Whole Health

ISPOR’s Ambitious Turn Toward a Whole New World?

The idea of Whole Health is not new. For decades, public health thinkers have reminded us that healthcare is only one of many determinants of health – and not necessarily the most important. The World Health Organisation defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, a vision broadened in its 1984 revision describing health as “a resource for everyday life”. The biopsychosocial model, salutogenesis, person-centred care and the modern language of well-being all flow from that root.

Yet Whole Health is enjoying a revival for the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) which has placed it at the centre of its Strategic Plan 2030, calling for “shaping the definition of value to include whole health”. In recent months, Value in Health has hosted a series of coordinated commentaries on the topic – from ISPOR itself, from the World Health Organisation, and from the US Centers for Disease Control and Prevention – framed by an editorial asking what this new turn might mean for health economics and outcomes research (HEOR).

The ISPOR commentary casts Whole Health as an evolution in the science of value: extending outcome measurement beyond physical and mental health to encompass behavioural, socioeconomic, environmental and even spiritual dimensions. The WHO contribution grounds the concept globally – linking it to primary care, universal coverage, the Sustainable Development Goals, and examples from Rwanda, Costa Rica and Bhutan. The CDC authors bring the concept closer to operational reality, describing efforts to integrate public health and healthcare through joint work on payment, quality measurement and workforce development. And the Value in Health editorial by Devlin, Mullins and van Baal ties these threads together, observing that while Whole Health introduces no new theory, it challenges HEOR to expand its practical scope far beyond the technologies and delivery systems that have traditionally defined the field.

An Expanding Vision – or a Stretch Too Far?

Whole Health’s revival brings a paradox. ISPOR’s official vision remains “a world where healthcare is accessible, effective, efficient and affordable for all” – a statement that still begins and ends with healthcare. Whole Health, by contrast, is about looking beyond it. The dissonance is striking. ISPOR aspires to lead a conversation about the determinants of health, yet its institutional machinery remains designed for technology evaluation. There is a structural irony in asking an organisation financed and oriented toward health technology assessment to redefine value across the social determinants of health.

This tension raises a legitimate question about disciplinary boundaries. Is ISPOR’s adoption of Whole Health a call for genuinely multisectoral analysis, or a rhetorical device that allows the organisation to repackage what it already does? Health economists have long recognised that healthcare is only one input to health. The value frameworks, distributional cost-effectiveness methods and welfare-based approaches developed over decades already gesture toward wider societal perspectives. Whole Health may therefore be less a paradigm shift than a reframing of enduring questions: whose perspective counts, what outcomes matter, and what costs are relevant?

But it could also be something more – an opportunity to extend HEOR into domains where health, environment and society intersect. Doing so would demand new methods, new data and new forms of collaboration reaching well beyond the healthcare sector.

The Environment as the Missing Determinant

If Whole Health is to mean anything substantive, the environment must sit near its core. Climate change, biodiversity loss, air pollution and ecosystem degradation are among the most profound influences on global health and well-being. Rising temperatures reshape disease transmission, food systems and migration patterns. Floods, fires and heatwaves damage health directly and indirectly through displacement, food insecurity and mental distress. The WHO has described climate change as “the single biggest health threat facing humanity” – a statement that should place environmental determinants at the heart of any Whole Health framework.

Yet much of the current discourse remains curiously anthropocentric, focused on integrating physical and social well-being while neglecting the ecological foundations that make those possible. Incorporating environmental impacts into economic evaluation is not a technical refinement: it reframes what counts as a health intervention at all. Energy policy, transport planning and housing design become legitimate objects of health economics, as much as diagnostics, devices or pharmaceuticals.

Recent work linking health co-benefits to climate action demonstrates how interconnected these systems are. Cleaner transport reduces air pollution and chronic disease; green urban design mitigates heat stress while encouraging physical activity; decarbonising household energy improves indoor air quality. These are quintessential Whole Health interventions – spanning sectors, time horizons and populations – yet they often lie beyond the remit of traditional HEOR.

Some research initiatives, including efforts to develop international guidance for evaluating the health and environmental impacts of adaptation and mitigation strategies, are beginning to fill this void. But the field as a whole still lacks the frameworks, data linkages and governance structures needed to bring environmental determinants into the mainstream of value assessment.

The Moral Test of Whole Health

There is also an ethical test. Earlier this year, ISPOR was asked to make a statement on the humanitarian disaster in Gaza. After thoughtful discussion, the Board decided not to issue one, preferring instead to develop a general policy for future crises. The caution is understandable – professional societies must guard their neutrality – yet the episode highlights the limits of neutrality when an organisation defines its mission around Whole Health.

Conflicts, displacement and humanitarian crises represent profound assaults on human well-being. If Whole Health is to be more than a rhetorical ideal, it must at least acknowledge that violence and instability destroy the social, environmental and economic conditions that underpin health. Just as climate change exposes the fragility of planetary health so conflict reveals the fragility of social health. Both demand that Whole Health grapple with the conditions that allow human wellbeing to flourish.

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Looking to Glasgow

As ISPOR members prepare to meet in Glasgow, there is an opportunity to reflect on what Whole Health really means for HEOR – an expansion of scope, a redefinition of value, or a mission stretch too far? The society deserves credit for provoking debate about the future of the discipline and for situating economic evaluation within a wider conception of human flourishing. But ambition must be matched by coherence.

The task ahead is not to colonise new territories but to collaborate across them – to work with public health, environmental science and social policy to build evidence that captures the full texture of well-being on a changing planet. If ISPOR truly intends to lead a Whole Health movement, it must help build the analytic bridges between health, environment and equity – turning Whole health from slogan into substance.