Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental or social changes. The World Health Organization (WHO) defined health in its broader sense in its 1948 constitution as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. This definition has been subject to controversy, in particular as lacking operational value, the ambiguity in developing cohesive health strategies, and because of the problem created by use of the word complete.