November, 2024
Health and Wellness is a complex and dynamic concept. Moreover, health and wellness is defined differently within certain movements and by different authors. Inspired by these various perspectives, this article forms its own view.
Health refers not only to physical functioning, but equally to a person's mental functioning. A person can be in optimal physical health and feel vital and full of energy, but at the same time experience difficulties mentally. Conversely, patients with a physical, chronic condition can still be well in their skin mentally.
In turn, physical and mental health cannot be disconnected from a person's social environment. Being connected through strong social relationships and being able to participate in society are a manifestation of good social health, while also contributing to physical and mental health.
So health has three dimensions: a physical, mental and social one, and of course they influence each other. In the literature, this is also called the biopsychosocial model of health. Health should therefore be seen as a holistic concept. On the one hand, it is about the human being as a whole and, on the other, it affects all aspects of daily functioning. Working on health always takes these three dimensions into account.
How healthy someone is is not only determined by the individual's (biomedically) measurable and objective status. The perception and experience of one's own health also play a role. So this is the subjective perception of one's own health. This subjective perception of health, is called well-being.
Well-being is variable
People's objective health status can vary widely, but their perception of health and ill-health, the value they place on health, and their expectations of health can also vary. Well-being can also vary and change throughout the life course of a single individual, partly due to major life events (e.g. burn-out, a cancer diagnosis, having a child, losing a loved one, etc.).
Interaction between wellbeing and objective health
How a person views their own health affects the lifestyle choices they make. In turn, those lifestyle choices affect the individual's objective, measurable health status. Therefore, preventive healthcare does not take into account objective health status exclusively, but subjective health (well-being) to an equal extent. A one-sided focus on objective health ignores the importance of subjective aspects, while conversely an exclusive focus on wellbeing can obscure objective health differences.
Working on wellbeing therefore does not absolve health promoters from their task of continuing to strive for a healthy physical and social environment for all, and the same opportunities for everyone to positively influence their own health. Even for people who experience high wellbeing, despite, for example, an unhealthy living environment, the health promoter remains committed.
A classical biomedical view of health starts from pathogenesis, or how diseases arise and develop, and will respond curatively and preventively to the risk factors underlying diseases or problems (e.g. oral care, hand hygiene ...). Yet health is much more than just the absence of disease.
Health more than absence of disease
Health promotion starts from a positive interpretation of health: salutogenesis. This view focuses on strengthening the determinants of health - rather than eliminating disease risks. Health is thus seen as more than the absence of disease (risks), but as the presence of protective factors of health.
Protective factors strengthen health
Within this conception of health, the main focus is on empowering (through knowledge and skills) people to make healthy lifestyle choices for themselves, as well as creating an environment that protects and supports health. This approach is thus broader than the elimination of disease risks, because it responds to a wider range of health determinants, but also because it addresses a wider audience (including those not immediately at risk of disease).
Good health allows you to achieve important life goals. Think about doing a job, travelling, playing with (grand)children, and so on. It gives you the chance to take control and thus pursue a quality life.
Obstacles
However, a person's health condition can also be an obstacle to achieving those life goals. For instance, physical and mental disorders can make it less evident to participate in social activities, to take up care of (grand)children or to carry out a meaningful daytime activity. So we see health as a condition that can make it easy, but also just as difficult(er) to realise certain life goals.
Impact on your life
‘Being healthy’ and ‘experiencing health’ therefore also have to do with how you, within the possibilities and limitations that your health status entails, shape your life and how you adjust your personal life goals accordingly. A physical or mental condition has an impact on (one or more dimensions of) a person's health status, but does not take away from the fact that a person can still experience health if they manage to adjust and adapt life goals to the health status.
Taking health into your own hands?
From the view that health is a means to achieving life goals, the aim is to ‘empower’ people to take the determinants of their own health into their own hands as much as possible.
However, this is not to say that people are entirely in charge and responsible for their own health. Biological factors (e.g. hereditary strain), the organisation of health care (availability and accessibility of quality care), and the physical, socio-cultural, economic and political aspects of the environment in which you live (e.g. the affordability of healthy food, legislation on the sale of tobacco and alcohol to minors, as well as the broader political and economic stability of the country or area in which you live), also have an impact on health.
Shared responsibility
Such factors are often beyond the individual's control. Health therefore remains a shared responsibility between the individual and the wider society. For health promotion, this implies a scope that goes beyond the (behaviour of the) individual, and includes a wide arsenal of possible environmental interventions.
Health in relation to wellness
Health and wellness are often mentioned together. The two concepts are closely related but are not the same. Wellness refers to the overall life satisfaction experienced by people and communities. Health is an important facet of wellness.
But besides health, well-being has several other facets that contribute to life satisfaction; such as respect, connectedness and self-determination. There are also living conditions that contribute to wellness: a quality and safe home, a safe and pleasant working environment, sufficient financial resources, and so on. And then there are broader political and social facets that also contribute to wellness, including country/region security and stability, social security, and gender and sexual orientation equality.
However, health is influenced and co-determined by these other facets of wellness. Sufficient financial resources and a safe and high-quality home, for example, contribute to good health. But also vice versa: good health contributes to being able to accumulate sufficient financial resources and thus a quality home, etc. In this sense, the facets of wellness are often mutually determinants of each other. As a result, by working on health - the focus of health promoters - you often touch those other facets as well.
Health in relation to the Sustainable Development Goals
We also find this embedding of health within a broader picture in the United Nations' Sustainable Development Goals or Sustainable Development Goals (2015). These goals strive for a better and more sustainable future for all. Good health for all is formulated as one of the 17 core Sustainable Development Goals by 2030. Other core goals include climate, quality education, economic growth and gender equality.
Health is thus just one objective for sustainable development towards a better future. But again, health is inextricably linked to other development goals. After all, we know that education and poverty, for example, are partly at the root of health: they are therefore determinants of it. And vice versa: health contributes to successful education and poverty avoidance. Working on the 16 other objectives is thus crucial to achieving the intended health gains. And at the same time, health in turn can also contribute to the other objectives.
Health promotion in perspective
So we always see health as part of a broader picture: as one of the facets that contribute to wellness, or as one of the goals that contribute to a sustainable future. For health promoters, this has an implication. It means that we do not work on health at the expense of other facets of wellness or other sustainable development goals.
For example, an intervention that stigmatises certain groups will have health gains at the population level, but a negative impact on the sense of feeling safe and respected among targeted groups. Or: a health intervention that uses environmentally harmful materials may benefit the health of (a certain group of) people, but have a negative impact on the climate.
While our focus is on promoting health, we always try to avoid negative impact on the other facets of wellness or other sustainable development goals and, if possible, even contribute positively to them.
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