Health, Well-Being, and Equity
Health is understood both in terms of the absence of disease or infirmity, and more broadly as a holistic state of physical, mental, and social well-being. “Human flourishing” or “thriving” describes the optimum state of health and well-being, taking into consideration the whole person. Physical health, mental and emotional health, social connection, spiritual life, financial security, and sense of purpose are all part of an interconnected whole that enable people to thrive.
Health Status and Health Outcomes
The level of overall health of an individual or population is referred to as “health status”. Change to an individual or population’s health status is linked with changes in “health outcomes”, specific results or consequences of a disease, infirmity, or healthcare intervention on the length or quality of a person’s life. Health status and health outcomes are influenced by a range of factors known as determinants.
Connecting the Dots
In the U.S. during the 19th and 20th Centuries, health outcomes–including life expectancy, infectious disease prevalence, and surgical outcomes–improved significantly. These gains are linked to control of vaccine-preventable infectious diseases, antibiotic treatment of acute infectious diseases, increased emphasis on child and maternal health care, improved nutrition and living standards, and other Public Health efforts. Better overall health status correlates with improvement to health outcomes.
Determinants of Health and Well-Being
Individual health and well-being is determined by genetics and biology, health behaviors, health care, and social characteristics.
Gentitics & Biology Genetics are sometimes called the “blueprints” for life because genes contain instructions necessary for the development, functioning, and maintenance of the human body. Genetics play a role in determining lifespan, likelihood of developing certain health conditions, and response to medications. Biological determinants, such as sex and age, affect physiology or the functioning of systems and organs within the body.
Health Behaviors Health behaviors are health-related practices that can improve or diminish health status. Behaviors that improve health include engaging in physical activity, eating a balanced diet, and taking medications as prescribed for diagnosed health conditions. Conversely, behaviors like using tobacco, drinking alcohol in excess, and engaging in risky sexual behavior can diminish health. Health behaviors are influenced by individual, social, environmental, and cultural factors.
Health Care Access to health care determines how, where, and when we can get the routine, specialty, and urgent health care services needed to prevent and treat disease. Insurance status, location of facilities, capacity of providers, and cost and quality of care are all factors that can impact an individual’s health.
Social Characteristics Social characteristics like education access and quality, economic stability, and neighborhood conditions, have the greatest overall impact on individuals’ opportunities to be healthy and well. Social characteristics shape the choices, opportunities, and challenges people encounter throughout their lives
These determinants of health and well-being, together, shape health status and health outcomes at both the individual and population levels. Given the profound impact of health behaviors, health care, and, particularly, social characteristics, much of what determines health and well-being is changeable. This is where Public Health comes in: shifting conditions, at the population-level, for individuals and communities to be healthy and well.
Health Equity
Not all people have the same opportunities to be healthy and well. Structural and systems challenges to health and well-being exist. Such challenges include poverty, unequal access to healthcare, limited education, stigma, and racism. These barriers result in health disparities, which are differences in health outcomes by factors such as gender, race, education, income, disability, geographic location, and sexual orientation. Efforts to improve health equity–a state wherein every individual has a just and equitable opportunity to reach their highest level of health and well-being, irrespective of their background or circumstances–seek to eliminate health disparities and overcome structural and systems challenges to health and well-being, and health care.
Reflection Questions
- What are the key differences between health status and health outcomes?
- What are examples of public health efforts that improved health outcomes in the 19th and 20th centuries?
- Which of the four categories of health and well-being determinants above has the greatest overall impact on individuals’ opportunities to be healthy and well?
- What is health equity?
- How does poverty and racism contribute to health disparities?