WHAT IS HEALTH?
What is health? On the surface, this seems like a simple question, yet the answer is anything but. When I tried to think of how I would define it, nothing seemed quite right – it appeared impossible to string together a few sentences that could sum up such a huge part of the human experience. The reality is that each of us experience health in our own unique way, therefore the definition each of us would give would be highly subjective. Our perceptions of health are likely to change as we go through various life experiences and age. The short video below is an excellent example of just how varied our answers can be (OHSU, 2014):
In the professional world, things are just as muddied.
In 1948 the World Health Organization (WHO) defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or immunity” (WHO, 1948). When it was published, the definition was largely seen as revolutionary as it included more than just physical wellbeing. It did not take long, however, for criticisms to emerge. Over the years it has been criticized as being unrealistic, unmeasurable, and overly broad, to name a few (Leonardi, 2018). The general consensus is that the definition is needs to be revised, yet, although many new definitions have been proposed, none has gained wide-spread support in the 60+ years since the WHO definition was published.
One of the proposed reasons why there has been no consensus takes us to the philosophy behind the definitions (Bickenbach, 2017). It is said that the definitions of health being proposed generally fall into one of two approaches:
Normative Approach: requires an understanding of why health is a ‘human good’ to be explained before health can be defined; Or,
Descriptive Approach: defines health using the language of the biological sciences.
Bickenbach states that each of these approaches has its strength and weaknesses, and that this is the driving force behind much of the on-going discussions and disagreements around revising the definition of health. It seems that they cannot be brought together, for they are fundamentally different, however, on their own, each are found to be lacking and susceptible to serious criticisms. The debate regarding how to redefine health will likely continue for the foreseeable future, and it is possible that we will never stumble upon a definition that satisfies all interested parties.
WHAT ARE THE DETERMINANTS OF HEALTH?
In the meantime, we have made considerable progress in health research and learning about factors outside of the health care system that have the ability to influence our health. These have been termed the ‘determinants of health’ and they include “personal, social, economic, and environmental factors” (Government of Canada, n.d.). The Government of Canada highlights the following as the main determinants of health:
- Income and social status
- Employment and working conditions
- Education and literacy
- Childhood experiences
- Physical environments
- Social supports and coping skills
- Healthy behaviours
- Access to health services
- Biology and genetic endowment
- Gender
- Cultures
- Race / Racism
In addition, much of the research on the determinants of health has focused specifically on the social determinants of health. Health Canada defines these as “a specific group of social and economic factors within the broader determinants of health” (Government of Canada, n.d.). Raphael et al. (2020) include the following 17 factors as the social determinants of health:
- Income and Income Distribution
- Education
- Unemployment and Job Security
- Employment and Working Conditions
- Early Childhood Development
- Food Insecurity
- Housing
- Social Exclusion
- Social Safety Net
- Healthy Services
- Geography
- Disability
- Indigenous Ancestry
- Gender
- Immigration
- Race
- Globalization
The authors argue that these social determinants of health affect our health far more profoundly than any lifestyle choices or medical treatments we may receive through our health care system. The infographic below illustrates how the main factor influencing your health are your lived everyday experiences (50%), followed by health care (25%), your biology (15), and your environment (10%) (Canadian Observatory on Homelessness, 2014).
As we review the various determinants of health and the social determinants of health, it is clear that, aside from a few exceptions, many of these factors have the potential to be modified. This means that we do have the ability to improve our health via factors beyond our health care system. It is also clear that many of these factors cannot be modified at the level of the individual. The next logical question is – how can they be modified to generate better health outcomes for a given population or individual? Enter multi-level health models – a topic I will discuss in my next blog post.
References:
Bickenbach, J. (2017). WHO’s Definition of Health: Philosophical Analysis. In T. Schramme & S. Edwards (Eds), Handbook of the philosophy of Medicine (pp. 961-974). Springer. https://onlinelibrary.wiley.com/doi/full/10.1111/jep.12793
Canadian Observatory on Homelessness. (2014, July 12). Infographic Wednesday - Social Determinants of Health. Homelesshub.Ca. https://www.homelesshub.ca/blog/infographic-wednesday-social-determinants-health
Government of Canada. (n.d.). What is health? Retrieved February 4, 2021, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-approach/what-is-health.html
Leonardi, F. (2018). The Definition of Health: Towards New Perspectives. International Journal of Health Services, 48(4), 735–748. https://doi.org/10.1177/0020731418782653
OHSU. (2014, January 25). What is Health? YouTube. https://www.youtube.com/watch?v=bI1OXWIQf3k
WHO. (1948, April 7). Constitution of the World Health Organization. https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1
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