Cancer and the Definition of Health

by Kirsten EfremovSurvivor, Acute Lymphoblastic Leukemia (ALL)February 18, 2020View more posts from Kirsten Efremov

In 1948,the world health organization defined health as:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”1

I have seen this definition, written about it and cited it in many papers and I have always thought it was a great definition even 60 years later. I have never looked at a deeper perspective.

At the 2019 Canadian Medical Association Health Summit Dr. Alejandro Jadad brought up this definition again. He made an amazing point that I never considered. Based on this definition alone, many people in today’s society, cannot consider themselves 100% healthy, can they?

Consider this:

  • Did you have a good night sleep?
  • Do you wear glasses?
  • Do you see a dentist regularly?
  • How about living in a city with smog?
  • What about psychosocial health:
    • Do you have a roof over your head?
    • Are you in debt?
    • Did you eat something today?

These factors (and many more) are not considered in that 1948 definition of health. Disease is changing. It is no longer acute but more chronic. In fact, 90% of people will die from a chronic disease (only 10% will die due to acute conditions like car accidents and heart attacks). But with the rise of chronic disease is this definition enough? Can it continue to sustain our governing bodies of health?

What we have done in science and medicine over the last 60 years? Specifically looking at cancer here are a few major accomplishments:

  • 60 years ago hormones linked to cancer are found and first chemo is approved for cancer
  • 40 years ago we declared a war on cancer and the most commonly mutated gene in human cancers was found
  • 30 years ago a link between melanoma to sun exposure is discovered and HPV 16/18 were shown to be a link to cervical cancer
  • 20 years ago the first targets anti-breast cancer drug shows an important impact on care and obesity shown to be a factor in cancer deaths.
  • 10 years ago the first vaccine to prevent cancer was approved and a record number of people are surviving cancer

There have been hundreds if not thousands of breakthroughs in medicine and cancer research over the last 60 years but yet the WHO definition of health has remained the same, which beckons the question, Why?

Do we expect nations to decide on their own definition of health as per their own country and their needs or do we take the definition as a community? There are so many versions of what health is to a community, city, country, nation, individual, group and more that how do we take such a broad definition and narrow it down. Should it be the WHO’s responsibility to make this happen?

Can any definition of health be operational?2

So what should be in the new definition?

In my mind the definition should include an aspect of communication. Patients aren’t getting the quality of care simply because we do not optimize communication. If we take the time to ensure patients understand options and decisions and are involved in the decision making process we could have a better and clearer outlook. Good communication is not taught in school. Medical school focuses on diagnosis and disease but does not give students the know-how of how to deliver diagnosis to patients. If they cannot relay information clearly to a patient and their families are they are going to be an effective player on your team.

Another element that could be included in the definition is patient understanding. Patients know their symptoms. Health care practitioners need to be respectful of those symptoms and a patient’s history. Again bringing in a level of communication. Understanding the patient demographic – just because we are young doesn’t mean we can’t get sick!

What does this mean for Young Adults with cancer?

Putting on the Patient/Survivor Lens

Are we ever truly healthy after a cancer diagnosis or treatment, especially as young adults? Can we take this current definition of health and use it to be “healthy” as a cancer patient’s, survivors, thrivers, warriors? Can we use a disease state to classify a new health term?

For me I consider myself somewhat healthy. I can work, I am educated, and I live in a nice neighborhood but issues like the fact that I can never donate blood, that I often have brain fog and I fear cancer recurrence make me think I am not healthy.

It is not just looking at the socioeconomic factors (usually measured as a group rather than individually) but it is so much more for this population. Many policy makers seem to focus solely on socioeconomic factors, mainly because they are always present in research and tell a lot about a community. However, with young adults with cancer it is such a different story.

When it comes to emotions we face anxiety/depression, fear/anger, brain fog, and loss or grief (former self, community and family/friends).

For medical issues we are concerned about fertility, pain, immune systems, nutrition, bone and joint concerns, carcinogenesis (fear of reoccurrence or actually reoccurrence of the cancer), secondary and tertiary cancers developing, organ function and obtaining necessary information for long term follow-up

Then we need to look at lifestyle and the growing concerns there like: debt, insurance, fatigue, inability to continue working/going to school, short and long term side effects of treatment, fertility, relationships, development (functional or mental), and finding support.

Finally two huge categories that are often left out is (1) loss and grief. This could be of community, self, family, friends, former life, future loss and grief knowing that you are now part of a cancer community and some of your new friends might die (this is an actual reality).  (2) Finding support – family cannot always support or take care of you especially if they are older – as the sandwich generation getting cancer means difficult.

Finally ones of the biggest challenges is ADVOCACY!

Most people have fought for years to get their diagnosis. Now they are “cured”, the fight begins again to have follow up tests and procedures done to ensure recurrence doesn’t happen. But we are often met with “your too young you will be fine, you have nothing to worry about”, the same words we were told before diagnosis.

Let’s Conclude

So after 60 years why does the WHO keep the same definition of health? Which words should we be incorporating into a new definition?

  • Quality of life;
  • Quantity of life;
  • Systems metrics;
  • Morbidity and Mortality;
  • Disease Stage or Type;
  • Age, Sex, Socioeconomic status;

Should there be a definition of health based on country (how health care is delivered or even available) or disease type (ie: should the definition of health be different for that of cancer than diabetes and Alzheimer’s) and if not how can we connect all diseases?

Do we bring in 3 different definitions based on physical, social and mental health?3

There are so many questions when it related to health and defining how we are healthy and it becomes even more complicated when you are a young adult with cancer. It becomes your definition of health and we need to own our own version of defining health and encourage health care professionals to challenge the typical definition.

A picture is worth 1000 words and thus is the definition of health. Everyone will have his or her own version, description and ideas. Trying to capture the views, ideas and health status of a population of 7 billion people, really puts into play the complexity of the definition of health.

Work Cited:

  1. https://www.who.int/about/who-we-are/frequently-asked-questions
  2. Jadad, A. R., & O’grady, L. (2008). How should health be defined?.
  3. Huber, M., Knottnerus, J. A., Green, L., van der Horst, H., Jadad, A. R., Kromhout, D., … & Schnabel, P. (2011). How should we define health?. Bmj343, d4163.

All of the posts written for Elephants and Tea are contributed by patients, survivors, caregivers and loved ones dealing with cancer.  If you have a story or experience you would like to share with the cancer community we would love to hear from you!  Please submit your idea at https://www.elephantsandtea.com/contact/submissions/.

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