I have been reading a very insightful short paper in German by Wilfried Belschner about the concepts of health and disease/sickness. I shall try to précis the paper from the original German and find links to illustrate the idea. Translations are mine and the condensation of the original German text is done from my perspective, the appendages and comments to the text are also mine. As far as possible I have marked these using a green text colour. Blue has been used to highlight quoted text. The concept can then be applied as a further perspective for the observation and evaluation of health systems.
The paper deals with the meaning and concept of “health” but also looks at other and broader contexts within which the concept of “health” has meaning.
WHO constitution and definitions of health:
“WHO remains firmly committed to the principles set out in the preamble to the Constitution”
- Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
- 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.
- The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States.
- The achievement of any State in the promotion and protection of health is of value to all.
- Unequal development in different countries in the promotion of health and control of diseases, especially communicable disease, is a common danger.
- Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development.
- The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.
- Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people.
- Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.
The book “The Enigma of Health” written by H-G Gadamer in 1993 (1) is a worthwhile philosophical take on the complex relationships within “health”, its limits and the “art of medicine”. Here is an excerpt from the book:The-enigma-of-health_preview
“There are people who don´t live at all anymore, they only live to prevent harm to themselves and die healthy.” (my translation from Manfred Lütz, Focus 07/2008, 51)
“We used to do our best to help patients. These days, cost-limitation appears to have taken centre stage” (my translation from Prof. Klaus Hankeln, Klinikum Bremen-Nord)
Which human image shall we choose?
- Which assumptions, models and preconceptions, which traditions and which power constellations do we adopt and utilise when we talk about “health”?
- Is it scientifically, socially and politically sensible and valid to simply talk about “health”?
- Does one risk getting entangled linguistically and in complex power-constellations by using the term “health”?
The terms “health” and “illness” are constructs.
The term “health” and the terms “sickness” or “illness” are cultural and social constructs. Health has become a prioritised aim in life for individuals as well as in society generally. The idea of health has advanced from being a construct in our mind to being a “thing” one can possess, it has almost become an object.
If one accepts the prioritisation of “health” in our society then this can imply an acceptance of other current social priorities: the ability to work, the abilty to consume… these priorities have changed over time but these appear to be current social and economic priorities.
Due to differing understandings and concepts of the terms “health” and “illness”, Wilfried Belschner calls for the use of a different term, he calls it “Werdens” (in German) which translates to “attainment” or “fulfillment”. I shall use the abbreviation AF for it.
AF is understood to be the fulfillment of the individual potential of a person.My translation of the German “Werdens” meaning attainment or fulfillment (AF)
The concept of AF:
Wilfried Belschner calls for the prioritisation of the development and incorporation of AF in social institutions (schools, hospitals, media, industries…) and in component social institutions (law, economic systems, education, state structures…).
A person should not serve an egocentric economic system. The main focus should be the creation of an allocentric, co-creative, co-existance structure (see common good economy) in which people can fulfill or attain their individual potential. The common good is not to be seen as a repair function to reduce or balance the destructive effects of an egocentric economic system.
The use of the term “Werdens”/AF could allow a change in paradigm in our social and economic structures.
A discussion about “health” leads to existential questions such as “For what reason am I in this world?” or “What is the why of my life?”. The attempt to see “health” as a given and non-questionable aim in life will probably not lead to a satisfactory answer.
The prioritisation of “health” in society deflects from a confrontation with more fundamental existential questions and issues of basic human needs (see references below, Steven Reiss and Abraham Maslow). For example, some people would have difficulty giving an experience-based answer to the question, “do I feel welcome in this world?”
Definitions and perspectives of the term “health”:
In discussions about health, one frequently gets the impression that the concept of health is so obvious that it requires no explanation or definition, it cannot be misunderstood.
Questions about health, complete the following questions:
- I am healthy because…
- I feel healthy when…
- I am seen as healthy by friends/employer/colleagues/etc if…
- I will be diagnosed as healthy by my doctor/therapist/etc if…
The answers to the above questions will probably be more or less subtly different due to context and perspective. If you answer the questions again but this time using sick or ill instead of healthy, then the context and/or perspective may become more apparent. There are many dimensions of “health”.
“Health” as a fragile process:
“Health” cannot be adequately evaluated without its individual context. Everyone´s life situation can change. An everyday situation can become a critical situation, in which it is unclear whether the individual can “cope”, that is, whether his or her physical, psychological, social and financial ressources are sufficient. Coping with a critical situation would confirm the physical and psychological “health” of an individual. This may or may not require external support from either family and/or friends or from social support systems.
“Health” structures are prone to overpowering and overwhelming the individual (and their support systems) and can lead to a feeling of impotence or powerlessness in a critical situation.
This might imply that social systems that support people in critical situations need to balance empowerment of the individual with the inherent rigidity and enormity of “health” structures.
Biopsychosocial model of illness:
I shall continue this post in part 2 with an attempt to transfer the AF concept into institutions and society. This post will also be updated in due course.
- If a quote contained the whole content of a book or speech then the book or speech would be unnecessary. A quote needs a similar context to place its meaning correctly. Who defines “correctly”? How to set context?
- “Operoma” – SKK idea – “hat er was?” Concept in surgery of whether a patient has something which can be alleviated or solved with surgery or whether non-surgical treatment and wait-and-see might be a wiser course. An operoma is defined as a structure that needs operating on.
- Perspectives on health with differing measures
- A disease can be the absence of health in a specific way with or without knowledge of the causal mechanism
- Concept of attainment or fulfillment
- The Enigma of Health: The Art of Healing in a Scientific Age (German: Über die Verborgenheit der Gesundheit) is a 1993 book about the philosophy of medicine by Hans-Georg Gadamer, in which the author examines the key components of medical practice such as death, life, anxiety, freedom, health and the relationship between the body and the soul based on the phenomenological framework developed by Martin Heidegger in Being and Time.
Literature references by W. Belschner:
“Werden cooperative” website with content initiated by Prof. Belschner (in German):