BM2011:343d4163do:10.1136bmd4163 ANALYSIS Such instruments offer valuable information about a variety of Provenance and peer review: Not commissioned; externally peer pects, from functioning to the experienced quality of life. Yet nere are few instruments for measuring aspects of health like theindividualscapacitytocopeandtoadaptortomeasurethe1Who.ConstitutionoftheWorldhEalthOrganization2006.www.who.intgovemancevebr strength of a persons physiological resilience. A new ho constitution en.pdf. hat is health? The ability to adapt (editorial]. Lancer 2009: 373: 781 formulation about health could stimulate research on this 4smIthR.TheendofdiseaseandthebeginningofhealthBmjGroupBlogs2d08.http bmi. com/bm 2008/D7/0Brichard-smith-the-end-of-disease-and-the-beginning-of Conclusion 5 Larson JS. The conceptual zation of health. Med Care Res Rev 1999 56: 123-35. Just as environmental scientists describe the health of the earth Publication A10VD4 gezondheidsraad. nVsnes/ as the capacity of a complex system to maintain a stable anungo S, Tsuzuki A, Deen JL, Lopez AL, Rajendran K, Manna B, et al. Us topsy to determine mortality pattems in an urban slum in Kolkate, Ind a. Bul Word formulation of health as the ability to adapt and to self manage. 8 Otawa h aster bo ic inter atonism: erspective and method. Prentice Hal, 1969. This could be a starting point for a similarly fresh, 2lst centur way of conceptualising human health with a set of dynamic features and dimensions that can be measured. Discussion about 11 McEwen BS Interacting med ators of allostasis and allostatic load: towards an this should continue and involve other stakeholders including 12 Antonovsky A Health, stress and coping. Jossey-Bass, 1979 2):10-6. patients and lay members of the public ahavioural health: a handbook of heahh enhancement and disease prevention. John We thank Jennie Popay, Atie Schipaanboord, Eert Schoten, and Rudy 14 De Lange FP, Koers A, Kakman JS, Bleijenberg G, Hagoort P, Van der Meer JWM, et Westendorp for their thoughts Contributors and sources: This paper builds on a two day invitational onference in the Netherlands on defining health, organised by the mized trial. Med Care 1999 37: 5-14 Health Council of the Netherlands(Gezondheidsraad) and the 16 Long KR, Ritter PL, Gonzalez VM. Hispanic chronic disease self management: a Netherlands Organisation for Health Research and Development GusseklooJ, Lagaay AM, van Dongen (ZonMw). At the conference a multidisciplinary group of 38 international experts discussed the topic and were guided by a review of the literature. 01;161÷2694-70 IH organised the conference and drafted the report and this article Meyboom-de Jong B. LG, HvdH, ARJ, DK, BL, KL, MIL, JvdM, PS, RS, and Cvw contributed easuning functional health status with the COoP/onca charts. Northen Centre for speakers. HS hosted the conference with JAK, who chaired it. All Competing interests: All authors have completed the ICJME unified ption of the CooP Chart method and preliminary findings. disclosureformatwww.icmje.org/coi_disclosure.pdfavailableon 21 Rockstrom J, Steffen W, Noone K, Persson A, Chapin AS, Lambin EF, et al. A safe berating space for humanity. Nature 2009: 461: 472-5 any organisation for the submitted work; no financial relationships wi Accepted: 15 June 2011 any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that Cite this as. BMJ2011: 343: d4163 ould appear to have influenced the submitted work. REprints:http://journals.bmjcom/cgi/reprintform Subscribehttp:/resources.bmjcom/bmj/subscribers/how-to-subscribeSuch instruments offer valuable information about a variety of aspects, from functioning to the experienced quality of life. Yet there are few instruments for measuring aspects of health like the individual’s capacity to cope and to adapt, or to measure the strength of a person’s physiological resilience. A new formulation about health could stimulate research on this. Conclusion Just as environmental scientists describe the health of the earth as the capacity of a complex system to maintain a stable environment within a relatively narrow range,21 we propose the formulation of health as the ability to adapt and to self manage. This could be a starting point for a similarly fresh, 21st century way of conceptualising human health with a set of dynamic features and dimensionsthat can be measured. Discussion about this should continue and involve other stakeholders, including patients and lay members of the public. We thank Jennie Popay, Atie Schipaanboord, Eert Schoten, and Rudy Westendorp for their thoughts. Contributors and sources: This paper builds on a two day invitational conference in the Netherlands on defining health, organised by the Health Council of the Netherlands (Gezondheidsraad) and the Netherlands Organisation for Health Research and Development (ZonMw). At the conference a multidisciplinary group of 38 international experts discussed the topic and were guided by a review of the literature. MH organised the conference and drafted the report and this article. LG, HvdH, ARJ, DK, BL, KL, MIL, JvdM, PS, RS, and CvW contributed as speakers. HS hosted the conference with JAK, who chaired it. All authors contributed to the article. JAK is guarantor. Competing interests: All authors have completed the ICJME unified disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work. Provenance and peer review: Not commissioned; externally peer reviewed. 1 WHO. Constitution of the World Health Organization. 2006. www.who.int/governance/eb/ who_constitution_en.pdf. 2 What is health? The ability to adapt [editorial]. Lancet 2009;373:781. 3 Jadad AR, O’Grady L. How should health be defined. BMJ 2008;337;a2900. 4 Smith R. The end of disease and the beginning of health. BMJ Group Blogs 2008. http:/ /blogs.bmj.com/bmj/2008/07/08/richard-smith-the-end-of-disease-and-the-beginning-of￾health/. 5 Larson JS. The conceptualization of health. Med Care Res Rev 1999;56;123-36. 6 Health Council of the Netherlands. Publication A10/04. www.gezondheidsraad.nl/sites/ default/files/bijlage%20A1004_1.pdf. 7 Kanungo S, Tsuzuki A, Deen JL, Lopez AL, Rajendran K, Manna B, et al. Use of verbal autopsy to determine mortality patterns in an urban slum in Kolkate, India. Bull World Health Organ 2010;88:667-74. 8 Ottawa Charter for Health Promotion. www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf. 9 Blumer H. Symbolic interactionism: perspective and method. Prentice Hall, 1969. 10 Schulkin J. Allostasis, homeostasis, and the costs of physiological adaptation. Cambridge University Press, 2004. 11 McEwen BS. Interacting mediators of allostasis and allostatic load: towards an understanding of resilience in aging. Metabolism 2003;52(suppl 2):10-6. 12 Antonovsky A. Health, stress and coping. Jossey-Bass, 1979. 13 Antonovsky A. The sense of coherence as a determinant of health. In: Matarazzo J, ed. Behavioural health: a handbook of health enhancement and disease prevention. John Wiley, 1984:114–29. 14 De Lange FP, Koers A, Kalkman JS, Bleijenberg G, Hagoort P, Van der Meer JWM, et al. Increase in prefrontal cortical volume following cognitive behavioural therapy in patients with chronic fatigue syndrome. Brain 2008;131:2172-80. 15 Lorig KR, Sobel DS, Stewart AL, Brown BW, Bandura A, Ritter P, et al. Evidence suggesting that a chronic disease self management program can improve health status while reducing utilization and costs: a randomized trial. Med Care 1999;37:5-14. 16 Lorig KR, Ritter PL, González VM. Hispanic chronic disease self management: a randomized community-based outcome trial. Nurs Res 2003;52:361-9. 17 Von Faber M, Bootsma-van der Wiel A, van Exel E, Gussekloo J, Lagaay AM, van Dongen E, et al. Successful aging in the oldest old: who can be characterized as successfully aged? Arch Intern Med 2001;161:2694-700. 18 WHO. WHO family of international classifications.www.who.int/classifications. 19 Van Weel C, König-Zahn C, Touw-Otten FWMM, van Duijn NP, Meyboom-de Jong B. Measuring functional health status with the COOP/Wonca charts. Northern Centre for Health Care Research, University of Groningen, 1995. www.globalfamilydoctor.com/ research/research.asp?refurl=r#R4. 20 Nelson E, Wasson J, Kirk J, Keller A, Clark D, Dittrich A, et al. Assessment of function in routine clinical practice: description of the COOP Chart method and preliminary findings. J Chron Dis 1987;40(suppl 1):55S-63S. 21 Rockström J, Steffen W, Noone K, Persson Å, Chapin AS, Lambin EF, et al. A safe operating space for humanity. Nature 2009;461:472-5. Accepted: 15 June 2011 Cite this as: BMJ 2011;343:d4163 Reprints: http://journals.bmj.com/cgi/reprintform Subscribe: http://resources.bmj.com/bmj/subscribers/how-to-subscribe BMJ 2011;343:d4163 doi: 10.1136/bmj.d4163 Page 3 of 3 ANALYSIS