Global health definition survey | McKinsey
The classic Roman aphorism mens sana in corpore sano, or “a healthy mind in a healthy body,” reflects the belief that both types of health are important for a rich and meaningful life. But today, “health” often refers exclusively to physical health. Indeed, an estimated 75 percent of studies related to health have primary end points that address physical health only,
while other critical components of health—mental, social, and spiritual (spiritual health including meaning, belonging, purpose, and identity, not strictly religious belief
)—have been largely ignored.
The McKinsey Health Institute (MHI) has found that countries and societies would benefit from adopting a modernized, holistic framework for health that encompasses multiple dimensions.
Such a broad definition of health, with a greater emphasis on well-being, was proposed as far back as 1948 by the World Health Organization (WHO), which defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
In 2022, MHI conducted a global survey of approximately 1,000 respondents in each of 19 countries to understand how communities around the world define health and what factors they believe influence it. Overall, respondents placed value on all four dimensions of health—physical, mental, social, and spiritual—adopting a much broader view than the health systems in the countries in which they live. Results also showed that feeling healthy is not constrained to the absence or presence of disease, indicating that people all over the world may focus more on how they can live a full and functional life on their own terms.
At the same time, the survey results revealed substantial differences in individual views, needs, and support received, often based on country, gender, age, or income. For example, even though more than 70 percent of respondents rated their overall health as good or very good, this percentage ranges from about 30 percent in Japan
to about 90 percent in Nigeria.
Less than 7 percent of total respondents rated their health poor or very poor.
Key survey findings
This article highlights the most meaningful survey findings as a starting point for an ongoing dialogue and exploration (for more information about the survey, see sidebar, “Survey scope and methodology”).
All dimensions of health matter
Approximately 85 percent of total respondents rated mental and physical health as very important or extremely important; 70 percent and 62 percent, respectively, used those two ratings to describe the importance given to social health and spiritual health. Recent studies also reinforce the importance of social and spiritual health, showing, for example, that loneliness and social isolation are associated with higher risks of heart attack and strokes
or linking greater purpose in life with lower risk of stroke.
Attitudes varied most with regard to the importance of spiritual health. A relatively smaller proportion of respondents from countries with higher median incomes
rated spiritual health as very important or extremely important compared with those from countries with lower median incomes.
With respect to age groups, similar proportions of younger and older respondents listed physical and mental health as important, while social and spiritual health were rated less important by older respondents.
The presence of disease doesn’t always align with perceptions of health
More than 40 percent of all respondents who reported having a disease
still perceived their health as good or very good. Conversely, more than 20 percent of individuals who reported no disease reported they are in fair, poor, or very poor health. Additionally, approximately 25 percent of respondents who reported having a physical disease perceived their ability to accomplish physical tasks as high.
These findings yield two encouraging hypotheses that warrant further investigation. First, people do not always define themselves or feel constrained by their conditions. Second, people may be more focused on living their lives in accordance with what matters to them (for example, pursuing tasks they find meaningful) than on the presence or absence of disease.
Age does not always equate to perceptions of health
Self-reported levels of health decreased with age, although not by much. Among those aged 18 to 24, 70 percent reported good or very good overall health, while approximately 60 percent of those aged 75 to 84 did so.
Meanwhile, older age groups recorded higher scores than younger groups did on some health dimensions, notably mental health. In 15 of 19 countries, a higher share of respondents aged over 65 rated their mental health as good or very good compared with respondents younger than 24 who did so. This finding is consistent with some recent studies highlighting that members of Generation Z
report lower mental health.
This observation is also true for social health: in most countries, a higher share of respondents younger than 24 reported fair or poor social health than did those over age 65.
There is a negative correlation between life expectancy at birth and perception of health
Respondents living in countries with greater life expectancy at birth did not necessarily consider themselves healthier. For example, within the 19 countries surveyed, Japan has the highest life expectancy at birth,
but respondents there rated their health lowest. Respondents from other countries with high life expectancy at birth, including Italy and Australia, also had comparatively lower ratings for self-reported health.
One potential explanation is that respondents in countries with the highest levels of self-reported health often had the highest life-expectancy growth in recent years. For example, in the past two decades, life expectancy grew by more than seven years in India and more than eight years in South Africa and Turkey.
Although this finding warrants further investigation, it may suggest that improvement in living conditions contributes to higher perceived health than is reported in countries that have long had high life-expectancy rates.
Health perception and household income are positively connected in most countries
Within most countries, the more that people earned, the higher their perceptions of their health. For example, approximately 60 percent of the highest-income respondents in Sweden rated their health as good or very good compared with 35 percent of lowest-income respondents. This observation was most pronounced within countries with higher median incomes.
These findings are consistent with a 2019 OECD study,
in which almost 80 percent of adults in the highest-income quintile rated their health as good or very good, compared with 60 percent of adults in the lowest-income quintile. Likewise, national-level studies affirm the findings; for example, a study conducted in the United Kingdom found that an increase in household income of £1,000 is associated with an eight-month increase in female healthy life expectancy.
However, on average, respondents living in countries with higher median incomes did not consider themselves healthier than respondents living in countries with lower median incomes. For example, approximately 75 percent of Mexican and Indonesian respondents rated their health as good or very good, compared with approximately 45 percent of German and Italian respondents.
Overall, people feel best supported in their health needs by family and friends
Health-related support can come from a variety of sources, including family and friends, the public-healthcare system, the private-healthcare system (including employer coverage), and communities, such as social and faith groups.
Yet the love and embrace of family and friends may be of more help than institutional support. More respondents indicated family and friends—even more than public- or private-healthcare systems—provide the highest level of health support across countries, genders, and age groups. Less than 10 percent of respondents globally selected “not applicable” to describe family and friends support, compared with much higher percentages for all other types of support. This finding stresses the importance of social environment for individuals’ health, beyond traditional healthcare-system support.
Proportionately more respondents from countries with lower median incomes considered social and faith communities as valued sources of health support. Only approximately 15 percent of these respondents reported support from communities as “not applicable,” compared with approximately 45 percent of individuals in countries with higher median incomes.
People who feel well supported in their health needs report better health
Overall, respondents who reported high health support rated their health better than those reporting low support, regardless of the source of support. Building from the previous point, it may be hard to replace family and friends: across countries, the largest gap regarding support appears around family and friends, with approximately 80 percent of respondents who reported high support rating their health as good or very good, compared with only 40 percent of respondents who reported low support.
At the country level, this gap was widest in the United Kingdom, Germany, Sweden, and Turkey. In Germany, approximately 60 percent of respondents reporting high support from family and friends rated their health as good or very good, compared with only 20 percent of respondents reporting low support.
Women and men report equivalent health support, despite evidence of inequities
Overall, male and female respondents reported comparable levels of health support and attributed similar importance to support categories such as healthcare systems and family and friends. Interestingly, men in countries with higher median incomes reported higher health support from private- and public-healthcare systems than women did. Although women and men reported the same level of health support, recent research provides evidence that across countries, women are less likely to receive comparable support.
For example, despite suffering more severe and frequent pain over longer periods of time, women are less likely than men to be treated for pain and their symptoms are at times described as “emotional” or “psychosomatic.”
In the United Kingdom, women are 50 percent more likely than men to be misdiagnosed following a heart attack and more likely than men to die from heart attacks.
In the United States, one analysis of gender-specific procedures found that physician reimbursements by Medicare led to a bias in procedure selection. This reflected that reimbursements for male procedures were higher than for female procedures more than 80 percent of the time. Reimbursements were 28 percent higher on average, even though male procedures were typically no more complex.
Individuals with a disease report lower health support than those with no disease
Overall, individuals with a disease reported lower health support, across all categories of support. For example, approximately 50 percent of individuals with a disease reported low support from public-healthcare systems, compared with 35 percent of individuals without any disease.
This finding is exacerbated for individuals with mental illness. For example, approximately 30 percent of individuals with self-reported mental illness reported low support from family and friends, compared with 10 percent of individuals with no self-reported mental illness.
Several explanations for this finding are possible. First, once individuals become ill, they tend to perceive their health support as lower because their needs and expectations increase, and they discover how difficult it can be to navigate the health system.
Second, individuals are more likely to get sick if they have a low level of health support. Studies in Australia
and in the United States
revealed that loneliness, social isolation, and a lack of social support in older adults significantly increased the risk of premature death from all causes—a risk comparable in degree to that posed by smoking, obesity, and physical inactivity.
Finally, a low perception of health support can be symptomatic of the reported disease itself. For example, symptoms of depression can include feeling helpless, avoiding contact with friends, and taking part in fewer social activities, which can in turn lead one to feel unsupported.
If individuals, businesses, and countries widen their understanding of health, they may reap the benefits of gains in life expectancy and quality of life.
Toward a modernized approach of health
Our survey suggests that people define their own health much more broadly than the presence or absence of a disease—physical and mental health matter, but so does the degree to which people feel connected, socially valued, or have a sense of purpose. This broader definition of health, encompassing physical, mental, social, and spiritual dimensions, is relevant but still nascent.
The adoption of a more comprehensive approach is likely necessary to create the lasting, meaningful, and material shifts in societal attitudes and actions to reach the full potential from improved health. If individuals, businesses, and countries widen their understanding of health, they may reap the benefits of gains in life expectancy and quality of life. This change in viewpoint may take time and may require unprecedented collaboration with a much broader set of stakeholders; more comprehensive and better data; and new ways to measure and evaluate interventions intended to improve the health of individuals.
At its heart, MHI was created to help people live longer, fulfilling lives. One facet is engaging with other stakeholders to further understand each dimension of health and the linkages between them, to identify
the barriers to adopting more holistic views of health, and how to address them.
