Operational Definitions and Health

Operational definitions are clear, detailed, and yet concise definitions of given measures. Their intended purpose is to minimize confusion that can result from more variable or nebulous definitions.  Operational definitions have an important place in the health sciences but can be very difficult to delineate. Think about this: what does it mean to be healthy?

According to the World Health Organization (WHO), Health encompasses three dimensions: It is a complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity. This is a useful definition if we look at health from a high-level, epidemiologic perspective, but it can be difficult to apply to ourselves as individuals. We all have days when we don’t feel like we are complete on all of these dimensions. Does that mean we aren’t healthy on those days? The answer is maybe but not necessarily.

Most of us have an operational definition of health the not only encompasses being free from disease or disorder but also some degree of overall wellness, which echoes the WHO’s definition. But what does wellness mean, then? Wellness generally includes both physical and mental health. But what does it mean to be mentally healthy…? I could do this all day but I won’t. I hope, though, that it illustrates the difficulty involved in coming up with a meaningful operational definition of good health.

Charlatan trudeauI started thinking about operational definitions in this context because I recently read that Kevin Trudeau, the sociopathic swindler behind the whole series of “They” don’t want you to know about conspiracy books, recently declared bankruptcy to avoid paying $37 million in fines to the federal government and now faces potential incarceration. These fines were originally levied because he defied a 2004 settlement with the FTC in which he was banned from peddling any products other than his books because of fraudulent  claims that he and his infomercial costar, “Dr.” Robert Barefoot (another self-aggrandizing quack), made about coral calcium being a cure for cancer. Trudeau had been off of my radar for a while but hearing about him again reminded me of something he wrote in his  digest of misinformation Natural Cures “They” Don’t Want You To Know About, that always stuck with me as a perfect example of why it is important to think about operational definitions when it comes to making decisions about our health. In his book, Trudeau offers what is perhaps the most unattainable definition of good health that I have ever seen. According to Trudeau:

An ideal scenario would be waking up in the morning full of energy and vitality, content, and feeling absolutely great. You go throughout your day with energy, a bounce in your step, a smile on your face. You don’t feel stressed, anxious, or depressed’ you don’t feel tired, you have no headaches or pain in your body’ you are not overweight and you don’t get colds or flus or sickness. You don’t get diseases, you have no pain, you’re not ravenous with your appetite, you eat what you want and you are never that hungry. You don’t deprive yourself of the foods you enjoy. You go to sleep at night and you sleep soundly and peacefully and get a wonderful whole night’s rest. Your sexual desires are healthy and strong, and you are capable of both giving and receiving sexual pleasure. Your skin, your hair, and your nails look healthy and radiant. You have strength and tone in your muscles, your body is fluid, graceful, and flexible. You are firm, strong, vibrant, and feel great! (pg 11)

Sure this would be ideal, however it is pretty clear that Trudeau is either profoundly unaware of the human experience—nobody feels that good all of the time—or that he is creating a market for himself. If we believe his definition of what it means to be healthy then we will inevitably feel unhealthy most of the time. Trudeau, who despite his general sleaziness is very good at the game that he plays, then has the opportunity to assuage the concern that he contrived for us by making unsubstantiated claims then selling us books about them. Trudeau is a highly visible hack but there are many others who use the same tactics.

Mental-HealthIn fact, it is entirely normal to have some mood variation throughout the day. A 2007 study by Katerndhal and colleagues, showed that healthy patients without an underlying mood disorder such as depression or panic disorder, experience maximum and minimum mood levels throughout the day that reflect their circadian rhythm. Further these same healthy people also have additional mood fluctuations in response to sporadic stressors. The point is that variable moods, and stress levels are a normal part of good mental and physical health.

Furthermore, with regard to stress levels, if we are never exposed to both physical and mental stresses, we can become very unhealthy.  On the physical side, think about exercise:  the reason we need to do it is because we need to stress our bodies by overloading them in order to stay in good condition. On the mental side, there is a great deal of emerging evidence that we can maximize our cognitive function by keeping our brains and bodies active.

So despite the fact that it is tough to define health, a good place to start is first with the absence of disease, then with the WHO’s definition of physical, mental, and social activity. However it is important that we also account for the fact that we aren’t going to be in top form all of the time; further someone who is free from disease and able to recover from bouts, even prolonged bouts, of poor physical, mental, or social acuity likely has a good prognosis with regard to his overall health and wellness.

Health science is an objective physical science so I do not mean to imply that we should choose a subjective and unfalsifiable definition of health that fits any situation; this would be as ridiculous as any claim made by Trudeau and his ilk. There are, in fact, a variety of risk factors that can rob us of our physical and mental health and shorten our time on earth. I merely mean to imply that we should all remember that un-scientific charlatans like Kevin Trudeau, Robert Barefoot, and the plethora of other self-serving nostrum peddlers out there have only their own interests in mind and are using operational definitions that meet their own needs at the expense of ours.

For more scientific info about health risk factors see the WHO’s report on global health risks at: http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf