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On April 7, 2019, the World Health Organization (WHO) turned 71-surpassing the proverbial life span of "three score and ten." Its definition of health as a "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" has been a guiding framework for the Centers for Disease Control and Prevention (CDC), Pan American Health Organization, and other WHO partners.1(p43) This circa-1948 definition reflected postwar optimism for the control of communicable diseases and the promise of the world's children. Since then, communicable diseases such as smallpox, polio, diphtheria, and tetanus have been brought under control, infant and childhood mortality have fallen, and life expectancies worldwide have dramatically risen.
Longer lives foreground a new health concern: living well with multiple chronic conditions. Chronic diseases are prevalent, nearly ubiquitous, in older adults. More than two thirds of Americans aged 65 years and older are managing two or more diseases; one in seven is managing six or more diseases.2 Globally, noncommunicable diseases now account for 73% of deaths and a wide spectrum of disabilities.3 The WHO definition of "complete" health thereby sets either unrealistic expectations for older adults or categorically excludes them from frameworks ofhealth. Do we need a new definition of health to incorporate aging populations into its basic tenets? What measures will advance attention to the health needs of this growing, at times vulnerable, and largely overlooked population?
Context matters. Important changes in population aging and disease management in the last 70 years urge new consideration of the particular health needs of the elderly as an essential component of health in an aging world.
WHO FRAMEWORK FOR HEALTH, 1946-1948
In the summer of 1946 in New York City, the United Nations (UN) convened the International Health Conference, which led to the creation of the WHO in 1948.4 Sixty-one nations, including the United States and members of the UN, signed its Constitution. The chair of the US delegation, Surgeon General Thomas Parran, commended the WHO Constitution as a "magna carta for health," guiding postwar efforts for eradicating disease, fostering international peace, and ensuring the health of the world's children.1(piii) The organization set out as its first objective the meaning of health as complete physical, mental, and social wellbeing. It also emphasized the...