Public Health Ethics   VOLUME 16 • ISSUE 3 • 2023 • 210–218 210

Health as Complete Well-Being: The WHO

Definition and Beyond
Thomas Schramme *, Department of Philosophy, University of Liverpool, Gillian
Howie House, Mulberry Street, Liverpool, L69 7SH, UK
Corresponding author: Thomas Schramme, Department of Philosophy, University of Liverpool, Gillian Howie House, Mulberry Street, Liverpool, L69 7SH,
*

UK. E-mail: [Link]@[Link]

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The paper defends the World Health Organisation (WHO) definition of health against widespread criticism. The
common objections are due to a possible misinterpretation of the word complete in the descriptor of health as
‘complete physical, mental and social well-being’. Complete here does not necessarily refer to perfect well-being
but can alternatively mean exhaustive well-being, that is, containing all its constitutive features. In line with the
alternative reading, I argue that the WHO definition puts forward a holistic account, not a notion of perfect health.
I use historical and analytical evidence to defend this interpretation. In the second part of the paper, I further
investigate the two different notions of health (holistic health and perfect health). I argue that both ideas are
relevant but that the holistic interpretation is more adept for political aims.

Introduction health with the largest degree of well-being, that is, with
perfect well-being or—in less technical terms—with
‘Health is a state of complete physical, mental and social happiness.
well-being and not merely the absence of disease or However, the term complete can also have a qualitative
infirmity’ (World Health Organisation [WHO], 1948: meaning.2 When we say that something is a complete
100). In this paper, I argue that this famous WHO defi- specimen of its kind, then we mean that it has all the fea-
nition of health is fully adequate. Criticism that has been tures that are constitutive of it. For instance, a complete
levied against it is based on a specific interpretation that dinner is one that contains a starter, a main dish and
is not the only alternative. In addition to defending the a dessert. Accordingly, complete well-being might be
WHO definition, I will discuss two different meanings understood as a state that is exhaustive of all constitutive
of the concept of health, which can lead to confusion if features of well-being. These are, according to the WHO,
not properly kept apart. This is important, for historical physical, mental and social aspects. I will call this holistic
and analytical reasons, because the WHO definition can health.3 In brief, I will claim that the WHO endorses a
indeed be interpreted in different ways and because we holistic account of health, not a perfectionist account.4
need to get to grips with the differences between types In the second section, I briefly introduce the most
of definitions of health. My second aim in this paper is important objections to the WHO definition. They have
hence to explain and to properly keep apart two differ- mainly to do with an alleged confusion of health with
ent conceptualisations of health.1 happiness, which then purportedly leads to a form of
As regards the WHO definition, I will claim that crit- medicalisation of human life. In the third section, I dis-
ics have read the word complete in the phrase ‘complete cuss the likely intentions behind the WHO definition.
physical, mental and social well-being’ in a way that goes I do this by referring to the two readings mentioned
against the likely intentions of the draftees of the defini- before, perfect health and holistic health. There are
tion. The common objections, for instance, accusing the systematic and historical reasons as to why the WHO
WHO definition of utopianism and overreach, are based plausibly intended a holistic interpretation of health.
on an implicit assumption, according to which complete In the fourth section, I discuss the two interpretations
is a quantitative term. In other words, critics assume that of health in their own right. I introduce their purposes
the phrase means that health is a state of well-being to and some objections to either notion. As is the case with
the largest degree. I will call this interpretation perfect many concepts we use, there is no single right or wrong
health. So, the critics claim that the WHO identifies conceptualisation of health. However, I argue that a

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Online publication date: 27 July 2023
© The Author(s) 2023. Published by Oxford University Press.
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 HEALTH AS COMPLETE WELL-BEING • 211

holistic concept of health is better suited for the pur- on well-being. However, such a view seems to conflict
poses of the WHO and more generally for political and with the perspectives of relevant groups of people them-
economic agendas. selves (Fallon and Karlawish, 2019: 1104).
Despite the widespread criticism from many differ-
ent disciplinary backgrounds, the WHO never amended
Criticism of the WHO Definition their definition of health. It seems that they did not see
The health definition of the WHO has often been dis- a need to change their point of view. In the following
missed by philosophers of medicine and medical scien- section, I will argue that the critique is indeed based on
tists (for an overview, see Leonardi, 2018). One of the a misunderstanding of the WHO’s perspective.
main reasons has been the alleged confusion of health
and happiness, that is, a state of complete well-being.5 If

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health is understood as happiness, it has been argued, Interpreting the WHO Definition of
there are many highly problematic consequences, most Health
importantly the medicalisation of people’s lives. After all,
health is also interpreted as a basic human right in the As explained, I will argue that the WHO defines health
same document: ‘The enjoyment of the highest attainable as holistic health, not as perfect health. To bolster this
standard of health is one of the fundamental rights of claim about the intentions of the institution, I need to
every human being without distinction of race, religion, consider the history of its constitution. In this section,
political belief, economic or social condition’ (WHO, I will therefore rely on historical documents, which
1948: 100). If people fall short of the ideal of perfection, are in the public domain. In addition, I have benefitted
that is, if they are not in a state of complete well-being, from an enormously helpful recent publication by Lars
their health ought to be enhanced. With health care Thorup Larsen (2022), who gives a detailed account spe-
being an important instrument to reach health, the lives cifically of the genealogy of the WHO definition, based
of people seem to fall under the remit of health-related on archival research.
institutions, especially medicine, in all their aspects. An important fact that supports my reading of the
For instance, if someone is sad, they lack health in the WHO’s intentions is that the word complete was only
sense of complete well-being. Accordingly, following the inserted into the definition at the very final stages of
WHO constitution, they apparently have a justified claim its conception. It is fairly obvious that it was as a form
to be made healthy, that is, happy, potentially by using of editorial amendment, not a substantial change,
mood-enhancing drugs or other medical means. because otherwise it would have required exten-
A prominent and influential critique of the WHO sive debate. If the word complete would have fixed
definition stems from Daniel Callahan: ‘[T]he most spe- the intended definition of health to a perfectionist
cific complaint about the WHO definition is that its very account, this would have either stirred up a debate or
generality, and particularly its association of health and would have had to be uncontroversial. However, there
general well-being as a positive ideal, has given rise to a is no evidence in the relevant documents that the
variety of evils. Among them are the cultural tendency to draftees of the WHO constitution definitely under-
define all social problems, from war to crime in the streets, stood health as perfection. The term complete, accord-
as “health” problems’ (Callahan, 1973: 78; see also Kass, ing to my reading, was rather intended to clarify the
1975: 14, for a very similar critique). This is an example of phrase ‘physical, mental and social well-being’, the
the critique of overreach (cf. Bickenbach, 2017: 962), that latter of which had been part of the definition since
is, of applying a medical concept to areas that pose other the drafting period.6 The word complete summarises
types of problems than healthcare problems. and jointly describes the three aspects of well-being.
Another problem that has repeatedly been pointed out It also adds a rhetorical contrast to the second part of
is the utopianism of the definition. It seems that ‘[t]he the sentence that denies the sufficiency of the absence
requirement for complete health “would leave most of of disease or infirmity for health. A perhaps better way
us unhealthy most of the time”’ (Huber et al., 2011: 235; to express the notion would have been to state that:
quoting Smith, 2008; see also Saracci, 1997: 1409, 1409; health is a state of complete well-being, that is, a state
Card, 2017). This can specifically be deemed problematic that comprises physical, mental and social elements.
in relation to people with disabilities, chronic diseases But this locution would not have worked straightfor-
and people of advanced age. They would by definition wardly in a one-sentence definition, which was appar-
permanently be missing out on health and accordingly ently aimed at by the WHO.
212 • SCHRAMME

The late arrival of the term complete of course does be more or less healthy than comparison groups. For
not present conclusive evidence that the WHO did instance, it might be declared that mine workers are
not intend to push an account of perfect health. The less healthy than millionaires. This does not mean that
historical records are not sufficient in this respect. all mine workers acutely suffer from a disease; rather, it
The final draft of the constitution, which had been means that they are more likely to fall ill, due to their
penned by the Technical Preparatory Committee, was circumstances of life. Public health has traditionally
discussed at a meeting in New York City in 1946.7 The studied the causes of disease and has made big strides
relevant draft definition reads: ‘Health is not only the in the prevention of disease. Accordingly, its focus is
absence of disease, but also a state of physical and men- upstream, as it is sometimes put (Marmot, 2010: 41;
tal well-being and fitness resulting from positive fac- Venkatapuram, 2011: 189), towards the conditions that
tors, such as adequate feeding, housing and training’ make disease more likely. Health becomes a disposi-

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(WHO, 1947: 58). The final version, which was even- tional term that allows for different grades.
tually adopted, had been prepared by the so-called From a public health perspective, it is fairly obvious
Committee I, which ‘had given careful consideration that health is ‘more than the absence of disease’. It is
to amendments submitted by the delegations of South more in the sense of additionally requiring dispositional
Africa, Mexico, Australia, Belgium, Netherlands, elements, not because it is a quantitatively better condi-
Chile, United Kingdom, Iran, China, Philippines, tion than medical normality (i.e. the absence of disease).
Poland, Venezuela, United States of America and People who live in destitute circumstances might not
Canada’ (WHO, 1948: 44). Unfortunately, there are suffer from a disease, but they are often lacking in terms
no published minutes or other forms of evidence in of a sufficient disposition to maintain minimal health.
relation to this decisive period—decisive, as far as the The public health perspective, therefore, is a gradual
introduction of the term complete is concerned. We perspective on health, allowing parlance of more and less
simply do not know who added the word. This would health, or being healthier than others. Although such a
have been important, though, to get a better grasp of perspective does not necessarily lead to an account of
the intentions behind the addition.8 perfect health, it is nevertheless compatible with the lat-
Importantly, many members of the Technical ter. People with a perfect health disposition—marked by
Preparatory Committee, who had been involved to dif- a very low probability to fall ill—might accordingly be
ferent degrees in the drafting of the WHO constitution, deemed in a state of perfect health. Importantly, falling
came from a public health background (Farley, 2008: below the ideal point of perfection on a scale does not
12ff.; Cueto et al., 2019: 39ff.). Renowned proponents imply having a disease. In other words, not being per-
of so-called social medicine, such as Andrija Štampar, fectly healthy would not constitute a condition of being
René Sand, Karl Evang and Thomas Parran, were lead- unhealthy; it would merely mean being less healthy than
ing members of the drafting group. This is significant others (Schramme 2019: 29ff.). This shows that some of
because public health usually has a different under- the criticism levied against the WHO definition, even
standing of the concept of health than clinical medicine. if understood as a perfectionist account, is implausible.
Whereas for the latter, health can be defined as absence More specifically, it does not necessarily follow that, for
of disease (Smith, 2008), that is, in absolute terms, health instance, people with disabilities would be constantly
in public health is a multifarious and scalar notion deemed unhealthy because they lack perfect health. As
(Schramme, 2017; Valles, 2018: 31ff.). explained, health is not a binary term according to the
In clinical medicine, health is often understood as relevant perspective.
absence of disease. This makes sense because the focus So far, I have argued that the WHO definition is sup-
is on individual patients. These either have a disease or posed to allow for grades of health. For that purpose, it
not. Patients might suffer from a more or less severe dis- takes its cue from public health perspectives, though I
ease, but that does not mean that they are more or less do not want to claim that it is identical to it. After all,
diseased than others. Similarly, health over and above the WHO definition still incorporates the traditional
the absence of disease is not usually the focus of clinical medical perspective on health as absence of disease.
medicine. If there is no disease, then that is sufficient to There are, nevertheless, important qualms to do with the
establish health. There is no need to refer to health in a notion of perfect health. The WHO refers to health as a
positive way, that is, to define it in its own terms. state of well-being and this might itself be deemed prob-
In contrast, public health scientists usually refer to lematic. To be sure, the conceptual connection between
populations. In their parlance, chosen populations can health and the good life for human beings has long been
 HEALTH AS COMPLETE WELL-BEING • 213

established (Temkin, 1973).9 The connection also makes many scientists do not assume the perfectionist health
sense from an experiential point of view. Health has interpretation (see also Ware et al., 1981: 621).11
indeed to do with how we fare. Still, if we read the defini- In contrast, the holistic health interpretation leads
tion as a perfectionist account of health, it would define to the following point of view: Health is seen as a state
health as perfect well-being. If that were the case, this of well-being with numerous aspects—physical, men-
would apparently lead to the alleged dangerous confu- tal and social.12 Given these dimensions of well-being,
sion of health and happiness mentioned earlier. After all, health statuses can be assessed in a combined approach,
sufficient health but not happiness seems to be the busi- taking the full range of health-related factors into
ness of welfare state institutions. It is true, of course, that account. Importantly, health is not a fictional point at
health care from a public health perspective includes the end of the scale, but any point along a scale. Some
vastly more than just medical care, especially aspects to people might have a comparatively bad health status,

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do with work, education and the environment. Yet, we some might be in good health; all will be positioned
normally see good reasons to restrict the remit of state along a spectrum. From the health definition itself,
institutions to a form of needs provision, basic secu- nothing follows as to when health is good enough or
rity and enablement of self-determination (cf. Goodin, so bad that state institutions need to interfere. In other
1988: 363ff.). So, if perfect health were the focus of the words, important political decisions regarding thresh-
state, it would probably end up becoming unjustifiably olds of sufficient health are not prejudged if we follow
expansive. a holistic health definition. Such a perspective is much
I do not believe that the WHO is guilty of this charge. more amenable to the political remit of the WHO, which
To be sure, there are reasons for thinking that a public ended up with fairly limited interventionist power (cf.
health perspective occasionally tends towards an expan- Packard, 2016: 99ff.; Larsen, 2022: 123ff.).
sive view of health politics (cf. Preda and Voigt, 2015). The overarching focus of the holistic health interpre-
Yet, it is hardly imaginable that a nascent institution— tation is maintenance of health. It is thereby acknowl-
still precarious in its status at the time of drafting its con- edged that to counter the various threats to health not
stitution including the health definition—would intend only medical means are required, but a dynamic level
to basically take over the whole established welfare state of physical, mental and social assets. This has been an
agenda and indeed even to expand it by making perfect insight of early public health practitioners. For instance,
health a political aim. This is even less credible, as one Henry Sigerist, who evidently had a significant indirect
of the global health institutions predating the WHO, the influence on the WHO definition via Raymond Gautier’s
League of Nations Health Organization, had come under draft (Larsen, 2022: 119), had already been concerned
fire for its alleged political overreach during these times with the aim of health maintenance.13 This provides a
of increasing national isolationism (Cueto et al., 2019: dynamic element in the conceptualisation of health,
20ff.). There were, accordingly, strong political reasons which is also implicit in the WHO definition, despite
not to endorse a perfectionist health definition, or at its reference to a state, which seemingly suggests a static
least to keep such ambitions hidden from plain view, view. When Sigerist writes that ‘health is more than the
especially in 1946, with very fresh memories of the dan- absence of disease’ (Sigerist, 1932: 293), this is meant as
gers of totalitarianism being abundant.10 a conclusion to an argument acknowledging the envi-
A more science-oriented reason as to why the WHO ronmental and social determinants of health. His point
is unlikely to have opted for an account of perfect health becomes quite clear in a later quote:
is that such an ideal is not measurable. After all, it refers
to an abstract point of reference. To quantify the health A healthy individual is a man [sic!] who is well
statuses of populations, scientists need metrics and they balanced bodily and mentally, and well adjusted
need to determine thresholds. In other words, they need to his physical and social environment. He is in
to plot health along a scale. If health were only a hypo- full control of his physical and mental faculties,
thetical point on a limitless scale, it would hardly be a can adapt to environmental changes, so long as
they do not exceed normal limits; and contributes
useful metric for scientific purposes. Again, this is not a
to the welfare of society according to his ability.
decisive reason to reject the perfectionist interpretation Health is, therefore, not simply the absence of
of the WHO definition. But there are numerous publi- disease: it is something positive, a joyful atti-
cations by health scientists who use the WHO definition tude toward life, and a cheerful acceptance of the
without running into the mentioned problems (Breslow, responsibilities that life puts upon the individual
1972; Greenfield and Nelson, 1992). So, it seems that (Sigerist, 1941: 100).14
214 • SCHRAMME

Sigerist’s terminology, referring to being well balanced, interesting information about health-related inequali-
adjusted and in full control, is not aiming towards an ties between persons.
ideal of perfection. Rather, he is stating several elements Importantly, in contrast to perfect health, the scope
of a good human life within the limits of reality. He of holistic health can be contoured by thresholds. As
believes that health enables an affirmative view of indi- explained, complete well-being can be understood as hav-
viduals towards their life, not unlimited happiness. ing all elements that are constitutive of it. What exactly that
In this section, I have discussed the WHO definition means in relation to health is of course contested, and I
partly from an analytical point of view, in that I distin- have already insinuated that the WHO did not set a thresh-
guished two possible interpretations, a perfectionist old, perhaps intentionally. Still, the required level of holistic
and a holistic account of health. I have added historical health could be determined via political decision-making
information regarding the drafting period. Both analyt- processes. This makes holistic health open for different

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ical and historical reasons speak in favour of my the- substantial interpretations and hence political ambitions.
sis that the WHO definition should be read as defining Despite these advantages, the conceptualisation
health in a holistic way. Health as complete well-being of health as holistic health has serious drawbacks.15
refers to the full range of factors determining a specific Most significantly, the distinction between health con-
disposition of people to prevent ill health (cf. Ware et ditions and determinants of health becomes blurry
al., 1981). This ties in nicely with a more recent official (Bickenbach, 2017: 968, 968; van Druten et al., 2022:
statement by the WHO, the Ottawa Charter, which I will 2).16 Environmental and social determinants of health
cite as final support of my thesis: ‘[H]ealth is a resource come with certain probabilities, sometimes unknown,
for everyday life, not the objective of living. Health is to fall ill or to stay healthy, but they are not constituents
a positive concept emphasizing social and personal of medical conditions themselves; rather, they are their
resources, as well as physical capacities’ (WHO, 1986). presumed causes (Whitbeck, 1981: 617). As we have
Health is not the best possible state of well-being but a seen in the previous example of miners’ health, a poor
multifarious instrument, including external as well as health disposition is not the same as being unhealthy,
internal resources, to pursue a good life. that is, suffering from disease or illness.17
The potential confusion between poor health disposi-
tions and disease or illness leads to normative confusion
Why We Need to Distinguish as well, especially when we are assessing claims of jus-
Between Holistic Health and tice. Disease has a different normative status than a rel-
Perfect Health atively bad health disposition. Arguably, disease has an
immediate urgency in relation to human needs, in terms
I have not argued that a conceptualisation of perfect of threatening or involving harm. A comparatively high
health is wrong-headed or even harmful. Rather, I propensity to fall ill or membership in a vulnerable pop-
claimed that perfect health is not the notion that the ulation as such does not obviously have such normative
WHO has been after. It is of import to distinguish urgency. Important normative discussions about health
between the two notions of health introduced earlier, justice are short-circuited if we transfer direct urgency
because confusing them will lead to cross-purposes, to alleviating relatively poor holistic health statuses
not merely in respect to the WHO definition. In this without thinking about the impact on the lives of real
section I will take a closer look at the two health con- people and merely consider relative positions.
ceptions and discuss the purposes which they can One way forward would be to acknowledge the basic
serve. I will also hint at problems with both interpre- insights of a holistic conceptualisation of health but to
tations that might eventually call for terminological nevertheless distinguish between health as a condition
reform. of an individual and health-related traits and circum-
Holistic health allows to pursue multiple political and stances that have an impact on the maintenance of indi-
economic purposes. For instance, it enables compari- vidual and population health. We would accordingly
sons between groups of people and is especially adept need a more adequate term than health for combining
to highlight social inequalities that have an impact on both of these aspects—an organismic condition, that is,
population health. This makes it more pertinent for health in the more narrowly medical sense, and a set of
political purposes than a negative conceptualisation of health-related resources. Such a revisionary conceptual
health as the absence of disease. The latter is absolute perspective can only be alluded to here (see Davies and
or non-comparative and hence does not allow for any Schramme, 2022).
 HEALTH AS COMPLETE WELL-BEING • 215

Accounts of perfect health have a different purpose allows for two different interpretations. A perfectionist
than accounts of holistic health. The former set an ideal; account, where health describes a hypothetical, perfect
an ambitious target for individual or social aspiration. state of well-being, or a holistic account, where health
According to this perspective, a person can always be is a state of exhaustive well-being, including all relevant
potentially healthier, because there is no fixed point dimensions of its constitutive elements. I have argued
on a scale which suffices for health. It seems to me that the WHO intended to support a holistic account. I
that such an interpretation of health is fully adequate provided analytical and historical reasons for this point
for specific purposes, for instance, introducing a uto- of view.
pian goal and to stop people from becoming compla- To distinguish between the two interpretations of
cent about an important element of a good human life. health is important for systematic reasons as well, not
Perfect health shares features with traditional accounts merely in relation to the proper interpretation of the

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of the virtues, although it is not itself supposed to be a WHO’s definition of health. The two different accounts
virtue. Virtues are similar to perfect health in that they serve different purposes and run into different types of
describe human excellences. Virtues are excellences problems, as I have highlighted in this paper. Still, both
of character, or perfect dispositions to act fully ade- are perfectly valid notions of health.
quately; health is excellence in relation to well-being,
or a perfect organismic disposition to keep harmful
and disadvantageous conditions at bay. Becoming vir- Notes
tuous can be an aspiration for human beings and so can
becoming perfectly healthy. 1 There can, of course, be even more than just these
However, there is a danger of imposing such an ideal two conceptualisations of health. For instance, many
on everyone. If we always have to strive for more health, would probably define health simply in terms of the
then we might lose sight of other values, such as pursuing absence of disease or illness. Indeed, one of the rea-
friendships, taking risks or enjoying unhealthy choices. sons why the WHO definition has raised concerns is
This is a real risk in many modern societies, where health probably due to its explicit diversion from the wide-
has been turned into a kind of religion and individual spread conceptualisation in negative terms, that is, as
mission (Katz, 1997). Socially, similar developments absence of something.
can be studied in relation to so-called ‘healthism’ and 2 The Oxford Dictionary of English (2015) entry on
generally the moralisation of health (Conrad, 1992).18 the adjective forms of complete states: ‘1. having all
The problems intensify if health dispositions and risk the necessary or appropriate parts: a complete list of
factors are not clearly distinguished from health condi- courses offered by the university | no woman’s ward-
tions. Every single action a person pursues might have
robe is complete without this pretty top ( … ) 2. [attrib-
an impact on their health, according to the perfectionist
utive] (often used for emphasis) to the greatest extent
health account. Hence, if combined with a prescriptive
or degree; total: a complete ban on smoking | their
reading of the ideal—as something to be sought—then
marriage came as a complete surprise to me’.
health can turn into a totalitarian imperative. This would
clearly undermine the initial purpose of setting an ideal. 3 The term holistic has been used in relation to health
Whether perfect health will fail to meet its purposes by Lennart Nordenfelt (see Nordenfelt, 1995: 12ff.,
will be established by experience and through history. It 35ff.). By using this term, I do not want to claim that
is not a necessary feature of the account. As mentioned, Nordenfelt endorses the WHO definition.
there are warning signs. However, more importantly, 4 A slightly different distinction between two mean-
there is a need to clearly distinguish between holistic ings of the concept of complete—complete in an
health and perfect health because perfect health, in con- ‘all-or-nothing sense’ and in a sense that ‘admits of
trast to holistic health, should never be the remit of state degrees’—has been drawn by Sissela Bok in relation
institutions. to the WHO definition (Bok, 2008: 592). In passing,
I also want to note that the label perfectionist is of
course not supposed to refer to perfectionism in
Conclusions value theory, where it denotes an objective theory of
‘Health is a state of complete physical, mental and the good.
social well-being and not merely the absence of dis- 5 Possibly the first philosopher of medicine to take
ease or infirmity’ (WHO, 1948: 100). This definition note of this feature and the likely consequences was
216 • SCHRAMME

Owsei Temkin: ‘I do not think that I read too much This speaks against assuming a focus on health
into this formula [the WHO definition] if I believe enhancement.
that it tends to include moral values and to identify 11 Indeed, numerous researchers claim that although
health with happiness. ( … ) But is the pursuit of the WHO definition sets a political ambition, its
happiness itself wholly a medical matter? Our life has main purpose is to set a framework that makes
many values and ( … ) happiness can sometimes be health measurable (Salomon et al., 2003; Rubinelli et
achieved at the sacrifice of health. ( … ) [I]f health is al., 2018; cf. Chatterji et al., 2002).
defined so broadly as to include morality, then the 12 In line with this reading, in more recent years, there
danger exists that the physician will also be burdened was also a discussion in the WHO whether to add
with all the duties of the medieval priest’ (Temkin, spiritual well-being to the definition (WHO, 1997:
1949: 20). 2; cf. Larson, 1996; Nordenfelt, 2016: 214). The dis-

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6 This needs to be qualified, because the term social cussion around a fourth aspect of well-being did not
was introduced fairly late in the drafting process. lead to official changes, though.
However, the point I am making here is to do with 13 Bok also mentions that Sigerist was a close friend of
the fact that elements of well-being had been listed Štampar’s, who was—as mentioned earlier—a mem-
for some time during the drafting period and that the ber of the drafting group (Bok, 2008: 594).
word complete was added to characterise these ele- 14 Georges Canguilhem similarly declared that ‘[h]
ments jointly. ealth is a set of securities and assurances ( … ),
7 The Technical Preparatory Committee itself relied securities in the present, assurances for the future’
on earlier drafts of senior members of related institu- (Canguilhem, 1966: 198).
tional bodies, especially the League of Nations Health 15 Surely not everyone would see the political negotia-
Organization (Larsen, 2022). Larsen gives a detailed bility of adequate health thresholds as an advantage.
account of the origins of the WHO definition, trac- However, I am here concerned with a relative advan-
ing it back to Henry Sigerist’s influential publications tage over the perfectionist account of health.
in the history, sociology and philosophy of medi- 16 Once the determinants of health are confused with
cine, dating mainly from the 1930ies. Sigerist’s ideas health itself, there is an additional danger of concep-
were not revisionary or highly original, though, at tualising immorality and incivility as forms of health
least not in its focus on positive health. The idea that disruptions (cf. Farley 2008: 56). WHO officials were
health includes elements that cannot be captured by not immune to this problem. For instance, in a mem-
the phrase ‘absence of disease’ goes back to antiquity. orandum called International Health of the Future
Especially the notion of health as a form of equilib- (1943), Gautier wrote: ‘For health is more than the
rium and—in modern terms—resilience has been absence of illness; the word health implies something
known for centuries (Edelstein, 1967: 303ff.). So, positive, namely physical, mental, and moral fitness.
even if Sigerist’s work probably had a role in finding This is the goal to be reached’ (Larsen, 2022: 117; see
the relevant formulations, the underlying ideas had also Chisholm, 1946: 16; cf. Cueto et al., 2019: 33).
been prevalent. 17 The otherwise philosophically important distinction
8 One of the members of the Technical Preparatory between disease and illness does not matter for the
Committee, Szeming Sze, recalled 40 years later that purposes of my essay. I use the terms interchangeably
James H.S. Gear ‘improved the wording’ (WHO, for ease of reading.
1988: 33). However, there is no identifiable evidence 18 An important and still highly recommendable early
to corroborate Sze’s recollection. critique of the utopian standard of health is Rene
9 The notion of well-being here is a state of a person Dubos’s Mirage of Health (Dubos, 1959).
including their circumstances. It should not be inter-
preted as a mental state only, that is, as a kind of
feeling. Acknowledgements
10 It should also not be forgotten that the early
I would like to thank Lars Thorup Larsen and one of the
focus of public health institutions, including the two anonymous reviewers for helpful comments.
precursors of the WHO, was on the prevention
of diseases, specifically communicable diseases. Manuscript received: March 2023
 HEALTH AS COMPLETE WELL-BEING • 217

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