The 1948 constitution of the World Health Organization (WHO) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. It was a bold and revolutionary health idea to gain international consensus in a period characterized by fervent anti-communism. This article explores the genealogy of the health definition and demonstrates how it was possible to expand the scope of health, redefine it as ‘well-being’, and overcome ideological resistance to progressive and (...) international health approaches. The first part of the article demonstrates how the health definition was composed through a trajectory of draft ideas from scholars in the history of medicine, as well as political actors working to promote national health insurance. The definition was authored by League of Nations veteran Raymond Gautier, but secretly drew heavily on medical historian Henry E. Sigerist’s controversial book Socialized Medicine in the Soviet Union (1937). The second part analyses how it was possible to resist the ideological pushback against the WHO and secure US ratification. The WHO’s progressive constitution was not simply a deviation from dominant health ideas, but a direct outcome of the entrenched health conflict. The genealogy is based on original archival material from international organizations and US government archives. The article contributes to understandings of the political controversies surrounding the WHO and to scholarship on understandings of health. It also illustrates how influential health ideas cross the boundaries between politics and health sciences, as well as the boundaries between domestic health policy and global health. (shrink)

There has been a move in medicine towards patient-centred care, leading to more demands from patients for particular therapies and treatments, and for wish-fulfilling medicine: the use of medical services according to the patient's wishes to enhance their subjective functioning, appearance or health. In contrast to conventional medicine, this use of medical services is not needed from a medical point of view. Boundaries in wish-fulfilling medicine are partly set by a physician's decision to fulfil or decline a patient's wish in (...) practice. In order to develop a better understanding of how wish-fulfilling medicine occurs in practice in The Netherlands, a qualitative study (15 semistructured interviews and 1 focus group) was undertaken. The aim was to investigate the range and kind of arguments used by general practitioners and plastic surgeons in wish-fulfilling medicine. These groups represent the public funded realm of medicine as well as privately paid for services. Moreover, GPs and plastic surgeons can both be approached directly by patients in The Netherlands. The physicians studied raised many arguments that were expected: they used patient autonomy, risks and benefits, normality and justice to limit wish-fulfilling medicine. In addition, arguments new to this debate were uncovered, which were frequently used to justify compliance with a patient's request. Such arguments seem familiar from conventional medicine, including empathy, the patient–doctor relationship and reassurance. Moreover, certain arguments that play a significant role in the literature on wish-fulfilling medicine and enhancement were not mentioned, such as concepts of disease and the enhancement–treatment dichotomy and ‘suspect norms’. (shrink)