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A critical analysis of definitions of health as balance in a One Health perspective

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Abstract

Definitions of health in terms of some kind of balance form a category of their own within the sphere of health definition. Such definitions have their roots in the beginnings of scientific medicine, and popular versions are common among lay people. It has even been claimed that balance is fundamental to health for all species. Several present-day definitions of health in terms of balance are presented here. Particular attention is given to the call for a definition of health applicable to both humans and animals within the One Health approach, involving human medicine, veterinary medicine and ecology. Definitions in terms of balance have been suggested but none has been thoroughly analysed with regard to its suitability. There are therefore three concerns in this paper. The first is to introduce versions of the category of balance, as a first step towards a nomenclature of health definitions. The second is to analyse the claim made recently that balance is a universal criterion of health in all species including humans. The third is to ascertain whether any of the versions discussed is suited to the One Health approach.

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Notes

  1. Although Döring et al. (2015) uses the term resilience rather than balance, resilience is described as a balance. See also Footnote 4 for a further discussion on the idea of resilience.

  2. Ones concerned, that is, with only one value or aspect of health. Where more than one value or aspect was taken into account, Tengland used the term “pluralistic theories” (Tengland 2006). A similar term used in discussions on animal health is “conglomerate definitions” (Lerner 2017).

  3. Other terms for this approach exist such as one medicine and zoobiquity. For further references on this matter see Lerner and Berg (2015). For similar approaches to One Health, such as EcoHealth and Planetary Health, see Lerner and Berg (2017), where an attempt is made to distinguish between them.

  4. A fourth version of health as balance, health as resilience, might be added if one extends this analysis to the ecosystem level of health. Resilience has a connotation close to that of homeostasis but according to Döring et al. (2015) it is to be distinguished from homeostasis in that it includes adaptation to new conditions. There are two reasons for my not including resilience here. First, the term “resilience” is not commonly used in the description of individual health. Second, it can imply something not obviously related to balance. For example, a conceptual analysis based on nursing literature showed resilience more a question of hope, coping and self-efficacy (Garcia-Dia and O’Flaherty 2016) than of balance. I would say that the term “resilience” needs an analysis of its own before being included in any definition of health.

  5. Cannon also presented the idea of a social homeostasis related to the biological homeostasis (Cooper 2008). This aspect of homeostasis will not be dealt with here, mainly because Western science has not paid attention to it.

  6. This definition of Boorse’s does not belong to the category of definitions of health as balance. In Tengland’s categorization (mentioned above), it belongs to the category concerning health as absence of disease.

  7. In some categorizations of health definitions, Pörn’s and Lennart Nordenfelt’s (2007) theories of health will be placed in the same category. Here I have chosen to place Pörn’s definition within the category of Health as balance and treat Nordenfelt’s definition of health as belonging to the category of Health as general ability (see Tengland’s categorization early in this paper). The reason to place Pörn here is based on his own description of the definition as belonging to the tradition of balance theories of health (a distinction made even in Nordenfelt 2006). For a discussion on how Nordenfelt’s theory of health applies to One Health, see Lerner (2017).

  8. This is for example evident in the theory of health proposed by Georges Canguilhem (1991). In his distinction between the normal and the normative state, the normative state allows a person to shift between normal states due to changed circumstances.

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  1. Department of Health Care Sciences, Ersta Sköndal Bräcke University College, P.O. Box 11189, 100 61, Stockholm, Sweden

    Henrik Lerner

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Lerner, H. A critical analysis of definitions of health as balance in a One Health perspective. Med Health Care and Philos 22, 453–461 (2019). https://doi.org/10.1007/s11019-018-09884-1

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