9.1 What Does it Mean to be Healthy?
L D Worthy; T Lavigne; and F Romero
The meaning of health has evolved over time but early definitions of health focused on the theme of the body’s ability to function. Originally health was seen as a state of normal function that could be disrupted from time to time by disease. Disease is a broad reference to any condition that impairs normal functioning of the body. Most Western countries focus on the physical processes – pathology, biochemistry and physiology of a disease – as primary contributors to health. This is known as the biomedical model. According to the biomedical model, health means freedom from disease, pain, or defect but not does consider the role of social factors or individual subjectivity. There is a contrasting model of health that takes a more holistic approach, often referred to as traditional medicine.
The World Health Organization (WHO) defines traditional medicine as “the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures” (WHO, 2019). In 1977, American psychiatrist George Engel developed an interdisciplinary model that looked at the interconnection between biology, psychology, and socio-environmental factors. With his biopsychosocial approach, Engel strived for a more holistic approach to health by recognizing that each patient has his or her own thoughts, feelings, and history.
Engel’s biopsychosocial model views the development of illness through the complex interaction of biological factors (genetic, biochemical), psychological factors (mood, personality, behavior) and social factors (cultural, familial, socioeconomic, medical). For example, a person may have a genetic predisposition for depression, but he or she may have social factors such as extreme stress at work and family life, and psychological factors such as a perfectionistic tendency, which when combined can trigger this genetic code for depression.
Health, as defined by the World Health Organization (WHO), is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 2019). This definition has been subject to controversy, as it may have limited value for implementation. Generally, the context in which we live our lives is critical for our health and quality of life. It is increasingly recognized that health is maintained and improved not only through the advancement and application of health science, but also through intelligent lifestyle choices and efforts of the individual, as well as larger society.
According to the World Health Organization the main determinants of health include:
- Social environment
- Economic environment
- Physical environment
- Individual characteristics and behavior
- Global Indicators of Health
Health indicators are quantifiable characteristics of a population which researchers use for describing the health of a population. Adopting a standard system with reliable measures for defining health is important for global monitoring of changes in health (see Chapter 3 for more about reliability). Researchers using data collected from around the world look for patterns in identifying, preventing, and treating disease. There are three common global health indicators identified by The World Health Organization (WHO) that directly and indirectly measure and monitor global health:
- Life expectancy
- Infant mortality
- Subjective well-being
These three indicators serve as standard measures to assist health professionals working in both developed and developing countries. Each indicator is discussed in greater detail.
Life expectancy (LE) is a statistical measure of the average time an organism (in our case human) is expected to live, based on the year of its birth, its current age and other demographic factors including gender. There are great variations in life expectancy between different parts of the world, mostly caused by differences in public health, medical care, and diet. Comparing life expectancies from birth across countries can be problematic. There are differing definitions of live birth versus stillbirth even among more developed countries, and less developed countries often have poor reporting.
Worldwide, the average life expectancy at birth was 71.5 years, 68.4 years for males and 72.8 years for females over the period 2010–2015 according to United Nations World Population Prospects (UN Population Prospects, Revised 2015).
In the United States, African-American people have shorter life expectancies than their European-American counterparts. For example, white Americans born in 2010 are expected to live until age 78.9, but black Americans only until age 75.1. In contrast, Asian-American women live the longest of all ethnic groups in the United States, with a life expectancy of 85.8 years. The life expectancy of Hispanic Americans is 81.2 years (Center for Disease Control, CDC, 2019).
Overall, the United States ranks 49 globally in LE. The highest life expectancy is found in Monaco (Europe) and the lowest life expectancy is found in Angola (Africa) (“Life Expectancy”, 2019). Ranking 49 in the world in life expectancy doesn’t sound so bad when you consider over 200 countries contribute data but it is problematic and concerning given the comparative abundance of resources of the United States. Some argue that the United States, with access to health sciences, technology, and supported innovation should be a global leader in life expectancy rates with a much higher global ranking.
Infant mortality is the death of young children under the age of 1 and infant mortality rate (IMR) is the number of deaths of children under one year of age per 1000 live births. Infant mortality rate is used to standardize infant deaths for global comparisons (WHO, 2019). Premature birth is the largest contributor to the IMR. Other leading causes of infant mortality are birth asphyxia, pneumonia, congenital malformations, diseases and malnutrition. Many factors contribute to infant mortality, such as the mother’s level of education, environmental conditions, and political and medical infrastructure. Improving sanitation, access to clean drinking water, immunization against infectious diseases, and other public health measures can help reduce high rates of infant mortality.
The reported IMR provides one statistic which reflects the standard of living in each nation. However, the method of calculating IMR often varies widely between countries, based on how they define a live birth and how many premature infants are born in the country. For these reasons, reporting infant mortality rate can be inconsistent and may be understated. Of the 27 most developed countries, the United States has the highest IMR, despite spending much more on health care per capita. In particular, IMR varies greatly by race and socio-economic status (“Infant Mortality”, 2019). These numbers are disconcerting given the resources available and technological advances available for health care in the United States. The relatively high IMR raises questions about culture and the impact this racial and socio-economic disparity has on infant health.
