The Concept of Health and Disease

Definition of "Health"

Since the WHO definition after the Second World War, health has been defined as a state of complete physical, mental and social well-being and not the mere absence of disease and infirmity,

"a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".

This contains an ideal that can hardly be achieved objectively, because health also includes the subjective side, the experience of the patient. Health thus becomes a relative, context-dependent concept.

A historical analysis shows that since antiquity, depending on societal, religious, socio-cultural, and individual perspectives, no consistent conception has existed. Rather, it follows the ontology that is applied in each case - in other words, what has been or is primarily recognized as being.

Epistemological perspective

From an epistemological understanding, essential ways of thinking can be identified that can be used individually or in combination as a basis for the most diverse conceptualisations of health. (Schmidt, 2010)

Harmony of different parts as functions of a whole

Harmony of different parts as functions of a whole, e.g. as harmony with gods, ancestors or nature and the environment (antiquity), in the relationship between family, society and the individual (bio-psychosocial model) or as a balance between physical and mental processes (psychosomatics) or also as the current concept of homeostasis and homeodynamics (regulation of inflow and outflow as an expression of a dynamic "steady state" balance).

Battle between opposing forces or principles

The battle between opposing powers or principles, the eternal conflict between good and evil, which seeks to preserve and secure its own integrity by repelling and destroying the foreign, whether it is devils and demons (medieval world view) or defence against bacteria and viral invasion (microbiological era of the 20th century) or even the socio-political fear of foreign infiltration.

Moment of a dialectical process

Moment of a dialectical process in which health and illness are mutually dependent, as opposing poles on a scale with the idea of a balanced oscillation between the poles. Viewed in this way, health and illness are relative states that are part of the life process itself and therefore also part of growth and personal development, illness as an opportunity.

Hierarchy of parts and functions of different levels

Hierarchy of parts and functions of different levels, in the sense of a system of rule or order, which is based on a hierarchy between spiritual, psychological and physical functions, as well as the rule of the organic over the inorganic (Hegel), the soul over the body (Plato) or the relationship of mental functions to each other (Freud) up to the postulate of an autocratic life force that holds everything together with the measure of the right proportions (Hufeland).

Potentiality

Potentiality, the ability to and suitability for something, is a concept of realising what is possible, of setting things in motion (Aristotle), also viriditas, the freshness of life (Hildegard von Bingen), as well as freedom of spirit (phase of idealism), the constant metamorphosis of inner processes (Goethe) or the potential for cheerfulness and optimism about life (Luther), but also the ability to perform and work in modern society.

Transcendence

Transcendence or the movement towards a higher, spiritual state, which includes all religious, spiritual, philosophical and mystical concepts that understand health as a process of cognition in life that seeks and gives meaning.

Autonomy or virtue

Autonomy or virtue, i.e. the result of self-responsible action, from the virtue teachings of antiquity with the concept of moderation and self-control, also as the result of wisdom and the formation of a reflective life in the sense of comprehensive health counselling from dietetics to hygiene to the morally and ethically "right" life in all cultures (many authors over the centuries).

Causal mechanisms of action as a concept of interlocking, mechanically analysable processes

Causal mechanisms of action as a concept of interlocking, mechanically analysable processes - this development began in the 17th century with the emergence of causal-mechanically quantifiable research and established modern natural science in the 19th century. With mechanisation, this approach to medicine pushed all other concepts into the background in the 20th century. The ability to research and visualise bodily functions in ever smaller components defines health as a trouble-free process in which targeted intervention is made in order to achieve the statistically verified appropriate parameters on the basis of measured values. The elimination of all subjective distortions is intended to achieve the highest possible degree of objectivity and provide a causal basis for the empirical-analytical procedure. Correlations are established between measured values, behaviour and frequencies of disease progression, etc., which determine the decision-making processes based on the statistical data.

Organisation of state healthcare

Organisation of state health care "Public Health", for example as a result of state planning and health policy, guided by the concept of empirically based usefulness and efficiency in relation to the economic prosperity of modern society. This development emerged with the industrial revolution from the middle of the 19th century and established the natural science subjects as the basis of medicine due to technical efficiency. In 1861 the Tentamen philosophicum was replaced by the Physikum (Bühring, 1997). Dies ist nicht

Plurality and heterogeneity

Plurality and heterogeneity as a separate concept that depends on the individual context and can no longer be generalised. In the postmodern era, this is the logical consequence of the repression of all alternative ideas of health by the mainstream of causal-mechanistic reductionism. In addition to individualisation and contextualisation, the aim is to implement further research approaches and methods outside the pure natural sciences as part of health research.

Outlook

This synopsis shows the spectrum and complexity of the concept of health in its central meaning.

For a constructive perspective, it will be important in future to integrate all the elements described into a meaningful structure of complementary interdisciplinary research approaches in order to counteract dilution and de-professionalisation.

The reason for this necessary development is easy to understand. From the perspective of the purely causal-analytical, technical-mechanistic style of thinking, it is not possible to comprehensively and satisfactorily grasp health as an integral part of the human living environment, despite all the efforts of the past 100 years.

Thus, since the 1950s, there has been a parallel (further) development of a broad and confusing health market of many healing and health concepts, which, however, do not automatically endeavour to provide a scientific foundation, making it increasingly difficult and important to separate the wheat from the chaff (Matthiessen, 2018).

On the other hand, there is an increasingly polarising rationalisation of the healthcare system, which is shaped by the scientific paradigm and which, from the patient's point of view, leads to dehumanisation and the increasing desire for alternatives and extensions in healthcare.

This development also raises the question of the underlying images of humanity that characterise attitudes and dealings in everyday medical practice.

Sources and references

Bühring, M. (1997). Naturheilkunde: Grundlagen, Anwendungen, Ziele (p. 113). Beck.
Matthiessen, P. (Hrsg.). (2018). Stellungnahme vom Dialogforum für Pluralismus in der Medizin (DPM) zu unqualifizierten Pauschalverurteilungen der Komplementärmedizin.
Schmidt, J. M. (2010). Gesundheit! – Geschichte und Konzepte des Leitbegriffs der Medizin. Wiener klinische Wochenschrift, 122(17–18), 538–542. https://doi.org/10.1007/s00508-010-1429-7

Authors: glt | Rev.: gbh | Ed.: pz | last modified May 23, 2025