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Health has a variety of definitions, which have been used for different purposes over time. Health can be promoted by encouraging healthful activities, such as regular physical exercise and adequate sleep, and by reducing or avoiding unhealthful activities or situations, such as smoking or excessive stress. Some factors affecting health are due to individual choices, such as whether to engage in a high-risk behavior, while others are due to structural causes, such as whether the society is arranged in a way that makes it easier or harder for people to get necessary healthcare services. Still, other factors are beyond both individual and group choices, such as genetic disorders.
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the determinants of health of a population and the threats it faces is the basis for public health. The public can be as small as a handful of people or as large as a village or an entire city; in the case of a pandemic it may encompass several continents. The concept of health takes into account physical, psychological, and social well-being.
Community health refers to simple health services that are delivered by laymen outside hospitals and clinics. Community health is also the subset of public health that is taught to and practiced by clinicians as part of their normal duties. Community health volunteers and community health workers work with primary care providers to facilitate entry into, exit from and utilization of the formal health system by community members.
Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.
Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group". It is an approach to health that aims to improve the health of an entire human population. It has been described as consisting of three components. These are "health outcomes, patterns of health determinants, and policies and interventions".
Primary health care (PHC) is "essential health care" that is based on scientifically sound and socially acceptable methods and technology. This makes universal health care accessible to all individuals and families in a community. PHC initiatives allow for the full participation of community members in implementation and decision making. Services are provided at a cost that the community and the country can afford at every stage of their development in the spirit of self-reliance and self-determination. In other words, PHC is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy. PHC includes all areas that play a role in health, such as access to health services, environment and lifestyle. Thus, primary healthcare and public health measures, taken together, may be considered as the cornerstones of universal health systems. The World Health Organization, or WHO, elaborates on the goals of PHC as defined by three major categories, "empowering people and communities, multisectoral policy and action; and primary care and essential public health functions as the core of integrated health services[1]." Based on these definitions, PHC cannot only help an individual after being diagnosed with a disease or disorder, but can actively contribute to preventing such issues by understanding the individual as a whole.
Health promotion is, as stated in the 1986 World Health Organization (WHO) Ottawa Charter for Health Promotion, the "process of enabling people to increase control over, and to improve their health."
The social determinants of health (SDOH) are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk or vulnerability for a disease or injury. The distribution of social determinants is often shaped by public policies that reflect prevailing political ideologies of the area.
Social medicine is an interdisciplinary field that focuses on the profound interplay between socio-economic factors and individual health outcomes. Rooted in the challenges of the Industrial Revolution, it seeks to:
- Understand how specific social, economic, and environmental conditions directly impact health, disease, and the delivery of medical care.
- Promote conditions and interventions that address these determinants, aiming for a healthier and more equitable society.
Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society". According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people.
In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The concept of rural health incorporates many fields, including wilderness medicine, geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.
While epidemiology is "the study of the distribution and determinants of states of health in populations", social epidemiology is "that branch of epidemiology concerned with the way that social structures, institutions, and relationships influence health." This research includes "both specific features of, and pathways by which, societal conditions affect health".
America's Health Rankings started in 1990 and is the longest-running annual assessment of the nation's health on a state-by-state basis. It is founded on the World Health Organization holistic definition of health, which says health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. America's Health Rankings is a partnership of the United Health Foundation, and the American Public Health Association.
Research shows many health disparities among different racial and ethnic groups in the United States. Different outcomes in mental and physical health exist between all U.S. Census-recognized racial groups, but these differences stem from different historical and current factors, including genetics, socioeconomic factors, and racism. Research has demonstrated that numerous health care professionals show implicit bias in the way that they treat patients. Certain diseases have a higher prevalence among specific racial groups, and life expectancy also varies across groups.
The social determinants of health in poverty describe the factors that affect impoverished populations' health and health inequality. Inequalities in health stem from the conditions of people's lives, including living conditions, work environment, age, and other social factors, and how these affect people's ability to respond to illness. These conditions are also shaped by political, social, and economic structures. The majority of people around the globe do not meet their potential best health because of a "toxic combination of bad policies, economics, and politics". Daily living conditions work together with these structural drivers to result in the social determinants of health.
Population health, a field which focuses on the improvement of the health outcomes for a group of individuals, has been described as consisting of three components: "health outcomes, patterns of health determinants, and policies and interventions". Policies and Interventions define the methods in which health outcomes and patterns of health determinants are implemented. Policies which are helpful "improve the conditions under which people live". Interventions encourage healthy behaviors for individuals or populations through "program elements or strategies designed to produce behavior changes or improve health status".
Special considerations are needed to provide appropriate medical treatment for refugee migrants to the United States, who often face extreme adversity, violent and/or traumatic experiences, and travel through perilous regions. Such considerations include screenings for communicable diseases, vaccinations, posttraumatic stress disorder, and depression.
The weathering hypothesis was proposed to account for early health deterioration as a result of cumulative exposure to experiences of social, economic, and political adversity. It is well documented that minority groups and marginalized communities suffer from poorer health outcomes. This may be due to a multitude of stressors including prejudice, social alienation, institutional bias, political oppression, economic exclusion, and racial discrimination. The weathering hypothesis proposes that the cumulative burden of these stressors as individuals age is "weathering," and the increased weathering experienced by minority groups compared to others can account for differences in health outcomes. In recent years, the biological plausibility of the weathering hypothesis has been investigated in studies evaluating the physiological effects of social, environmental and political stressors among marginalized communities. This has led to more widespread use of the weathering hypothesis as a framework for explaining health disparities on the basis of differential exposure to racially based stressors. Researchers have also identified patterns connecting weathering to biological phenomena associated with stress and aging, such as allostatic load, epigenetics, telomere shortening, and accelerated brain aging.
Health politics or politics of health is an interdisciplinary field of study concerned with the analysis of social and political power over the health status of individuals.
Noralou Preston Roos is an American-Canadian professor emerita of community health sciences. She has won several awards for her work in health policy, public health, publicly funded health care, and advocacy of evidence-based medicine and health promotion.
References
- 1 2 3 Lalonde M. A new perspective on the health of Canadians. A working document. Ottawa: Government of Canada, 1974.
- ↑ Hancock, Trevor. "Beyond Health Care: From Public Health Policy to Health Public Policy." Canadian Journal of Public Health 76, Supplement One (May/June 1985).
- ↑ Minkler, M (Spring 1989). "Health education, health promotion and the open society: an historical perspective". Health Educ Q. 16 (1): 17–30. doi:10.1177/109019818901600105. PMID 2649456.
- 1 2 Glouberman S. Towards a New Perspective on Health Policy. Archived 2015-12-08 at the Wayback Machine Canadian Policy Research Networks, 2001. Accessed 18 July 2011.
- ↑ Coburn, D.; Denny, K.; Mykhalovskiy, E.; McDonough, P.; Robertson, A.; Love, R. (2003). "Population health in Canada: A brief critique". American Journal of Public Health. 93 (3): 392–396. doi:10.2105/ajph.93.3.392. PMC 1447750 . PMID 12604479.
- ↑ Frohlich, KL; Potvin, L (Feb 2008). "Transcending the known in public health practice. The inequality paradox: the population approach and vulnerable populations". Am J Public Health. 98 (2): 216–21. doi:10.2105/ajph.2007.114777. PMC 2376882 . PMID 18172133.