Chapter 1
Overview of Health

Chapter Outline

• Health Defined
• Two Aspects of Health: Physical and Mental
• Wellness Defined
• Risk and Protective Factors That Influence Health
• Health Determinants
• The Three P's: Population, Poverty, and Pollution
• Health as a Basic Human Right
• Chapter Summary
• Review Questions
• Key Terms
• Chapter Activities
• Bibliography and Works Cited

Chapter Objectives

• Define health and wellness.
• Identify the two aspects of health: physical and mental.
• Describe and give examples of health determinants.
• Compare and contrast risk factors and protective factors that influence health.
• Explain how the three P's-population, poverty, and pollution-influence health.
• Summarize why health is a basic human right.

This chapter introduces concepts of health and wellness. It also explains how determinants as well as risk and protective factors influence health. Some determinants such as the three P's-poverty, population, and pollution-cause many health problems for people at the local, national, and global levels. The chapter also offers a rationale for why health is a human right.

Health Defined

Health is not easy to define. To some people, health is a sense of well-being, of "feeling good." For others, health means not being sick, and if sick, healing quickly.

For still others, health is a moral issue; that is, sickness is a result of a person's having done something "bad" or "wrong." For most of us, however, health means doing what we want to do with little or no pain.

The definition of health has changed several times over the course of Western history. In the past, it was limited to the "absence of disease." Now, this definition includes not only an absence of disease but also how health is influenced by other factors, such as lifestyle, genetic makeup, and the environment. For example, the most often quoted definition of health was developed in 1948 by the World Health Organization (WHO): "The state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

The WHO 1948 definition recognizes that multiple factors influence health. Health is more than a physical condition and more than just the absence of disease. The WHO definition defines health more as a holistic state; that is, health is multidimensional and is affected by multiple factors.

In the 1986 Ottawa Charter for Health Promotion, WHO expanded the definition of health: "a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities." This expanded definition means that health is not just a state of physical, mental, and social well-being but also the ability to develop personal and social resources that are necessary to adapt to changes in one's environment. Health helps us function daily, reach our goals, and be active in family, community, school, and work activities (Corbin, Pangrazi, & Franks, 2005).

The 1948 and the 1986 WHO definitions recognize the holistic state of health. However, there are differences among cultures, ages, genders, and socioeconomic statuses that make it difficult to establish a universal definition of health. These differences include the following:

1. Culture differences Purnell (2003) expands the WHO 1948 and 1986 definitions by adding that health is "a state of wellness that includes physical, mental, and spiritual states and is defined by individuals within their cultural group."
2. Age differences Older adults may define health as mobility and independence. Middle-aged adults may define health as an inner strength and the ability to handle life's challenges. Young adults and adolescents may define health as good physical condition, energy, and personal attractiveness. Children may define health as physical strength. In other words, views of health change as we grow older. Health across the lifespan means that physical, mental, and social factors are interconnected and that health is a life-course process that requires a changing definition as we age (Manderscheid et al., 2010) (see Figure 1.1).
3. Gender differences The different roles for men and women have negative as well as positive impacts on health. Work, parenthood, marriage, and aging, for example, create gender-specific physiological and psychological stresses that affect health.
4. Socioeconomic status (SES) Those who have a high SES may view health as enjoying life, and those who have a low SES may view health as meeting basic needs of food, shelter, and safety.

Figure 1.1 Definitions of Health Across the Lifespan

Adding to the complex influences of culture, age, gender, and SES, health and disease can coexist in a person. For example, a person can have asthma, but if she takes her medications as prescribed and adjusts her lifestyle to manage the disease, she can still experience physical, mental, and social health.

In summary, health is a holistic state and includes many factors beyond just freedom from physical disease and pain. Historically, the definition of health evolved from a limited view that focused on the absence of disease to a view that is multidimensional and includes many different influences on health (Office of Disease Prevention and Health Promotion, 2014).

Two Aspects of Health: Physical and Mental

Regardless of a person's culture, age, gender, and SES, most people accept that there are two aspects of health: physical (body) and mental (mind). Physical health or physical well-being concerns our bodies and is associated with being physically fit due to healthy choices related to exercise, nutrition, sleep, and relaxation.

Fitness contributes to physical health and it reflects cardiorespiratory endurance, muscle strength, flexibility, and body composition. Other contributors to physical health include appropriate weight, responsible sexual behavior, and hygiene.

Mental health or mental well-being is intellectual and emotional well-being. According to the National Mental Health Information Center (2015), mental health includes

our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.

Most people also agree that mental health includes the ability to enjoy life, bounce back from stressful events, achieve balance, be flexible, and feel safe.

Many of us see mental health defined as a biomedical term: the "absence of mental illness." For some, this definition is not enough because it adds little to understanding the person and the factors that lead to health or illness. The goal of treatment in mental health is to understand as much about a person's emotions, thoughts, and behaviors as about the signs and the symptoms of a disease (Manderscheid et al., 2010). As William Osler (1849-1919), an icon of modern medicine, stated, "It is much more important to know what sort of person has a disease than what sort of disease a patient has."

Wellness Defined

Health and wellness are related terms. Both focus on balancing the physical, social, and emotional aspects of a person's life. Wellness is an active, lifelong process of becoming aware of healthy choices and making decisions that promote a more balanced and fulfilling quality of life-that is, a general sense of happiness and satisfaction with one's life and environment. Simply put, wellness is the degree to which a person feels positive and enthusiastic about life and has developed the ability to manage feelings and behaviors.

There are two aspects to quality of life. The first is a person's general quality of life, which involves such factors as health, recreation, culture, and values, and the environments that support these factors. The second is health-related quality of life, which involves a personal sense of physical and mental well-being and the ability to engage in healthy behaviors.

Risk and Protective Factors That Influence Health

A person's health is shaped by biological factors, such as genes, age, and gender. However, these biological factors are generally not sufficient to ensure that someone will be healthy. Both health and illness can also be caused by social, economic, educational, cultural, and political factors, ranging from the availability of food to personal responsibility to quality of health care (Doll, 1992; Institute of Medicine, 2001; UN Committee on Economic, Social and Cultural Rights [CESCR], 2000; World Health Organization, 2008).

Those factors associated with illness are referred to as risk factors. Risk factors are certain conditions or habits...