Health is a nebulous concept that can vary widely from one person to the next. It ranges from a narrow, biomedical definition that includes only the absence of disease or infirmity to the World Health Organization’s more expansive vision of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. These definitions are useful for different reasons: the former offers easy measurement of healthcare and measurable outcomes, while the latter avoids assuming full responsibility for community economic or social conditions on the part of medical care systems.
Nevertheless, even the broadest definition of health is still too narrow for the current era of rapid and profound knowledge change. The new understanding of disease at molecular, individual and societal levels means that it is no longer possible to guarantee risk-free wellbeing. Even the most optimistic of health advocates must recognize that it is impossible to prevent all disease and injury, or to achieve perfect fitness.
Thus, it is important to think about what is meant by the term health and what can be done to promote it. For the purposes of this article, we will consider health as an ability to adapt and self-manage in a complex and rapidly changing environment. It is also about a positive sense of well-being, which entails an appreciation for the diversity of human experience and an active engagement in the community.
The traditional targets for healthcare have been specific diseases or behaviors and categorical funding streams encourage this approach. But there is growing recognition that healthy communities have a powerful impact on the health of people within those communities. For example, a child’s experience of school bullying can have as great an effect on his or her health as an allergy to peanuts.
A healthy workforce can be more productive, a school population can master lessons more readily and a healthy community is better able to function in support of broader societal goals. Yet, these impacts are not easily captured in the formal metrics of our healthcare and public health systems.
In this article, we will explore the ways in which we can promote health in our local communities by addressing the determinants of health. These determinants are the broad environmental, economic and social conditions that influence people’s ability to make healthy choices in their lives. They are known as risk or protective factors, and they may be targeted in ways that include prevention and promotion.
We’ll start with a focus on the factors that lead to poor health, then move on to discuss how we can address these issues through a range of strategies – from simple interventions like encouraging walking groups to more sophisticated approaches, such as developing and testing new policies and models of healthcare delivery in the community. We will also look at some examples of successful community health initiatives that reflect this new perspective.