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Volume 16
Issue 3
November 2023


ARTICLE CONTENTS

 * Abstract
 * Introduction
 * Criticism of the WHO Definition
 * Interpreting the WHO Definition of Health
 * Why We Need to Distinguish Between Holistic Health and Perfect Health
 * Conclusions
 * Acknowledgements
 * References
 * Footnotes

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Journal Article


HEALTH AS COMPLETE WELL-BEING: THE WHO DEFINITION AND BEYOND

Thomas Schramme
Thomas Schramme
Department of Philosophy, University of Liverpool
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Gillian Howie House, Mulberry Street, Liverpool, L69 7SH
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UK
Corresponding author: Thomas Schramme, Department of Philosophy, University of
Liverpool, Gillian Howie House, Mulberry Street, Liverpool, L69 7SH, UK. E-mail:
t.schramme@liverpool.ac.uk
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Public Health Ethics, Volume 16, Issue 3, November 2023, Pages 210–218,
https://doi.org/10.1093/phe/phad017
Published:
27 July 2023
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Received:
15 March 2023
Published:
27 July 2023

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ABSTRACT

The paper defends the World Health Organisation (WHO) definition of health
against widespread criticism. The common objections are due to a possible
misinterpretation of the word complete in the descriptor of health as ‘complete
physical, mental and social well-being’. Complete here does not necessarily
refer to perfect well-being but can alternatively mean exhaustive well-being,
that is, containing all its constitutive features. In line with the alternative
reading, I argue that the WHO definition puts forward a holistic account, not a
notion of perfect health. I use historical and analytical evidence to defend
this interpretation. In the second part of the paper, I further investigate the
two different notions of health (holistic health and perfect health). I argue
that both ideas are relevant but that the holistic interpretation is more adept
for political aims.

Issue Section:
Original Articles


INTRODUCTION

‘Health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity’ (World Health Organisation [WHO],
1948: 100). In this paper, I argue that this famous WHO definition of health is
fully adequate. Criticism that has been levied against it is based on a specific
interpretation that is not the only alternative. In addition to defending the
WHO definition, I will discuss two different meanings of the concept of health,
which can lead to confusion if not properly kept apart. This is important, for
historical and analytical reasons, because the WHO definition can indeed be
interpreted in different ways and because we need to get to grips with the
differences between types of definitions of health. My second aim in this paper
is hence to explain and to properly keep apart two different conceptualisations
of health.1

As regards the WHO definition, I will claim that critics have read the word
complete in the phrase ‘complete physical, mental and social well-being’ in a
way that goes against the likely intentions of the draftees of the definition.
The common objections, for instance, accusing the WHO definition of utopianism
and overreach, are based on an implicit assumption, according to which complete
is a quantitative term. In other words, critics assume that the phrase means
that health is a state of well-being to the largest degree. I will call this
interpretation perfect health. So, the critics claim that the WHO identifies
health with the largest degree of well-being, that is, with perfect well-being
or—in less technical terms—with happiness.

However, the term complete can also have a qualitative meaning.2 When we say
that something is a complete specimen of its kind, then we mean that it has all
the features that are constitutive of it. For instance, a complete dinner is one
that contains a starter, a main dish and a dessert. Accordingly, complete
well-being might be understood as a state that is exhaustive of all constitutive
features of well-being. These are, according to the WHO, physical, mental and
social aspects. I will call this holistic health.3 In brief, I will claim that
the WHO endorses a holistic account of health, not a perfectionist account.4

In the second section, I briefly introduce the most important objections to the
WHO definition. They have mainly to do with an alleged confusion of health with
happiness, which then purportedly leads to a form of medicalisation of human
life. In the third section, I discuss the likely intentions behind the WHO
definition. I do this by referring to the two readings mentioned before, perfect
health and holistic health. There are systematic and historical reasons as to
why the WHO plausibly intended a holistic interpretation of health. In the
fourth section, I discuss the two interpretations of health in their own right.
I introduce their purposes and some objections to either notion. As is the case
with many concepts we use, there is no single right or wrong conceptualisation
of health. However, I argue that a holistic concept of health is better suited
for the purposes of the WHO and more generally for political and economic
agendas.


CRITICISM OF THE WHO DEFINITION

The health definition of the WHO has often been dismissed by philosophers of
medicine and medical scientists (for an overview, see Leonardi, 2018). One of
the main reasons has been the alleged confusion of health and happiness, that
is, a state of complete well-being.5 If health is understood as happiness, it
has been argued, there are many highly problematic consequences, most
importantly the medicalisation of people’s lives. After all, health is also
interpreted as a basic human right in the same document: ‘The enjoyment of the
highest attainable standard of health is one of the fundamental rights of every
human being without distinction of race, religion, political belief, economic or
social condition’ (WHO, 1948: 100). If people fall short of the ideal of
perfection, that is, if they are not in a state of complete well-being, their
health ought to be enhanced. With health care being an important instrument to
reach health, the lives of people seem to fall under the remit of health-related
institutions, especially medicine, in all their aspects. For instance, if
someone is sad, they lack health in the sense of complete well-being.
Accordingly, following the WHO constitution, they apparently have a justified
claim to be made healthy, that is, happy, potentially by using mood-enhancing
drugs or other medical means.

A prominent and influential critique of the WHO definition stems from Daniel
Callahan: ‘[T]he most specific complaint about the WHO definition is that its
very generality, and particularly its association of health and general
well-being as a positive ideal, has given rise to a variety of evils. Among them
are the cultural tendency to define all social problems, from war to crime in
the streets, as “health” problems’ (Callahan, 1973: 78; see also Kass, 1975: 14,
for a very similar critique). This is an example of the critique of overreach
(cf. Bickenbach, 2017: 962), that is, of applying a medical concept to areas
that pose other types of problems than healthcare problems.

Another problem that has repeatedly been pointed out is the utopianism of the
definition. It seems that ‘[t]he requirement for complete health “would leave
most of us unhealthy most of the time”’ (Huber et al., 2011: 235; quoting Smith,
2008; see also Saracci, 1997: 1409, 1409; Card, 2017). This can specifically be
deemed problematic in relation to people with disabilities, chronic diseases and
people of advanced age. They would by definition permanently be missing out on
health and accordingly on well-being. However, such a view seems to conflict
with the perspectives of relevant groups of people themselves (Fallon and
Karlawish, 2019: 1104).

Despite the widespread criticism from many different disciplinary backgrounds,
the WHO never amended their definition of health. It seems that they did not see
a need to change their point of view. In the following section, I will argue
that the critique is indeed based on a misunderstanding of the WHO’s
perspective.


INTERPRETING THE WHO DEFINITION OF HEALTH

As explained, I will argue that the WHO defines health as holistic health, not
as perfect health. To bolster this claim about the intentions of the
institution, I need to consider the history of its constitution. In this
section, I will therefore rely on historical documents, which are in the public
domain. In addition, I have benefitted from an enormously helpful recent
publication by Lars Thorup Larsen (2022), who gives a detailed account
specifically of the genealogy of the WHO definition, based on archival research.

An important fact that supports my reading of the WHO’s intentions is that the
word complete was only inserted into the definition at the very final stages of
its conception. It is fairly obvious that it was as a form of editorial
amendment, not a substantial change, because otherwise it would have required
extensive debate. If the word complete would have fixed the intended definition
of health to a perfectionist account, this would have either stirred up a debate
or would have had to be uncontroversial. However, there is no evidence in the
relevant documents that the draftees of the WHO constitution definitely
understood health as perfection. The term complete, according to my reading, was
rather intended to clarify the phrase ‘physical, mental and social well-being’,
the latter of which had been part of the definition since the drafting period.6
The word complete summarises and jointly describes the three aspects of
well-being. It also adds a rhetorical contrast to the second part of the
sentence that denies the sufficiency of the absence of disease or infirmity for
health. A perhaps better way to express the notion would have been to state
that: health is a state of complete well-being, that is, a state that comprises
physical, mental and social elements. But this locution would not have worked
straightforwardly in a one-sentence definition, which was apparently aimed at by
the WHO.

The late arrival of the term complete of course does not present conclusive
evidence that the WHO did not intend to push an account of perfect health. The
historical records are not sufficient in this respect. The final draft of the
constitution, which had been penned by the Technical Preparatory Committee, was
discussed at a meeting in New York City in 1946.7 The relevant draft definition
reads: ‘Health is not only the absence of disease, but also a state of physical
and mental well-being and fitness resulting from positive factors, such as
adequate feeding, housing and training’ (WHO, 1947: 58). The final version,
which was eventually adopted, had been prepared by the so-called Committee I,
which ‘had given careful consideration to amendments submitted by the
delegations of South Africa, Mexico, Australia, Belgium, Netherlands, Chile,
United Kingdom, Iran, China, Philippines, Poland, Venezuela, United States of
America and Canada’ (WHO, 1948: 44). Unfortunately, there are no published
minutes or other forms of evidence in relation to this decisive period—decisive,
as far as the introduction of the term complete is concerned. We simply do not
know who added the word. This would have been important, though, to get a better
grasp of the intentions behind the addition.8

Importantly, many members of the Technical Preparatory Committee, who had been
involved to different degrees in the drafting of the WHO constitution, came from
a public health background (Farley, 2008: 12ff.; Cueto et al., 2019: 39ff.).
Renowned proponents of so-called social medicine, such as Andrija Štampar, René
Sand, Karl Evang and Thomas Parran, were leading members of the drafting group.
This is significant because public health usually has a different understanding
of the concept of health than clinical medicine. Whereas for the latter, health
can be defined as absence of disease (Smith, 2008), that is, in absolute terms,
health in public health is a multifarious and scalar notion (Schramme, 2017;
Valles, 2018: 31ff.).

In clinical medicine, health is often understood as absence of disease. This
makes sense because the focus is on individual patients. These either have a
disease or not. Patients might suffer from a more or less severe disease, but
that does not mean that they are more or less diseased than others. Similarly,
health over and above the absence of disease is not usually the focus of
clinical medicine. If there is no disease, then that is sufficient to establish
health. There is no need to refer to health in a positive way, that is, to
define it in its own terms.

In contrast, public health scientists usually refer to populations. In their
parlance, chosen populations can be more or less healthy than comparison groups.
For instance, it might be declared that mine workers are less healthy than
millionaires. This does not mean that all mine workers acutely suffer from a
disease; rather, it means that they are more likely to fall ill, due to their
circumstances of life. Public health has traditionally studied the causes of
disease and has made big strides in the prevention of disease. Accordingly, its
focus is upstream, as it is sometimes put (Marmot, 2010: 41; Venkatapuram, 2011:
189), towards the conditions that make disease more likely. Health becomes a
dispositional term that allows for different grades.

From a public health perspective, it is fairly obvious that health is ‘more than
the absence of disease’. It is more in the sense of additionally requiring
dispositional elements, not because it is a quantitatively better condition than
medical normality (i.e. the absence of disease). People who live in destitute
circumstances might not suffer from a disease, but they are often lacking in
terms of a sufficient disposition to maintain minimal health.

The public health perspective, therefore, is a gradual perspective on health,
allowing parlance of more and less health, or being healthier than others.
Although such a perspective does not necessarily lead to an account of perfect
health, it is nevertheless compatible with the latter. People with a perfect
health disposition—marked by a very low probability to fall ill—might
accordingly be deemed in a state of perfect health. Importantly, falling below
the ideal point of perfection on a scale does not imply having a disease. In
other words, not being perfectly healthy would not constitute a condition of
being unhealthy; it would merely mean being less healthy than others (Schramme
2019: 29ff.). This shows that some of the criticism levied against the WHO
definition, even if understood as a perfectionist account, is implausible. More
specifically, it does not necessarily follow that, for instance, people with
disabilities would be constantly deemed unhealthy because they lack perfect
health. As explained, health is not a binary term according to the relevant
perspective.

So far, I have argued that the WHO definition is supposed to allow for grades of
health. For that purpose, it takes its cue from public health perspectives,
though I do not want to claim that it is identical to it. After all, the WHO
definition still incorporates the traditional medical perspective on health as
absence of disease. There are, nevertheless, important qualms to do with the
notion of perfect health. The WHO refers to health as a state of well-being and
this might itself be deemed problematic. To be sure, the conceptual connection
between health and the good life for human beings has long been established
(Temkin, 1973).9 The connection also makes sense from an experiential point of
view. Health has indeed to do with how we fare. Still, if we read the definition
as a perfectionist account of health, it would define health as perfect
well-being. If that were the case, this would apparently lead to the alleged
dangerous confusion of health and happiness mentioned earlier. After all,
sufficient health but not happiness seems to be the business of welfare state
institutions. It is true, of course, that health care from a public health
perspective includes vastly more than just medical care, especially aspects to
do with work, education and the environment. Yet, we normally see good reasons
to restrict the remit of state institutions to a form of needs provision, basic
security and enablement of self-determination (cf. Goodin, 1988: 363ff.). So, if
perfect health were the focus of the state, it would probably end up becoming
unjustifiably expansive.

I do not believe that the WHO is guilty of this charge. To be sure, there are
reasons for thinking that a public health perspective occasionally tends towards
an expansive view of health politics (cf. Preda and Voigt, 2015). Yet, it is
hardly imaginable that a nascent institution—still precarious in its status at
the time of drafting its constitution including the health definition—would
intend to basically take over the whole established welfare state agenda and
indeed even to expand it by making perfect health a political aim. This is even
less credible, as one of the global health institutions predating the WHO, the
League of Nations Health Organization, had come under fire for its alleged
political overreach during these times of increasing national isolationism
(Cueto et al., 2019: 20ff.). There were, accordingly, strong political reasons
not to endorse a perfectionist health definition, or at least to keep such
ambitions hidden from plain view, especially in 1946, with very fresh memories
of the dangers of totalitarianism being abundant.10

A more science-oriented reason as to why the WHO is unlikely to have opted for
an account of perfect health is that such an ideal is not measurable. After all,
it refers to an abstract point of reference. To quantify the health statuses of
populations, scientists need metrics and they need to determine thresholds. In
other words, they need to plot health along a scale. If health were only a
hypothetical point on a limitless scale, it would hardly be a useful metric for
scientific purposes. Again, this is not a decisive reason to reject the
perfectionist interpretation of the WHO definition. But there are numerous
publications by health scientists who use the WHO definition without running
into the mentioned problems (Breslow, 1972; Greenfield and Nelson, 1992). So, it
seems that many scientists do not assume the perfectionist health interpretation
(see also Ware et al., 1981: 621).11

In contrast, the holistic health interpretation leads to the following point of
view: Health is seen as a state of well-being with numerous aspects—physical,
mental and social.12 Given these dimensions of well-being, health statuses can
be assessed in a combined approach, taking the full range of health-related
factors into account. Importantly, health is not a fictional point at the end of
the scale, but any point along a scale. Some people might have a comparatively
bad health status, some might be in good health; all will be positioned along a
spectrum. From the health definition itself, nothing follows as to when health
is good enough or so bad that state institutions need to interfere. In other
words, important political decisions regarding thresholds of sufficient health
are not prejudged if we follow a holistic health definition. Such a perspective
is much more amenable to the political remit of the WHO, which ended up with
fairly limited interventionist power (cf. Packard, 2016: 99ff.; Larsen, 2022:
123ff.).

The overarching focus of the holistic health interpretation is maintenance of
health. It is thereby acknowledged that to counter the various threats to health
not only medical means are required, but a dynamic level of physical, mental and
social assets. This has been an insight of early public health practitioners.
For instance, Henry Sigerist, who evidently had a significant indirect influence
on the WHO definition via Raymond Gautier’s draft (Larsen, 2022: 119), had
already been concerned with the aim of health maintenance.13 This provides a
dynamic element in the conceptualisation of health, which is also implicit in
the WHO definition, despite its reference to a state, which seemingly suggests a
static view. When Sigerist writes that ‘health is more than the absence of
disease’ (Sigerist, 1932: 293), this is meant as a conclusion to an argument
acknowledging the environmental and social determinants of health. His point
becomes quite clear in a later quote:

> A healthy individual is a man [sic!] who is well balanced bodily and mentally,
> and well adjusted to his physical and social environment. He is in full
> control of his physical and mental faculties, can adapt to environmental
> changes, so long as they do not exceed normal limits; and contributes to the
> welfare of society according to his ability. Health is, therefore, not simply
> the absence of disease: it is something positive, a joyful attitude toward
> life, and a cheerful acceptance of the responsibilities that life puts upon
> the individual (Sigerist, 1941: 100).14

Sigerist’s terminology, referring to being well balanced, adjusted and in full
control, is not aiming towards an ideal of perfection. Rather, he is stating
several elements of a good human life within the limits of reality. He believes
that health enables an affirmative view of individuals towards their life, not
unlimited happiness.

In this section, I have discussed the WHO definition partly from an analytical
point of view, in that I distinguished two possible interpretations, a
perfectionist and a holistic account of health. I have added historical
information regarding the drafting period. Both analytical and historical
reasons speak in favour of my thesis that the WHO definition should be read as
defining health in a holistic way. Health as complete well-being refers to the
full range of factors determining a specific disposition of people to prevent
ill health (cf. Ware et al., 1981). This ties in nicely with a more recent
official statement by the WHO, the Ottawa Charter, which I will cite as final
support of my thesis: ‘[H]ealth is a resource for everyday life, not the
objective of living. Health is a positive concept emphasizing social and
personal resources, as well as physical capacities’ (WHO, 1986). Health is not
the best possible state of well-being but a multifarious instrument, including
external as well as internal resources, to pursue a good life.


WHY WE NEED TO DISTINGUISH BETWEEN HOLISTIC HEALTH AND PERFECT HEALTH

I have not argued that a conceptualisation of perfect health is wrong-headed or
even harmful. Rather, I claimed that perfect health is not the notion that the
WHO has been after. It is of import to distinguish between the two notions of
health introduced earlier, because confusing them will lead to cross-purposes,
not merely in respect to the WHO definition. In this section I will take a
closer look at the two health conceptions and discuss the purposes which they
can serve. I will also hint at problems with both interpretations that might
eventually call for terminological reform.

Holistic health allows to pursue multiple political and economic purposes. For
instance, it enables comparisons between groups of people and is especially
adept to highlight social inequalities that have an impact on population health.
This makes it more pertinent for political purposes than a negative
conceptualisation of health as the absence of disease. The latter is absolute or
non-comparative and hence does not allow for any interesting information about
health-related inequalities between persons.

Importantly, in contrast to perfect health, the scope of holistic health can be
contoured by thresholds. As explained, complete well-being can be understood as
having all elements that are constitutive of it. What exactly that means in
relation to health is of course contested, and I have already insinuated that
the WHO did not set a threshold, perhaps intentionally. Still, the required
level of holistic health could be determined via political decision-making
processes. This makes holistic health open for different substantial
interpretations and hence political ambitions.

Despite these advantages, the conceptualisation of health as holistic health has
serious drawbacks.15 Most significantly, the distinction between health
conditions and determinants of health becomes blurry (Bickenbach, 2017: 968,
968; van Druten et al., 2022: 2).16 Environmental and social determinants of
health come with certain probabilities, sometimes unknown, to fall ill or to
stay healthy, but they are not constituents of medical conditions themselves;
rather, they are their presumed causes (Whitbeck, 1981: 617). As we have seen in
the previous example of miners’ health, a poor health disposition is not the
same as being unhealthy, that is, suffering from disease or illness.17

The potential confusion between poor health dispositions and disease or illness
leads to normative confusion as well, especially when we are assessing claims of
justice. Disease has a different normative status than a relatively bad health
disposition. Arguably, disease has an immediate urgency in relation to human
needs, in terms of threatening or involving harm. A comparatively high
propensity to fall ill or membership in a vulnerable population as such does not
obviously have such normative urgency. Important normative discussions about
health justice are short-circuited if we transfer direct urgency to alleviating
relatively poor holistic health statuses without thinking about the impact on
the lives of real people and merely consider relative positions.

One way forward would be to acknowledge the basic insights of a holistic
conceptualisation of health but to nevertheless distinguish between health as a
condition of an individual and health-related traits and circumstances that have
an impact on the maintenance of individual and population health. We would
accordingly need a more adequate term than health for combining both of these
aspects—an organismic condition, that is, health in the more narrowly medical
sense, and a set of health-related resources. Such a revisionary conceptual
perspective can only be alluded to here (see Davies and Schramme, 2022).

Accounts of perfect health have a different purpose than accounts of holistic
health. The former set an ideal; an ambitious target for individual or social
aspiration. According to this perspective, a person can always be potentially
healthier, because there is no fixed point on a scale which suffices for health.
It seems to me that such an interpretation of health is fully adequate for
specific purposes, for instance, introducing a utopian goal and to stop people
from becoming complacent about an important element of a good human life.
Perfect health shares features with traditional accounts of the virtues,
although it is not itself supposed to be a virtue. Virtues are similar to
perfect health in that they describe human excellences. Virtues are excellences
of character, or perfect dispositions to act fully adequately; health is
excellence in relation to well-being, or a perfect organismic disposition to
keep harmful and disadvantageous conditions at bay. Becoming virtuous can be an
aspiration for human beings and so can becoming perfectly healthy.

However, there is a danger of imposing such an ideal on everyone. If we always
have to strive for more health, then we might lose sight of other values, such
as pursuing friendships, taking risks or enjoying unhealthy choices. This is a
real risk in many modern societies, where health has been turned into a kind of
religion and individual mission (Katz, 1997). Socially, similar developments can
be studied in relation to so-called ‘healthism’ and generally the moralisation
of health (Conrad, 1992).18 The problems intensify if health dispositions and
risk factors are not clearly distinguished from health conditions. Every single
action a person pursues might have an impact on their health, according to the
perfectionist health account. Hence, if combined with a prescriptive reading of
the ideal—as something to be sought—then health can turn into a totalitarian
imperative. This would clearly undermine the initial purpose of setting an
ideal.

Whether perfect health will fail to meet its purposes will be established by
experience and through history. It is not a necessary feature of the account. As
mentioned, there are warning signs. However, more importantly, there is a need
to clearly distinguish between holistic health and perfect health because
perfect health, in contrast to holistic health, should never be the remit of
state institutions.


CONCLUSIONS

‘Health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity’ (WHO, 1948: 100). This definition
allows for two different interpretations. A perfectionist account, where health
describes a hypothetical, perfect state of well-being, or a holistic account,
where health is a state of exhaustive well-being, including all relevant
dimensions of its constitutive elements. I have argued that the WHO intended to
support a holistic account. I provided analytical and historical reasons for
this point of view.

To distinguish between the two interpretations of health is important for
systematic reasons as well, not merely in relation to the proper interpretation
of the WHO’s definition of health. The two different accounts serve different
purposes and run into different types of problems, as I have highlighted in this
paper. Still, both are perfectly valid notions of health.


ACKNOWLEDGEMENTS

I would like to thank Lars Thorup Larsen and one of the two anonymous reviewers
for helpful comments.


REFERENCES

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FOOTNOTES

1

There can, of course, be even more than just these two conceptualisations of
health. For instance, many would probably define health simply in terms of the
absence of disease or illness. Indeed, one of the reasons why the WHO definition
has raised concerns is probably due to its explicit diversion from the
widespread conceptualisation in negative terms, that is, as absence of
something.

2

The Oxford Dictionary of English (2015) entry on the adjective forms of complete
states: ‘1. having all the necessary or appropriate parts: a complete list of
courses offered by the university | no woman’s wardrobe is complete without this
pretty top ( … ) 2. [attributive] (often used for emphasis) to the greatest
extent or degree; total: a complete ban on smoking | their marriage came as a
complete surprise to me’.

3

The term holistic has been used in relation to health by Lennart Nordenfelt (see
Nordenfelt, 1995: 12ff., 35ff.). By using this term, I do not want to claim that
Nordenfelt endorses the WHO definition.

4

A slightly different distinction between two meanings of the concept of
complete—complete in an ‘all-or-nothing sense’ and in a sense that ‘admits of
degrees’—has been drawn by Sissela Bok in relation to the WHO definition (Bok,
2008: 592). In passing, I also want to note that the label perfectionist is of
course not supposed to refer to perfectionism in value theory, where it denotes
an objective theory of the good.

5

Possibly the first philosopher of medicine to take note of this feature and the
likely consequences was Owsei Temkin: ‘I do not think that I read too much into
this formula [the WHO definition] if I believe that it tends to include moral
values and to identify health with happiness. ( … ) But is the pursuit of
happiness itself wholly a medical matter? Our life has many values and ( … )
happiness can sometimes be achieved at the sacrifice of health. ( … ) [I]f
health is defined so broadly as to include morality, then the danger exists that
the physician will also be burdened with all the duties of the medieval priest’
(Temkin, 1949: 20).

6

This needs to be qualified, because the term social was introduced fairly late
in the drafting process. However, the point I am making here is to do with the
fact that elements of well-being had been listed for some time during the
drafting period and that the word complete was added to characterise these
elements jointly.

7

The Technical Preparatory Committee itself relied on earlier drafts of senior
members of related institutional bodies, especially the League of Nations Health
Organization (Larsen, 2022). Larsen gives a detailed account of the origins of
the WHO definition, tracing it back to Henry Sigerist’s influential publications
in the history, sociology and philosophy of medicine, dating mainly from the
1930ies. Sigerist’s ideas were not revisionary or highly original, though, at
least not in its focus on positive health. The idea that health includes
elements that cannot be captured by the phrase ‘absence of disease’ goes back to
antiquity. Especially the notion of health as a form of equilibrium and—in
modern terms—resilience has been known for centuries (Edelstein, 1967: 303ff.).
So, even if Sigerist’s work probably had a role in finding the relevant
formulations, the underlying ideas had been prevalent.

8

One of the members of the Technical Preparatory Committee, Szeming Sze, recalled
40 years later that James H.S. Gear ‘improved the wording’ (WHO, 1988: 33).
However, there is no identifiable evidence to corroborate Sze’s recollection.

9

The notion of well-being here is a state of a person including their
circumstances. It should not be interpreted as a mental state only, that is, as
a kind of feeling.

10

It should also not be forgotten that the early focus of public health
institutions, including the precursors of the WHO, was on the prevention of
diseases, specifically communicable diseases. This speaks against assuming a
focus on health enhancement.

11

Indeed, numerous researchers claim that although the WHO definition sets a
political ambition, its main purpose is to set a framework that makes health
measurable (Salomon et al., 2003; Rubinelli et al., 2018; cf. Chatterji et al.,
2002).

12

In line with this reading, in more recent years, there was also a discussion in
the WHO whether to add spiritual well-being to the definition (WHO, 1997: 2; cf.
Larson, 1996; Nordenfelt, 2016: 214). The discussion around a fourth aspect of
well-being did not lead to official changes, though.

13

Bok also mentions that Sigerist was a close friend of Štampar’s, who was—as
mentioned earlier—a member of the drafting group (Bok, 2008: 594).

14

Georges Canguilhem similarly declared that ‘[h]ealth is a set of securities and
assurances ( … ), securities in the present, assurances for the future’
(Canguilhem, 1966: 198).

15

Surely not everyone would see the political negotiability of adequate health
thresholds as an advantage. However, I am here concerned with a relative
advantage over the perfectionist account of health.

16

Once the determinants of health are confused with health itself, there is an
additional danger of conceptualising immorality and incivility as forms of
health disruptions (cf. Farley 2008: 56). WHO officials were not immune to this
problem. For instance, in a memorandum called International Health of the Future
(1943), Gautier wrote: ‘For health is more than the absence of illness; the word
health implies something positive, namely physical, mental, and moral fitness.
This is the goal to be reached’ (Larsen, 2022: 117; see also Chisholm, 1946: 16;
cf. Cueto et al., 2019: 33).

17

The otherwise philosophically important distinction between disease and illness
does not matter for the purposes of my essay. I use the terms interchangeably
for ease of reading.

18

An important and still highly recommendable early critique of the utopian
standard of health is Rene Dubos’s Mirage of Health (Dubos, 1959).


© The Author(s) 2023. Published by Oxford University Press.
This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted reuse, distribution, and reproduction in any medium,
provided the original work is properly cited.



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