In a world where the threat of COVID-19 and other public health concerns underscore the interconnectedness of people and their environments, it is time to reassess our definitions of health. While some define health as the absence of disease, others see it in terms of a dynamic process. This new definition of health is one that is fluid and multidimensional, with adaptation to life circumstances at its core. This definition invites us to consider a wide range of health-related issues, including the importance of spiritual and emotional health, and its relationship to personal values.
Historically, the dominant view of health has been a biomedical construct in which the primary determinants are genes, lifestyle, and access to healthcare services. This approach has been rewarded with categorical funding streams for both research and healthcare delivery. This perspective has shaped the goals of the field of health promotion, which emphasizes prevention and community-based efforts to improve the social and environmental conditions that promote health.
However, this framework has limitations. For example, the biologic pathways through which poverty or low socioeconomic status influence health have not been fully elucidated. Furthermore, a health care system that is heavily focused on improving specific diseases or medical conditions often overlooks the fact that other factors can also contribute to an individual’s sense of well-being.
A growing number of writers have been exploring alternative views of health that expand its meaning. One such view, popularized by the author Paul Zahra, defines health as “a positive state that is defined not merely by the absence of disease or infirmity but by the inclusion of dimensions such as mental and social well-being.”
In their qualitative study, Fugelli and Ingstad interviewed people from different places and backgrounds on their views of the determinants of health. Their results showed that people who identified the environment as the determinant of health were more likely to report being satisfied with their lives and having good relationships. They were also more likely to have jobs and live in communities that provide a variety of opportunities for work and recreation.
A broad and generative definition of health is essential for the success of initiatives that seek to improve community health. Using such a definition, it is possible to identify a wider range of potential targets for intervention and to assess their impact. For example, the committee’s definition of health permits efforts to address factors that could lead to unintended pregnancies, drug and alcohol use, and high school dropout rates. Consequently, it is important to consider whether current health improvement efforts are targeted to these targets. This is particularly relevant as many of these interventions rely on limited funding and resources. It is also critical to understand that, if an initiative is successful in improving some indicators of health, it may have unforeseen impacts on other indicators that are outside its direct scope of action. This can include a change in individuals’ perceptions of and responses to their illnesses.