Understanding Health and its Influencers

Defining health allows for a shared understanding of health, facilitating more coherent research, better policies, and healthcare delivery (McCartney et al. 2019). The practicality or operationalism in health definitions allows for the innovation and implementation of strategies to maximize health at the individual, community and societal level (Huber, 2011; McCartney et al., 2019). WHO’s 1948 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 argued to be limited and inadequate in recent years (Huber, 2011; McCartney et al., 2019). With such definition, being healthy would be difficult most times (Huber, 2011). Misuse of health interventions such as medications, screening from unnecessary diagnoses in which the “abnormalities” may never result in “illnesses” (Huber, 2011). In WHO’s definition, the change from acute diseases to chronic diseases being a greater burden of illness is not considered. More people are growing older with chronic illnesses, as opposed to dying early which was the trend in 1948. According to Huber (2011), defining people with chronic illnesses or disabilities as unhealthy based on such a definition ignores the human ability to adapt to the changing social, physical, and emotional challenges of life to attain the perception of well-being. Besides, measuring health with such a definition is not practical given the word “complete” can not be acted upon or measured. A more dynamic definition of health based on resilience or coping capacity to manage one’s self and restore integrity, equilibrium and sense of well-being is required - a practical concept of health that is measurable (Huber 2011; McCartney et al., 2019).

The definition of health has continued evolving over the years (McCartney et al., 2019). McCartney et al. (2019) evaluates more definitions of health and proposes a more practical health definition as “A structural, functional and emotional state that is compatible with effective life as an individual and as a member of society.” This definition is more wholesome by containing functional and experiential elements of physical, mental, and social dimensions, with a measurable outcome of effective living (McCartney et al., 2019; Huber 2011). Among other evaluated definitions is The Ottawa Charter for Health Promotion (1986) definition stating “Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realise aspirations, to satisfy needs and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being” (McCartney et al., 2019). McCartney et al. (2019) agrees with Huber (2011) on the impossibility of attaining a complete state of well-being. However, the Ottawa Charter for Health Promotion (1986) acknowledges the resilience or coping capacity to manage one’s self and restore integrity, equilibrium and sense of well-being. This definition equally brings focus on social and physical determinants of health by emphasizing physical capabilities, social and personal resources. Below is a video illustrating how social determinants of health improves strategies addressing health inequities in Canada.

Understanding the social determinants of health has proved useful in identifying and reducing health inequalities and improving population health (Raphael et al., 2020; McCartney et al, 2019). The living conditions experienced by individuals will primarily shape health outcomes beyond medical treatments or lifestyle choices (Mikkonen & Raphael, 2010). The changing world has resulted in the evolution of the Canadian social determinants of health from 14 determinants to include three new social determinants - Geography, Immigration and Globalization (Raphael et al., 2020; Mikkonen & Raphael, 2010). The other 14 social determinants of health in Canada include income and income distribution, education, unemployment and job security, employment and working conditions, early childhood development, food insecurity, housing, social exclusion, social safety net, health services, indigenous ancestry, gender, race, and disability.

The evolution of health definition and the social determinants of health over the years reflects the dynamic and relative nature of health (Raphael et al., 2020; McCartney et al., 2019). Identifying the influencers of health better informs health policies and interventions. The success and sustainability of such health policies and interventions will be maximized when the determinants of health are addressed. Promoting health equity is a fundamental approach to improving health outcomes at multiple levels of health, from the individual to the societal level. Several models capturing the multilevel influence on health have been adopted in improving health. Such models include Life course model, Dahlgren & Whitehead Model, and the Population Health Model (Jones et al., 2019; Dahlgren & Whitehead, 1991; Government of Canada, 2001). Check out this resource to further explore the models outlined.

References

Dahlgren G, Whitehead M. 1991. Policies and Strategies to Promote Social Equity in Health. Stockholm, Sweden: Institute for Futures Studies. http://repositori.uji.es/xmlui/bitstream/handle/10234/187797/GoeranD_Policies_and_strategies_to_promote_social_equity_in_health.pdf?sequence=1

Government of Canada. (2001). Population Health Promotion: An Integrated Model of Population Health and Health Promotion. Canada. https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-promotion-integrated-model-population-health-health-promotion/developing-population-health-promotion-model.html

Huber, M. (2011). Health: How should we define it? British Medical Journal, 343,(7817), 235-237. https://doi.org/10.1136/bmj.d4163

Jones, N. L., Gilman, S. E., Cheng, T. L., Drury, S. S., Hill, C. V., & Geronimus, A. T. (2019). Life course approaches to the causes of health disparities. American journal of public health, 109(S1), S48–S55. https://doi.org/10.2105/AJPH.2018.304738

McCartney, G., Popham, F., McMaster, R., & Cumbers, A. (2019). Defining health and health inequalities. Public health, 172, 22–30. https://doi.org/10.1016/j.puhe.2019.03.023

Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management. https://www.thecanadianfacts.org/The_Canadian_Facts.pdf

Raphael, D., Bryant, T., Mikkonen, J. and Raphael, A. (2020). Social Determinants of Health: The Canadian Facts. Oshawa: Ontario Tech University Faculty of Health Sciences and Toronto: York University School of Health Policy and Management. https://www.thecanadianfacts.org/The_Canadian_Facts-2nd_ed.pdf