Do we need to redefine the term „health“?

Adaption of the WHO definition in the face of chronic illness rise – An interview with a chronically ill

The current definition of „health“ by the WHO terms back to 1948 and describes it as:

„a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. “

Constitution of the World Health Organization. 2006

Should this absolute definiton be rewritten in favor of a more individual and dynamic approach? Considering the omnipresence of chronical illnesses, is it more accurate to take individual coping and adapting skills to diseases into account? Can the stage of „complete“ in relation to wellbeing even be reached?

Recently, there is broad support for moving from the present static formulation towards a more dynamic one based on the resilience or capacity to cope and
maintain and restore one’s integrity, equilibrium, and sense of
wellbeing. The preferred view on health was:

“the ability to
adapt and to self manage.”

Health Council of the Netherlands. Publication A10/04.

Maybe, the following interview report with a chronically ill, but highly sportive eldery will stimulate your thoughts on the topic. In the following we will refer to the old gentleman as „August“. August is 70 years old and has type 2 diabetes mellitus.

How does August experience his health?

August feels in good shape considering his age. In comparison to lots of his friends, he especially appreciates his great mobility and his independence. Until 2015 he did not experience any serious health issues and never had any bigger medical treatments, but back in 2015 he got diagnosed with diabetes mellitus type 2. The diagnosis was an incidental finding, since he did not experience any specific health issues which might have suggested a disease. He was diagnosed while doing a routine blood testing for a cancer screening at his urologist. His blood sugar levels were significantly higher than the average. In retrospect he realized that he might actually have noticed some effects of his undiagnosed diabetes like a pulling pain at his big toe. But the pain was not very strong. He could not specify the effects further and certainly not relate them to diabetes at earlier time. His father was also diagnosed with diabetes mellitus and eventually died of the effects in old age.

August tells that he actually doesn’t really know if his diabetes diagnosis was actually good or bad, as he now has a completely different life. He changed his complete lifestyle due to diabetes, now incorporating lots of healthy foods into his diet and lots of physical activity. He cut back on sugar, meat, fats and alcohol. Additionally, he rides his bike up and down the nearby mountains 2 hours a day, regardless of the weather. His blood sugar levels are normal. He had always been relatively slim and fit, but now he feels better and fitter than he had ever before. He seizes every day and now also has a new “task” to fill his days as a pensioner.

Does August experience limitations in daily life?

Even though August feels very good overall, he experiences some problems with his feet during winter while he is on the bike for a long time, due to circulatory disturbances. Sometimes he has problems with feelings in his feet in general, which also causes some slight balance disorders. As a result, his stand and steps are sometimes not as strong as they were before, thus making him more careful. The lifestyle and restrictions coming with diabetes are not a problem for August. He actually really appreciates the new diet and sports regimen as well as the discipline which is needed to maintain this lifestyle.

Aside the diabetes conscious lifestyle he tells that he has no special needs. His prostate is a bit enlarged, resulting in a bit higher urge to urinate. But this does not affect his satisfaction overall.

Additionally, his hearing got slightly worse than it was in his young years, but he can still listen and participate in normal conversations without any further issues. Thus he does not need any hearing aids.

Did August receive help from health care professionals?

Before 2015 he was very rarely receiving help from health care providers. If he would visit one, it was most likely an orthopaedist, mainly due to sport related injuries. He was also not seeing his family physician very regularly. He in general avoided going to a health care provider.  After his diabetes diagnosis this changed. Now he is participating in a disease management program, which he got recommended by his family doctor. Now he is taking a general health check every three months, including a physical examination, especially covering his feet and pulses, a blood pressure test as well as several blood tests. The blood tests cover mainly the fasting blood sugar levels, the long-time blood sugar levels and kidney values. After every test his physician explains the outcomes and points out if medicine is needed. August did not take any pills, due to personal beliefs, until a few months ago, when he started taking one pill for blood sugar reduction in the evenings. This was suggested by his physician, because of the feet issues.

Aside from that his urologist is suggesting an operation to help with the enlarged prostate, but August is denying and feeling confident with his present condition without further treatment.

Other help includes the treatments he is receiving in the form of screening and vaccination programs as described below.

Does August participate in a screening programme, for instance for breast cancer or bowel cancer? If yes, what screening programs?

August participates in a prostate cancer screening program regularly performed by his urologist. He is participating in this screening ones a year since several years. Additionally, he did a colonoscopy when he was 60, in order to screen for colon cancer. This was a one-time event, but he plans to do another check-up soon.

He also participates in comprehensive health check every 2 years, including blood tests, urine tests, pulse measurements, blood pressure measurements, ultrasound as well as a general body examination. The check also addresses blood sugar and cholesterol as well a liver and kidney values, in order to keep track of possible effects of his diabetes.

Does August participate in prevention programmes?

August is participating in a disease management program for his diabetes as described above, which includes a check-up every 3 month. This can also partly be seen as a prevention program, since he can correct his medicine intake or lifestyle, due to the outcomes and thus prevent future problems due to diabetes. Same can be said for the general preventive health check he performs every 2 years as described in the previous paragraph. Other than that, he is regularly getting all recommended vaccinations from his family physician.

Why or why not is he participating in those programs?

August was usually a bit sceptic about all the recommendations of health care providers and avoided dealing with them in general. But after his diabetes diagnosis he got sensitized and trusts their recommendations more. Thus he performs in all necessary programs, as emphasized by his doctors. He wants to be fit and independent as long as possible and sees the programs as a way to achieve this. August is not participating in skin cancer screenings, even though this is recommended. Partly due to his laziness, but mostly because he thinks that he is not at risk, since he’s got quite a dark skin.

With which health care professionals does August have experience?

With respect to the previous descriptions he has experiences with: family physicians, urologists, orthopaedists, pharmacists and internists. He also visited physiotherapists a few times.

What does August expect from the different health care professionals?

August expects selection and control of a feasible therapies for his health issues, performed in a competent and scientific way. He expects trust and respect in the relationship between the providers and him. Furthermore, he expects the different providers to explain the outcomes of all performed test, so that he can understand the results as well as the recommended therapy. Independence is the most important thing for him, thus he does not want to pressurized into a certain therapy. In general, he is not expecting too much outcome wise, since he thinks the healing process is mainly natural and dependent on his own behaviour. Thus he thinks his health is mainly upon himself.

Did they meet August’s expectations?

In general, they meet the expectations. August himself is not able to perform all this tests and therapies, thus he is glad for any help he receives. Nevertheless, he thinks that sometimes his family physician recommends way too many medications. Since August thinks less is more, he is taking the least amount possible. Also he disagrees with his urologists recommendation to get a prostate operation. However, he has a really good relationship to his urologist and trusts him very much, since he was the one to discover diabetes. Even though he is very positive about all the health care providers he met, he does not like the experiences with physiotherapist. Their treatment did not meet the expectations, as he could not see any positive changes due their therapy.

---

References

Constitution of the World Health Organization. 2006.

Health Council of the Netherlands. Publication A10/04

Private Interview