, and meaningfulness of a difficult situation. Strengthening the resilience and self-management often improves the subjective feeling of well being and can produce a positive interaction between mind and body - for example, patients with chronic fatigue syndrome treated with cognitive behavioral therapy reported positive effects on symptoms and well-being . This was accompanied by increased volume of gray matter in the brain, although there is no clear explanation for this association.Social healthWe can identify several dimensions of health in the social sphere, including the ability of people to fulfill their obligations to manage their lives with some degree of independence despite any illness and to participate in social activities, including work . Health in this area can be considered as a dynamic balance between opportunities and constraints, affected by external conditions, such as social and environmental challenges. By adapting to a disease, people can work and participate in social activities and feel healthy in spite of its limitations. This is demonstrated in program evaluations Stanford self-management of chronic disease: patients with chronic illnesses, very controlled, they learned to better manage their lives and cope with your illness, reported better-perceived health, less discomfort, less fatigue, more energy and lower perception of their disabilities and limitations in social activities after training. Moreover, the costs of their health care declined. If people can develop successful coping strategies (in relation to their age) the change in the operation will not change the subjective perception of their quality of life, a phenomenon known as the paradox of disability.Determination of health statusThe general concept of health is useful for the treatment and public policy, but operational definitions are needed to determine the state of health, research and evaluate interventions.For health status measurements can be constructed theoretical frameworks that systematize the different operational needs, for example, differentiate between individual health status and population and health indicators between objective and subjective. The first operational tools are the methods for determining the functional status, quality of life and sense of well being. WHO established classification systems that measure gradations of health. Evaluate aspects such as disability, functioning and the subjective perception of quality of life and well being.In primary care evaluation of functional state of the Dartmouth Cooperative Group (COOP) / Wonca (the world organization of family physicians), validated for different social and cultural contexts, was created to meet the subjective perception of health. The booklets of health assessment of COOP / Wonca report six different dimensions of health. Each is the ability to perform activities of daily life on a scale of 1 to 5.While these tools provide valuable information on various aspects, there are few tools to measure the ability of coping and adaptation or strength of physiological resilience of a person. A new formulation on health could stimulate research on these issues.ConclusionThe authors intend to make health as resilience and self-management. This could be the starting point for a new way of conceptualizing human health with a set of dynamic characteristics and dimensions can be measured. The analysis of this issue should continue and involve other stakeholders like patients and the general population.