Complex is not (the same as) difficult (6)
Pieter Jansen and Fredrike Bannink
The World Health Organization (WHO) still uses the definition for health as formulated in 1948, “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” This definition describes a state, a situation at a certain moment. It is a static view on health. Moreover, for many of us this ‘ideal’ state is practically unattainable.
In 2011, Huber and colleagues came up with a more dynamic concept: “Health as the ability to adapt and self-manage, in light of the physical, emotional and social challenges of life.” They called their concept Positive Health.
Health is no longer a state, but an ability, a power or competence. The importance of this concept is that it makes it possible for people to live a meaningful life – even in the presence of disease. In our book Positieve Gezondheidszorg [Positive Health Care], we write extensively on this subject.
Positive health does justice to the many factors that influence finding our way through life. In our opinion, these are not only physical, emotional and social factors, but also genetic, economic and environmental factors. The nature of these influences and the way they interact is constantly changing.
Therefore our health is always changing. Could that be the reason why we often ask about each other’s health? “How are you doing?” This changeability complicates working with results from research, because while doing research or an examination, the subject has already changed. When we take a picture, it is already outdated a moment later.
Positive health describes health as a complex system. There is an infinite number of causes and consequences that can no longer be unraveled. Health is an emergent property (see Complex (5)). Causality can only be recognized in small areas and/or relatively short duration.
From this perspective, the analysis paradigm falls short in working with health; in addition we need a functional approach. “Don’t ask for the meaning; ask for the use” (conform Wittgenstein*). A functional approach is not bothered by irregularity and unpredictability, but instead makes use of it.
When health is seen as an ability or competence, a competency-focused approach is indicated. A good example of such an approach is the solution-focused model (Bannink, 2013, 2015). It is a pragmatic model about finding what works for this patient, at this moment, in this context.
Bannink. F.P. (2013). 1001 Solution-focused questions. Handbook for solution-focused interviewing. New York: Norton.
Bannink, F.P. (2015). Book series: 101 Solution-focused questions for help with 1. Anxiety, 2. Depression, 3. Trauma. New York: Norton.
Bannink, F.P. & Jansen, P. (2017). Positieve gezondheidszorg. Oplossingsgericht werken in de huisartsenpraktijk [Positive health care. The solution-focused model in primary health care]. Amsterdam: Pearson.
Huber, M., Knottnerus, J.A., Green, L., Horst, H. van der, Jadad, A.R. et al. (2011). How should we define health? British Medical Journal, 343, d4163.
*This slogan is widely attributed to the later Wittgenstein – “Don’t ask for the meaning; ask for the use.” Although it was not a formulation actually employed by Wittgenstein himself, there is some consensus that this was Wittgenstein’s point, in Philosophical Investigations.