The Profound Implications of the Meaning of Health for Health Care and Health Equity

Health Equity

Policy Points:

  • The meaning of health in health care remains poorly defined, defaulting to a narrow, biomedical disease model. A national dialogue could create a consensus regarding a holistic and humanized definition of health that promotes health care transformation and health equity.
  • Key steps for operationalizing a holistic meaning of health in health care include national leadership by federal agencies, intersectoral collaborations that include diverse communities, organizational and cultural change in medical education, and implementation of high-quality primary care.
  • The 2023 report by the National Academies of Sciences, Engineering, and Medicine on achieving whole health offers recommendations for action.

Health matters to people and society. People generally desire to live longer, continue to function independently, and experience well-being throughout their lives. Yet, despite the United States spending more per person on health care than any other country, population health in the United States is declining and below its peer countries with persistent, stark racial and socioeconomic inequities.1-3

One potential contributor to poor US health is conceptual opacity regarding the meaning of health. When health’s meaning is opaque, health is tacitly defined narrowly as the absence of disease. This conceptual opacity perpetuates the biomedical paradigm in health care with its focus on diagnosing and treating disease. This tacit biomedical definition yields poor investment in people’s inherent health potential relative to drugs and technology, thus fostering a misalignment between the goals of health care and the goals of individuals, communities, public health, and society.

This paper aims to explore a broader, holistic understanding of health that includes biomedical health in addition to positive health that addresses the enhancement of human capabilities and well-being. We examine how the absence of a clear definition of health defaults to a narrow, biomedical meaning within the health care system with ensuing adverse consequences such as the objectification of people and the undermining of health care’s role in fostering the full health potential. Finally, we address the steps and challenges that must be considered to adopt a whole health meaning with the potential to transform and humanize health care and effectively promote equity in whole health.



  1. Schneider EC, Shah A, Doty MM, Tikkanen R, Fields K, Williams RD II. Mirror, mirror 2021: reflecting poorly: health care in the US compared to other high-income countries. The Commonwealth Fund. August 4, 2021. Accessed June 10, 2023.
  2. Woolf SH. Falling behind: the growing gap in life expectancy between the United States and other countries, 1933–2021. Am J Public Health. 2023; 0: e1- e11.
  3. Bilinski A, Emanuel EJ. COVID-19 and excess all-cause mortality in the US and 18 comparison countries. JAMA. 2020; 324(20): 2100- 2102.

Fiscella K, Epstein RM. The Profound Implications of the Meaning of Health for Health Care and Health Equity. Milbank Q. 2023;101(3):0721.