Health as a social concept

r NHE SOCIAL implications of health and disease are very great, but they are obscured by uncertainty as to what these two terms refer F i to, or, more correctly, how to know when health is or is not present in individuals. It is particularly in respect of mental health that this doubt comes up; but the same essential uncertainty prevails also about physical health. So soon as we pass from obvious good health, or obvious disease, into the penumbra where the dubious cases lie tsuch as the congenital deformities, the symptomless lesions and so on), we see that the concept of health needs to be clariSed: and we realize that it is hardly to be defined without reference to the material and the social environment within which each individual lives. If my theme were the social causes and the social consequences of disease, or if it were the social conditions propitious to the maintenance of health, my task, though not easy, might be easier than the one I have chosen. A great deal of factual knowledge exists on these matters they lend themselves to lively speculation, they can be illustrated by telling clinical instances, and there is less danger of an expositor losing himself in a tangle of intersecting paths. Such studies commonly presuppose that we already know what health is, and can always distinguish it from disease. But we cannot safely operate with ambiguous words and concepts, such as health and disease now are. If we are determining the needs that must be met in the National Health Service, we must first estimate the prevalence of disease; yet for mental disease, in all its forms, this is at present impossible, largely because we are unsure what is to be included. Similarly we cannot agree on the duration of illnesses and on the efficacy of treatment because we have no accepted criteria of recovered health: this may sound extravagant, but there is abundant evidence that it is so. I shall therefore be dealing to-night largely wzth a problem of definition. I shall not be considering how the forms of illness are classified and defined, that is, I shall say nothing of the principles and cTiteria of diagnosis, but shall examine only the criteria of health in general. And although the matter demands theoretical discussion, the purpose is a practical one to apply the criteria, whatever they may turn out to be, to the enumeration of sick people