What is Health? Expanding the Paradigm

What is Health? Expanding the Paradigm

If someone were to ask what part of the photograph above is the healthy part, what might you say? The baby? The mother? What about the health of the practitioner bringing the baby to mom? The question of the nature of health as a construct purposes the following article, and sheds light on how I approach my new position as the Associate University Research Chair for the Center for Health Engineering Research (CHER). Before I describe and explain the CHER mission, vision, and purpose designed to address this question and align with Boyer’s (1990) Model of Scholarship, I want to acknowledge the scholarship and successes of CHER under the leadership of Dr. Ellen Darosweski. Having spent the first month of my tenure studying the Center, I am impressed scholarly achievements resulting from the 2015-2016 health promotion agenda, and the leadership responsible for these accomplishments. It is my hope to build upon the strengths of CHER through facilitating scholarship regarding health and wellness across the lifespan.

What is 'Health'?

In 1948, The World Health Organization (WHO) defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."  Despite the fact that this statement is nearly 50 years old, we have yet to embrace a paradigm of health beyond a paradigm of disease. As a culture, we collectively shake our heads at the inefficiency of healthcare system design, the cost of effective healthcare delivery, and the gaps in access to healthcare for underserved populations. The traditional silos of healthcare systemically separate research, clinical practitioners, educators, administrators, students, and patients. The disease-based paradigm remains problematic. Maintaining constructs of people as patients, healthcare as medical treatment, and wellness as disease prevention, dysfunctional systems walled off from one another will remain. If, however, we approach the paradigm of health as the WHO suggested, as a state of well-being across physical, mental and social domains, we may create the causes for dismantling the silos of healthcare and designing sustainable systems of health and wellness.

From this expanded worldview, the mission, vision, and purpose of CHER are as follows:

CHER Mission

The Center for Health Engineering Research (CHER) purposes scholarly initiatives that explore and promote the design, delivery, and access to the full spectrum of physical, mental and social well-being.

The mission of CHER includes three core components:

1.     CHER seeks to promote scholarship regarding the design, delivery, and access to healthcare systems.

The mission expands the definition of healthcare through innovative system design and delivery. Potential areas of exploration include:

  • Electronic health record management

  • Digital systems technology

  • Transdisciplinary collaboration between leaders in healthcare, government, business, technology, and military to promote health in private, corporate, and public sectors.  

  • Access to health and wellness for communities of color; LGBTQ2A communities, immigrant communities, homeless population, the elderly

2.     CHER seeks to expand health research beyond the traditional silos within the healthcare system to support research projects that further the understanding of environmental, public, community, workplace, first responder, military, family, and individual health and wellness.

CHER will foster the growth of health awareness and education through interdisciplinary engagement. Considerations may include:

  • Environmental health: teratogenicity of environment and racial justice, food safety and sustainability, air quality, water safety, and non-organic chemical waste production

  • Public health: Epidemiology, disease prevention, public safety and disaster preparedness, wellness promotion

  • Community health: Community-based health promotion, education, and localized service provider education, faith-based leaders as health and wellness advocates, local and small business health and wellness partnerships (greening space, farm to table, organic food production, clean-energy transportation, community leader disaster management)

  • Workplace health: Environmental hazards, risk management, toxic stress, work and wellness, thriving, substance use and abuse

  • First responder health: Increasing health awareness in first responder communities, de-stigmatizing mental illness, expanded research regarding trauma, traumatic stress, and post-traumatic stress disorder for first responders and their partners (first responder could be operationalized as law enforcement, fire, search, and rescue, emergency medical providers)

  • Military health: Increasing healthcare systems innovations, military healthcare delivery innovations, wellness training integration, veteran health

  • Family health: Reproductive life course model application, perinatal health care, intergenerational health, family as health advocates

  • Individual health: Health and wellness for the individual, patient advocacy, life course model, individual and wellness

3.     CHER seeks scholarship that promotes mental health and psychological well-being as integral components of health in the public and private sectors. 

Advancing the research of the intersection of missions 1 and 2 and psychological science, mental health, and psychological well-being.

CHER Vision

In order to promote an agenda that supports the mission, the CHER vision is as follows:

To expand the current paradigm of health, wellness, and healthcare through scholarship, leadership, and education.


To contextualize the need for an expanded health paradigm in CHER, consider that healthcare employment is predicted to increase more than any other field by the year 2024, with a growth rate of as much as 19 percent, and an addition of a projected 2.3 million new jobs (US Bureau of Labor Statistics; 2011). Accordingly, the CHER mission, vision, and purpose align to meet the increasing needs of our students, faculty, and alumni engaged scholarship, practice, and education in the healthcare fields. However, we cannot remain within our silos of study. Moreover, other fields of scholarship have equally vested interest the pursuit of better healthcare systems and practices that include mental health and psychological well-being. Breaking down the silos of healthcare involves bringing all stakeholders to the table to define health and participate in the pragmatic purpose of putting health wisdom to work in the world.

So my one question is this: What does health mean to you? 


Boyer, E. L. (1990). Scholarship reconsidered: Priorities of the professoriate. New York, NY: Carnegie Foundation for the Advancement of Teaching with Jossey-Bass.

Index, C. P. (2011). US Bureau of labor statistics. Washington, DC.



Louise Underdahl's picture Louise Underdahl | September 22, 2017 9:46 pm MST
Hi Walker,
What does health mean to you? 
Thank you for this thought-provoking inquiry, which brings to mind our research on senior entrepreneurship (Underdahl et al., 2017).  Demographic changes associated with aging populations in the United States and Europe have catalyzed economic, social, and healthcare policy challenges and inspired disruptive innovation. In a 2013 YouGov survey, 89% confirmed that older people make positive contributions to the economy (Clegg & Fifer, 2014).  In the United States, the average life expectancy has increased from 47 in 1900 to 78 in 2016 (Jenkins, 2016, p. 13).  Longevity increases have been complemented by innovative approaches to sustaining good health.  
In 1980, Dr. James Fries, a Stanford University professor of medicine, postulated the "compression of morbidity" theory (Fries, 1980; Jenkins, 2016, p. 14), defined as minimizing time between onset of chronic illness and death.  Fries’s theory disrupted aging by replacing fatalistic perceptions on the inevitable declines of aging with proactive strategies delaying onset of morbidity and enhancing quality of life through prevention and lifestyle changes.  More specifically, Fries validated human interaction as an indicator of quality of life: “The older person requires opportunity for expression and experience and autonomy and accomplishment, not support and care and feeding and sympathy” (Fries, 1980, p. 135).  
Such views, in concert with demographic changes in age and health, economic issues associated with recession, and fewer workers supporting increasing numbers of non-workers (Botham & Graves, 2009), have enhanced the appeal of senior entrepreneurship (Stangler, 2014) and inspired thought leaders to “change the mindset and build an awareness of ageism to set the foundation for changing social norms” (Jenkins, 2016, p. 39; Kalache, Aboderin, & Hoskins, 2002).
Theorists differ on whether early retirees experience a higher probability of mortality than people in employment (Bingley & Martinello, 2011; Bonsang, Adam, & Perelman, 2012; Friis, 2011).  Research on U.S. participants suggested retirement triggers a significant (almost 10%) drop in cognitive function (Bonsang et al., 2012), while studies of European data validated the opposite (Bingley & Martinello, 2011). Studying the probability of death as an exact indicator for health status, Friis (2011) and Barslund (2015) found that early retirees have a subsequent higher probability of dying than people in employment. At 75, this results in a difference in survival of five percentage points.  
Marshall Goldsmith, a preeminent executive coach and founding director of the Alliance for Strategic Leadership, contends that even thinking about retirement can be a bad idea.  Traditional concepts of retirement are overrated and perilously incorrect.  Fulfilment and meaning are predicated on active engagement (Goldsmith, 2004), flow (Csikszentmihalyi, 1990), and in the purposeful, challenging, and creative activities that constitute transcendent work (Underdahl, 2000).
AARP CEO Jenkins defines social innovation as changing society while finding new solutions to social needs (Jenkins, 2016).  Jenkins views innovation as the engine to disrupt aging (Jenkins, 2016). In that spirit, now is the time for active aging policies to formalize the World Health Organization’s (WHO, 2015, p. 159) five key components of healthy ageing for older people, defined as the ability to (1) meet basic needs; (2) learn, grow, and make decisions; (3) be mobile; (4) build and maintain relationships; and (5) contribute.  
To illustrate the interrelatedness of these factors, work activities may contribute to meeting basic needs. Meeting basic needs may be a venue for learning and growth, which in turn may lead to building relationships (WHO, 2015). The first step in healthy ageing for older persons is catalyzing a “paradigm shift,” (WHO, 2015, p. 159) in social definitions and perspectives on ageing: “Pervasive ageist stereotypes of older people as uniformly frail, burdensome and dependent are not supported by evidence and limit society’s ability to appreciate and release the potential human and social resources inherent in older populations. Yet these negative attitudes influence decision-making, choices about public policy and public attitudes and behaviours” (WHO, 2015, p. 159).
The longitudinal study conducted by Possell et al. (2015) suggested that reducing hopelessness could reduce coronary heart disease (CHD).  The World Health Organization predicts that by 2030, depression and CHD will rank globally as two of the three most disabling conditions, surpassed only by HIV/AIDS (Mathers & Loncar, 2006).  Engagement in activities associated with senior entrepreneurship represents a potential antidote to hopelessness and associated chronic health conditions.  Halvorsen and Morrow-Howell (2016) postulated that senior entrepreneurship positively affects individual and societal well-being and economic stability. These studies underscore the importance of expanding research on topics related to the aging workforce (Anderson, 2015).  
Do Jensen's views on "disrupt aging" seem feasible?
Anderson, L. B. (2015). Changing the story of retirement: How AARP utilizes a strategic narrative to advocate for the aging workforce. Public Relations Review41(3), 357-364.

Bingley, P. & Martinello, A. (2011). Retirement improves cognitive performance, SFI Working Paper, 7. The Danish National Centre for Social Research, Copenhagen. 

Bonsang, E., Adam, S., & Perelman, S. (2012). Does retirement affect cognitive functioning? Journal of Health Economics31(3), 490-501.
Botham, R. & Graves, A. (2009, August).  The grey economy: How third age entrepreneurs are contributing to growth. NESTA, London www. nesta. org. uk.
Clegg, A., & Fifer, S. (2014). Senior self-employment and entrepreneurship—A PRIME perspective. Public Policy & Aging Report24(4), 168-172.  
Csikszentmihalyi, M. (1990). Flow:  The psychology of optimal experience.  New York, NY:  HarperCollins.
Fries, J. F. (2002). Aging, natural death, and the compression of morbidity. Bulletin of the World Health Organization80(3), 245-250. https://dx.doi.org/10.1590/S0042-96862002000300012
Friis, K. (2011). Is premature disengagement a health condition? Withdrawal and risk premature death, in J. G. Andersen and P. H. Jensen (eds) Withdrawal from Labor Market - Causes and Effects, Copenhagen: Frydenlund, pp. 129-135.
Goldsmith, M. (2004, January). Why even thinking about retirement can be a bad idea.  Fast Company.  Retrieved from https://www.fastcompany.com/48353/why-even-thinking-about-retirement-can-be-bad-idea
Halvorsen, C. J., & Morrow-Howell, N. (2016, October 7). A conceptual framework on self-employment in later life: Toward a research agenda. Work, Aging and Retirement, 00(00), 1-12.  DOI: 10.1093/workar/waw031
Jenkins, J. A. (2015, Spring).  Disrupting aging. Generations, 39(1), 6-9.
Jenkins, J. A. (2016). Disrupt aging: A bold new path to living your best life at every age.  Philadelphia, PA:  Perseus.
Kalache, A., Aboderin, I., & Hoskins, I. (2002). Compression of morbidity and active ageing: key priorities for public health policy in the 21st century. Bulletin of the World Health Organization80(3), 243-244.
Mathers, C. D., & Loncar, D. (2006, November 28). Projections of global mortality and burden of disease from 2002 to 2030. Plos Medicine3(11), e442.  Retrieved from http://dx.doi.org/10.1371/journal.pmed.0030442
Stangler, D. (2014, February 12). In search of a second act: The challenges and advantages of senior entrepreneurship:  Testimony before the U.S. Senate Special Committee on Aging & the Senate Committee on Small Business and Entrepreneurship.  Kauffman Foundation.  Retrieved from http://www.kauffman.org/what-we-do/research/2014/02/the-challenges-and-advantages-of-senior-entrepreneurship
Underdahl, L. (2000). The soul of work:  A quest for the transcendent. Bloomington, IN:  AuthorHouse.
Underdahl, L., Leach, R. G., Knight, M., & Heuss, R. (2017, January). Promoting senior entrepreneurship. Conference Proceedings: Promoting senior entrepreneurs. Lüneburg, Germany: 7th Leuphana Conference on Entrepreneurship <www.lce2017.org> 
World Health Organization. (2015). World report on aging and health. Retrieved from http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1


Walker Ladd's picture Walker Ladd | September 25, 2017 10:12 am MST

Hi, Louise,

Thank you for sharing your insights here regarding health and the intersection of senior entrepreneurship. As someone who just received her AARP card this year, purchases her own health insurance and has pre-existing conditions, your noting the stereotype of aging hits home. We must, as you noted, follow the lead of the WHO in challenging and changing the paradigm of age, health, and ability. My question is how? Consider that CHER is now the only healthcare Center among all of the Centers and that we are the only Center with only an Associate University Research Chair at the helm. Moreover, the change in leadership has understandably resulted in inertia and attrition. Is this a paradigm shift away from the focus on health science and scholarship? Are we being, in essence, retired? 

Where do we, as the boots on the ground in this field, gather the inner and external resources to raise not only our own professional stature but the awareness of the import of healthcare research in our Centers?

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