Moving Beyond the WHO Definition of Health: A New Perspective for an Aging World and the Emerging Era of Value-Based Care

Abstract

The WHO definition of health is not fit for purpose, especially in the emerging era of value-based care. Developed 70 years ago, it contributed to a very useful broadening of the lens through which we consider health; however, it cannot provide clear and useful goals for the value-based care movement, especially given the nuanced needs of an aging population. For the purpose of designing and evaluating systems to deliver health (as opposed to merely delivering services), something more practical is required. This paper outlines principles that should underlie an improved definition of health, and proposes a new definition: “Health is the experience of physical and psychological well-being. Good health and poor health do not occur as a dichotomy, but as a continuum. The absence of disease or disability is neither sufficient nor necessary to produce a state of good health.” This definition has implications for the goals and metrics of value-based care. Specifically, it highlights: (i) the need for patient-centered and goal-based metrics; (ii) the need to include measures of overall health status; and (iii) the need to aim for improved and preserved health status, as opposed to the impossible goal of “complete … well-being,” as called for in the WHO definition.