Chapter 1
Health and Wellness
Jeremy Wee
Conceptualizations of Health
- When health is negatively defined as the absence of disease, health and illness are
represented on a continuum, with maximum health at one end and death at the
other
- However, when health is positively defined health and illness are viewed as
distinct but interrelated concepts. It is possible to have a chronic illness but still
have healthy characteristics as well
Disease
- an objective state of ill health, the pathology of which can be detected by medical
science
Illness
- a subjective experience of loss of health (Labonte)
Health
- an objective process characterized by functional stability, balance and integrity
- WHO “a state of complete physical, mental and social well-being, and not
merely the absence of disease and infirmity”
- 1984 WHO “Health is viewed as the extent to which an individual or group is
able, on the one hand, to realize aspirations and satisfy needs; and on the other
hand, to change or cope with the environment. Health is seen as a resource for
everyday living; not the object of living. Health is a positive concept emphasizing
social and personal resources as well as physical capacities.”
Classifications of Health Conceptualizations
- Stability-oriented definition: the maintenance of physiological, functional and
social norms
- Actualization-oriented definition: the actualization of human potential. Those
who adhere to this definition often use the terms health and wellness
interchangeably
- Combined actualization and stability definition: Pender, “Health is the
actualization of inherent and acquired human potential through goal-directed
behaviour, competent self-care and satisfying relationships with others, while
adjustments are made as needed to maintain structural integrity and harmony with
relevant environments.”
Historical Approaches to Health in Canada
- 3 major approaches are used to form a framework to examine the evolution of
health orientations in Canada
Medical Approach
- Represents stability orientation to health
- Emphasizes that medical intervention restores health
- Less given to health promotion and disease prevention
Behavioural Approach
- When large amounts of money were spent on health care but the health status of
the population did not improve proportionately, a report was commissioned to
find out why
- The Lalonde Report shifted emphasis from a medical to a behavourial approach
to health
o Broadly defined health determinants (health field concept) as:
Lifestyle
Environment
Human biology
The organization of health care
- Aim was to decrease behavioural risk factors factors such as smoking, substance
abuse, lack of exercise, and an unhealthy diet
- Wanted to motivate individuals to engage in healthy behaviours
Socio-Environmental Approach
- Health is closely tied to the social structure. I.e. poverty and unhealthy physical
and social environments can affect health directly
- Health field concept was expanded to emphasize the social context of health and
the relationship between personal health behaviours and social and physical
environments
- Ottawa Charter for Health Promotion supported a socio-environmental
approach
o Outlined 5 major strategies to promote health
Building healthy public policy
Creating supportive environments
Strengthening community action
Developing personal skills
Reorienting health services
o Identified prerequisites for health as:
Peace
Shelter
Education
Food
Income
Stable ecosystem
Sustainable resources
Social justice
Equity
- The Jakarta Declaration identified 4 additional prerequisites for health
Human rights
Social security
Social relations
Empowerment of women
- The Epp Report identified 3 major health challenges influencing Canadians:
Reducing inequities
Improving prevention
Enhancing coping
Risk Factors and Risk Conditions
o Psychosocial risk factors are complex psychological experiences resulting
from social circumstances that include isolation, lack of social support,
limited social networks, low self-esteem and self-blame
o Socio-environmental risk conditions are social and environmental living
conditions that include poverty, low educational or occupational status,
dangerous or stressful work, dangerous physical environments, pollution,
discrimination, relative political or economic powerlessness and
inequalities of income or power
Strategies for Population Health
- Refer to Figure 1-5 for Population Health Approach
- The entire range of known individual and collective factors and conditions that
determine population health status, and the interactions among them, are taken
into account in planning action to improve health
- The key health determinants identified in this document are:
o Income and social status
o Social support networks
o Education
o Employment and working conditions
o Physical environments
o Biology and genetic endowment
o Personal health practices and coping skills
o Healthy child development
o Health services
Toronto Charter
- Social determinants of health outlined in charter:
o Early childhood development
o Education
o Employment and working conditions
o Food security
o Health care services
o Housing shortages
o Income and equitable distribution
o Social safety nets
o Social exclusion
o Unemployment and employment security
Determinants of Health
- 12 major determinants of health, each influences the others:
o Income and Social Status
Greatest determinant of health
Studies show Canadians who live in poverty have poorer health
People with lower incomes are more likely to die earlier and to
suffer more illnesses than those with higher incomes, regardless of
age, sex, race, culture and place of residence
o Social Support Networks
Affects health, health behaviours, and health care utilization
Support from families and friends and from informal and formal
groups can provide practical aid during times of crisis and
emotional support in times of distress and change
o Education
Important influence of health status because they affect may other
health determinants
Increases job opportunities and income security, giving one the
knowledge and skills to solve problems and gain a sense of control
over one’s life
People with higher education levels tend to smoke less, be more
physically active, and have access to healthier foods and physical
environments
o Employment and Working Conditions
Significantly affect physical, mental and social health
Paid work provides financial stability, a sense of identity and
purpose, social contacts and opportunities for personal growth
However, working conditions can also pose significant hazards
Work pace and time are also key influences, especially among
professionals and managers
Workplace stress is linked to increased risk of physical injuries at
work, high blood pressure, cardiovascular disease, depression and
increases in smoking and drinking
o Physical Environments
Housing, indoor air quality and community planning are important
determinants of health
Affordable and adequate housing is another important aspect of the
environment
o Biology and Genetic Endowment
Heredity is strongly influenced by social and physical
environments, and considerable effort has been expended to
prevent congenital defects through monitoring and improved pre-
conception and prenatal care
One should ask how much of a decline is related to biological
aging and how much is the result of other determinants such as
socio-economic status, social support and personal health practices
o Personal Health Practices and Coping Skills
Personal health practices are the primary focus of the behavioural
approach to health.
Effective coping skills help people to face challenges without
resorting to risk behaviours such as substance abuse
3 lifestyle practices with major detrimental health consequences
are:
Physical inactivity- promotes weight gain and obesity. It is
a major risk for many diseases
Poor nutrition- overconsumption of fats, sugars and
starches is linked to major causes of diseases.
Smoking- single most important preventable cause of death
o Healthy Child Development
Important to lifelong health
Conditions such as adequate and equitable income, effective
parenting and supportive environments affect healthy child
development
2 significant health risks are low birth weight and effects of
maternal tobacco, alcohol and drug use
o Health Services
Quality, accessible acute care treatment, long-term care, home care
and preventive services are important to a population’s health
status
o Gender
Both men and women are susceptible to diseases; men are more
likely to die prematurely from heart disease and cancer while
women are more likely to suffer from depression and stress
Gender-based social roles play a role in the health of each gender
o Culture
Culture and ethnic factors influence how people interact with a
health care system, their participation in programs of prevention
and health promotion, their access to health information, their
health-related lifestyle choices and their understanding of health
and illness
Language barriers can lead to isolation and decreased social
support networks
Prejudice can deny individuals opportunities for education,
employment and access to housing
o Social Environments
Defined as “the array of values and norms of a society that
influence in varying ways the health and well-being of populations.
In addition, social stability, recognition of diversity, safety, good
working relationships and cohesive communities provide support
that reduces or avoids many potential risks to good health”
By reducing or effectively erasing one risk of health another health
condition may increase i.e reducing income inequalities increases
community cohesiveness
Strategies to Influence Health Determinants
- Refer to Harbinder’s Nurs 1110 notes on Health Promotion